Henry Carus + Associates | Injury Lawyers

How Is a WorkCover Payout Calculated?

Warehouse worker with injured knee | Henry Carus + Associates

Injured workers have the right to lodge WorkCover claims in Victoria if they are hurt or acquire an illness on the job. Your WorkCover payments are determined by a number of factors, including the severity of your injury and the benefits you are due.

A knowledgeable workers’ compensation lawyer can help you make a claim and ensure that you get the full benefits and additional common law compensation you deserve. Henry Carus + Associates have extensive experience with WorkCover claims in Victoria, and we fight to maximise your payout.

Call Henry Carus + Associates at 03 9001 1318 today for a FREE, no-obligation consultation. We serve clients throughout VIC, with multiple offices in the Melbourne metropolitan area.

Calculating Treatment Expenses

If you are injured at work or develop an occupational illness, WorkSafe Victoria is required to pay the reasonable costs of medical treatment. Generally, invoices are sent directly to WorkSafe for payment. If you pay for treatment out of your own pocket, receipts must be sent to your WorkSafe agent or your employer. You will receive reimbursement within 30 days.

Not all treatment expenses are covered by WorkSafe Victoria. Some require approval by a WorkSafe agent, while others may be deemed ‘unreasonable’. Treatments and services are also subject to fee schedules. If the provider charges more than the maximum amount paid by WorkSafe, you will be responsible for making up the difference.

If a dispute arises in the course of your WorkCover claim, it is important to obtain legal counsel as soon as possible. Experienced WorkCover lawyers can appeal an adverse decision and pursue payment of necessary medical expenses.

Calculating Provisional Payments

Workplace injuries can be both physical and psychological in nature. If you have a work-related mental injury, you can access up to 13 weeks of provisional payments for counselling and mental health services—even if your claim is rejected later.

As with treatment expenses, WorkSafe doesn’t always pay the full cost of treatment and support for a mental health issue. You may be responsible for gap payments.

NOTE: The Parliament of Victoria recently passed major reforms to the WorkCover scheme. Central to these reforms are significant limitations on claims involving mental health. We are monitoring these reforms and will provide updates once they are implemented so workers have a complete understanding of their right to compensation.

Calculating Weekly Payments

Weekly payments help make up for the income you lose if a work injury or illness prevents you from doing your job. Your entitlement to weekly payments is calculated based on:

  • Your pre-injury average weekly earnings (PIAWE) over the 52 weeks prior to the injury
  • Your capacity for work

If you are totally unable to work, you are entitled to the maximum amount of weekly payments. For the first 13 weeks, you will receive 95% of your PIAWE. You are entitled to 80% of your PIAWE from week 14 through 130 weeks.

Weekly payments are subject to a statutory maximum. As of 1 July 2023, the payments you receive are limited to $2,660 per week.

You can still receive weekly payments if you are able to do some work. The same percentages apply (95% of PIAWE for the first 13 weeks, 80% for weeks 14–130), but the payments you receive are reduced based on your current earnings.

WorkCover claims in Victoria for weekly payments must be supported by a Certificate of Capacity. The Certificate of Capacity is an official document prepared by a medical practitioner that summarises your injury or illness and its effect on your ability to work.

Read More: What Is a Certificate of Capacity in a WorkCover Claim?

NOTE: The likelihood of weekly payments continuing past 130 weeks may be affected by the recently passed WorkCover reforms. Our firm will review these changes as they are implemented so we can advise clients what they should expect as to the continuation of benefits after 130 weeks.

Calculating Superannuation Payments

If you receive weekly payments for more than 52 weeks, you may be entitled to contributions to a superannuation account. Super payments are made ‘at the superannuation guarantee rate (charge percentage), based on your gross weekly payments’ to a super fund you select.

You are eligible for superannuation contributions as long as you are getting weekly payments benefits—even if you return to work in some capacity. A lawyer well-versed in WorkCover can advise you of your eligibility and help with the paperwork. 

Calculating the Permanent Impairment Benefit

The permanent impairment benefit is paid to workers whose work-related injury or illness meets the threshold for ‘permanent impairment’. It is paid as a one-time lump sum.

Eligibility for a permanent impairment benefit is determined through a specialised medical assessment. An Independent Impairment Assessor evaluates your condition and assigns a percentage of impairment for each injury. A WorkSafe agent will review the report and calculate the entitlement based on Victoria’s workers’ compensation legislation.

Currently, the minimum level of impairment to receive the benefit is:

  • Spinal impairment: 5% or higher
  • Physical injury: 10% or higher
  • Hearing loss: 10% or higher
  • Psychiatric impairment: 30% or higher

Impairment benefit calculations are complicated. The assessment of your injury and/or the amount you are awarded may not have been properly assessed.

A lawyer specialising in WorkCover claims in Victoria can help you dispute an unfavourable decision. There are options to obtain the entitlement you deserve, such as requesting a review of the decision and pursuing referral of the matter to a Medical Panel.

Calculating Common Law Damages

There are certain circumstances where a worker who gets injured on the job or becomes sick as a result of their employment can sue their employer. A claim for damages should be handled with the assistance of a qualified lawyer.

First, you need to establish that you have a ‘serious injury’. This term has a specific legal meaning. Details of the injury must be included in the application for common law damages submitted to WorkSafe Victoria.

Second, you will need to prove that your injury was caused by the negligence of another party (such as an employer, a co-worker, or another company or organisation). Each responsible party must be named in the application for common law damages.

Read More: Can I Sue for a Work-Related Injury?

Finally, you will need to specify the damages you are seeking. You may be entitled to compensation for common law damages such as loss of earning capacity and/or pain and suffering.

The process commences with an application to WorkSafe seeking a serious injury certificate. WorkSafe will review the application and determine if the injury meets the definition of ‘serious’. Once this condition is satisfied, the claim proceeds to a conference where all parties try to negotiate a settlement. If the matter isn’t settled, there will be an exchange of offers—one by WorkSafe known as a ‘statutory offer’ and, if not accepted, one by the injured worker known as a ‘statutory counter offer’.

If the claim is not resolved in this ‘offer’ stage, then the matter proceeds almost immediately to common law proceedings in court. Common law damages are subject to minimum and maximum payment thresholds, and the offers made will take into account those limits.

A lawyer with expertise in WorkCover claims in Victoria can help with all aspects of your claim, from the initial application to the settlement conference to managing offers and counteroffers. If necessary, your lawyer can initiate court proceedings to obtain maximum compensation for your common law damages.

Get Help with Your WorkCover Claim

Many workers don’t realise the full extent of benefits and other compensation they may be entitled to for a workplace injury or illness, or how essential it is to obtain all relevant evidence of  how they were injured soon after they are injured. At Henry Carus + Associates, we have a full understanding of the legislation, protocols, and formulae used by WorkSafe to calculate payouts.

You Deserve More. Our in-depth knowledge of WorkCover claims in Victoria enables us to maximise payouts for injured workers and their families, ensuring you get the medical treatment and support you need. We also evaluate your entitlement to a permanent impairment benefit, common law damages, and more.

If you need assistance with a WorkCover claim, contact Henry Carus + Associates for FREE. Our lawyers represent clients in Melbourne and all of Victoria.