What WorkCover Will Pay for Once Your Claim Is Accepted

what workcover pays for in a successful claim

WorkCover is a compulsory insurance system that helps ensure that Victorian workers are able to recover benefits in the unfortunate event that they are injured on the job. It is important that all injured workers understand the benefits that are available under WorkCover.

If you have any questions or concerns about recovering benefits for your workplace injury, please contact our experienced Melbourne WorkCover claims lawyers today for immediate legal assistance.

Medical and Related Benefits

Under WorkCover, injured employees are entitled to recover benefits for the full extent of their necessary medical expenses. This includes compensation for any reasonably related expenses as well.

Specifically, medical benefits will provide compensation for:

  • Any treatment received from medical practitioners, including treatment by specialists
  • Necessary medication
  • Required medical supplies
  • Needed domestic assistance services
  • Emergency ambulance services
  • The costs related to rehabilitation
  • Travel that became necessary as a result of the work injury.

It is also important to note that WorkCover generally requires that a treatment be pre-approved before being eligible for corresponding medical benefits. However, there are exceptions to that rule, in particular when emergency medical services are required.

Your necessary treatment deserves to be covered. If you believe that your medical benefits have been improperly denied, you should speak to an experienced WorkCover claims lawyer at Henry Carus + Associates as soon as possible.

Weekly Benefits (Income)

Injured workers are also entitled to weekly payments that will help replace any lost income. Your weekly benefits will vary based on the specific circumstances of your case. As a general rule, weekly benefits are based on your pre-injury earnings, though injured workers cannot recover more than the statutory maximum weekly benefits.

Starting in April 2016 and running through September 2016, the maximum weekly benefit is $2,110, as described by WorkSafe, an organisation associated with the Victorian State Government. The cap is adjusted twice a year for inflation.

Weekly benefits will also change over time. For the first 13 weeks that you are unable to work, you are entitled to the lesser amount of 95 percent of your pre-injury average earnings, or the maximum weekly benefit. Beginning at week 14, your weekly benefits will be reduced to the lesser amount of 80 percent of your pre-injury earnings, or the maximum weekly benefit.

As long as you are unable to return to work, you are entitled to receive benefits for up to 130 weeks. At that point, your condition would need to be independently evaluated in order to determine whether you still qualify. At 260 weeks, or 5 years, your weekly benefit payments will cease unless you can prove that your work injury impairment is likely to continue indefinitely.

In order to recover full work injury compensation, it is critical that your average weekly earnings are calculated fairly. Typically, pre-injury average weekly earnings are calculated by examining an employee’s previous 52 weeks of earnings. Though there are some exceptions. All ordinary earnings should be included in this calculation, including:

  • Hourly earnings
  • Overtime pay
  • Commissions
  • Non-pecuniary benefits
  • Any other form of salary

After 1 Year You May Be Entitled to a Lump-Sum Benefit

In order to qualify for lump sum benefits, you must either have a permanent physical impairment that is greater than 10 percent, or a permanent primary psychological impairment that is greater than 15 percent.

Qualifying permanent impairments come in a number of different forms. For example, accidents that result in a serious spinal cord injury, an amputation, or permanently reduced mobility, could all potentially qualify for lump-sum impairment benefits. Determining the precise percentage of a specific impairment is a highly technical process. An independent doctor will be required to make that evaluation. Further, your injury must have reached “maximum medical improvement” before such an assessment can be made.

After 18 Months You Can Be Considered for a Common Law Claim

Beyond recovering benefits through WorkCover, you may also be able to bring a common law claim to seek additional damages for your workplace accident. A common law claim requires that you prove that your injury was the fault of another party. Specifically, you need to prove that another party was negligent. Put simply, negligence, under the law, occurs when a person or organisation fails to take proper care when performing an activity.

Your common law compensation could potentially be significantly higher than your WorkCover benefits. A common law claim could include recovery for your pain and suffering, your loss of life enjoyment, and the full extent of any lost current and future earnings. However, you can bring a common law claim only if your injury meets the definition of “serious” under the law.

Specific conditions that could qualify you to bring a common law claim include:

  • Permanent disability
  • Permanent impairment
  • Loss of bodily function
  • Severe disfigurement
  • Permanent, and serious, psychological distress

Ultimately, if you are considering a common law claim, you should have an experienced Melbourne work injury lawyer at Henry Carus + Associates comprehensively review your case.

Important WorkCover Tips

Finally, it is important to remember that the WorkCover process is notoriously complex. You should always take extreme care when you lodge a WorkCover claim. The following is a list of tips that you should keep in mind:

  • Report your injury. You should notify your immediate supervisor, follow any company protocols, and start the WorkCover claims process as soon as you can.
  • Do not quit your job. You should not take any action until your claim is settled.
  • You need to be perfect on your WorkCover applications. You should always ensure that everything is filled out properly and with sufficient detail. The last you need is to have your claim denied or delayed due to avoidable mistakes.
  • Finally, you should seek legal advice sooner rather than later. An experienced WorkCover accident claims lawyer can help you through the process and will ensure that you are able to maximise your recovery.

You Need a Good Lawyer for WorkCover

If you have been injured on the job, our workplace injury lawyers are ready to help. At Henry Carus + Associates, our legal team has extensive experience successfully handling WorkCover claims as well as common law injury claims. Please do not hesitate to contact our office today to schedule a free legal review of your case. We proudly serve clients in Melbourne and throughout the surrounding areas of Victoria.

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