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Everyone has the right to go to work each day, knowing they’ll come home safely. If you’ve been injured or become ill at work you may be entitled to make a claim for workers’ compensation to cover lost wages, medical and rehabilitation costs, retraining expenses or a lump sum payment for permanent injuries. There have been a lot of changes to arrangements in NSW for seeking workers’ compensation in recent years. You could be forgiven for being a little confused about where to start. After all, workers’ compensation laws and entitlements are already a little hard to keep up with because they vary between states and territories and may be known as WorkCover, CTP or WorkSafe. Compensation and benefits can vary greatly depending on your injury and on the law you’re covered by.
If you’ve been injured at work in NSW, Littles has you covered. This blog explores the complex rules around weekly benefits for injured workers in NSW, and the so-called ‘260 Week Rule’. If you’re an injured worker, this can have very important consequences for you and your financial and medical wellbeing.
The effect of this rule is that if you are an injured worker, and receiving weekly workers’ compensation benefits, you won’t be entitled to weekly payments for more than an aggregate period of 260 weeks, or five years. Your weekly payment start date depends on when you were injured and when you made a claim.
For a claim made prior to 1 October 2012 (referred to as an ‘existing claim’), your 260 week count commences 1 January 2013. For claims made on or after 1 October 2012, your 260 week count commences on the first day of incapacity.
However, there are some key exceptions to this rule!
1. If you are assessed as having sustained an injury which results in an assessment of whole permanent impairment percentage (WPI) of more than 20 percent, you are entitled to a continuation of weekly payments beyond 260 weeks. This requires you to have an overall WPI assessment of 21 percent.
2. If you cannot be assessed for WPI because you have not yet reached “maximum medical improvement” (MMI), you can seek an exemption from the Personal Injury Commission. If you require future surgery or considerable treatment, the PIC may appoint a medical specialist to assess whether your weekly entitlements should continue beyond 260 weeks.
3. The 260 Week Rule does not apply to exempt workers, including police officers, paramedics, firefighters and coal miners.
If you have been told by your insurer that you are no longer entitled to weekly payments – and with that, payment of crucial medical treatments – you should obtain independent legal advice. It is possible to recommence weekly payments to an injured worker beyond 260 weeks, if certain criteria are met. Need a hand? Contact Littles today.
Calculating your WPI in this context can be very complicated. For example, it is possible to attain the threshold of 21 percent WPI by requesting a medical specialist in the PIC to convert and/or combine an injured worker’s previous WPI assessment with previous or current WPI assessments. There are many other ways of calculating WPI. As you can imagine, these can involve complex investigations, calculations and navigation of processes. If weekly payments are important to you and your family, it’s worth seeking high quality legal advice on this question.
Ceasing of your weekly entitlements will also impact your entitlement to medical expenses; however, it does not necessarily meant that you will no longer have any entitlement to “reasonably medical treatment and services”.
The important thing to know is that the duration for other medical or related treatment depends on the WPI assessment relied upon by the insurer at the time that weekly entitlements ceased.
If you have your weekly entitlements ceased, but you are then assessed between 0-10 percent WPI, you are entitled to a further two years of medical or related treatment from the date their weekly payments ceased. If you are assessed at between 11-20 percent WPI, you are entitled to a further five years of medical or related treatment from the date your weekly payments ceased.
Clearly, the workers’ compensation system can be complex, which is why it helps to seek quality legal advice as soon as possible. At Littles, we are experts in workplace injuries, and can help manage the process to ensure that you receive all appropriate entitlements and support. With Littles on your side, we can ensure that you get the fair treatment you deserve.
If your workers’ compensation claim has been rejected, or you would like to understand how to claim benefits to support you and your family while you are injured or ill, please get in touch for a no-obligation chat.
IMPORTANT: There are strict time limits for making and disputing a claim, so take advantage of our FREE initial consultation and get in touch. You have nothing to lose by speaking to one of our compensation law experts. The sooner we determine your eligibility to make or appeal a claim, the sooner we can help you to obtain or continue getting funding from the insurer so your rehabilitation can proceed smoothly.
Not only do we offer a FREE initial consultation we handle most insurance claims on a no win, no fee basis.
The Head of our NSW team, Jessica Cheung, is an expert in NSW workers’ compensation claims. If you think you might have a claim, reach out to Jessica and her team for high quality legal advice
Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles.