Workers Compensation is constructed to support people who have been injured at their job and are unable to continue working. A Melbourne workers’ compensation lawyer can offer you an unrivalled knowledge of WorkCover law that helps us maximise your compensation pay out.
From claims being rejected, medical benefits being unpaid, to income benefits being terminated and serious injury certificates being denied, there are many different disputes arising out of WorkCover Law.
Workers’ Compensation Claims Process
With more than 40 years’ experience in this area, the team at Henry Carus + Associates has seen all accident situations. One of our senior solicitors was also involved in the recent rewrite of the WorkCover legislation and is aware of its intricacies.
When it comes to WorkCover claims, we primarily see it as our job to step in and provide our expertise to dispute any improper decisions. So we’ll start by working hard to get you the workers’ compensation benefits you deserve.
We then immediately turn our minds to your entitlement to common law (generous) lump sum compensation for the serious injury you have suffered.
This usually involves chasing down all potential defendents for all relevant documentation and doing our own investigations of the accident. In doing this, it makes it significantly easier to show that a defendant is at fault for your workers compensation claim.
In our experience, such early intervention leads to a range of outcomes including:
- Conciliation of an improper insurance decision
- Successful referral to the Medical Panel on medical issues
- Successful contests at the Magistrate’s Court on any benefits dispute
- Successful serious injury application to the VWA or Self-Insured Company
- Successful application to the County Court for a serious injury certificate
- Successful common law claim seeking lump sum compensation at the Supreme Court
How Our Workers’ Compensation Lawyers Will Help You
The main difference between the big city law firms and us is our approach. Most firms have grown up with the WorkCover legislation given to them as a set piece of legislation that they believe is set in stone and can never be reinterpreted.
Our Principal Henry Carus is an ex-trial lawyer who has previously worked for insurance companies and government agencies so he understands the intricacies of WorkCover Law and Common Law concepts and how they can be used to a client’s advantage.
As a result we have been able to take more cases to trial – and be successful – than any other similar sized firm in Victoria when it comes to workers’ compensation.
Types of WorkCover Benefits
Victorian workers who suffer injuries in work-related accidents may be entitled to a variety of benefits through the WorkCover program. These benefits include:
- Payment of all injury-related medical expenses, including the cost of in-home assistance if necessary
- Partial replacement of wages lost due to time away from work caused by the workplace injury. Weekly benefits typically amount to 95% of the injured person’s pre-injury wages for the first 13 weeks of work absences, and then 80% thereafter. Injured workers who are still able to perform some work while recovering may receive weekly payments that replace 80% of the difference between their pre-injury wages and what they are now able to earn
- Lump-sum payments for permanent impairment caused by the work-related injury. The permanent impairment must reach the minimum level set by the WorkCover law, and must be assessed by an independent doctor
In addition to benefits paid through the WorkCover system, you may also be able to bring a common law claim for additional compensation if someone else’s negligence contributed to the accident. A successful workers compensation claim may result in significantly more money than what is available from WorkCover. These claims require bringing a lawsuit that is a separate matter from the WorkCover claim.
Types of workers compensation that may be recovered in a common law workplace accident claim include:
Payments for your pain and suffering and loss of enjoyment of life that resulted from the accident.
Payments for your lost wages – both past and future – that resulted from the accident
Your injury must meet the law’s definition of “serious” in order to bring a common law claim. A “serious” injury is generally defined as one that results in at least a 30% impairment rating for a WorkCover lump sum payment, or one that causes at least one of the following:
- Permanent serious impairment of a bodily function
- Loss of a bodily function
- Disfigurement that is both serious and permanent
- Permanent and severe mental or behavioral disorder
- Loss of a foetus
UPDATE: Cases of silicosis, a serious lung disease, are rising dramatically among tradies. Know your rights if you have been exposed to silica dust on the job and were diagnosed with silicosis.
How To Get Workers’ Compensation After An Injury In Melbourne
The WorkCover claim process typically begins with notification to your employer within 30 days after the accident. The next step is to complete a WorkCover claim form and submit the form to your employer, along with a Certificate of Capacity.
As a part of the processing of your claim, you may be required to undergo an independent medical examination, and you may be asked to provide a statement that details what happened during the accident. WorkSafe Victoria will issue a decision on your claim within 28 days.
A workers compensation lawyer with Henry Carus + Associates can assist you throughout the WorkCover claim process for your workplace injury. We can also help you if it is necessary to dispute a decision regarding your benefits.
The first step in the dispute process usually involves a senior agent reviewing the initial decision reached on the claim. If you do not receive an acceptable result at this stage, the claim may be referred to the Victorian Government’s Accident Compensation Conciliation Service. The Conciliation Service will arrange an informal meeting between you, WorkCover and sometimes your employer as well. The goal of this meeting is to facilitate an agreement about your claim.
If it is not possible to resolve your claim at conciliation, the conciliator may either declare a genuine dispute or refer your case to a Medical Panel if there is a medical question. The Medical Panel typically consists of two or three independent doctors who will review the case and provide an answer to the medical question. The Medical Panel’s decision is typically final and may not be appealed to court.
If the conciliator declares a genuine dispute rather than referring the case to the Medical Panel, you may pursue your claim in court. Most proceedings take place in the Magistrate’s Court, though some go to the County Court. Our firm handles workplace injury claims on a “no win, no fee” basis, which means you have nothing to lose by seeking our help. For more information about your right to compensation for a work-related injury, contact the Melbourne workers’ compensation lawyers at Henry Carus + Associates now for a free claim review and advice about your legal options.
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Frequently Asked Questions About Workers’ Compensation and WorkCover in Victoria
WorkCover insurance is compulsory for the majority of employers in Victoria. If a business employee gets hurt on the job or suffers an injury or illness because of their work, the employee can lodge a claim for workers’ compensation benefits through the employer’s WorkCover insurance.
You are entitled to WorkCover benefits if (a) you are injured or get sick because of your work and (b) you are classified as an employee. This includes full-time and part-time workers, ‘outworkers’ and students undertaking work experience.
Contractors, apprentices and trainees may also be entitled to workers’ compensation benefits in select situations. WorkSafe has established guidelines for employers to understand when a contractor or an apprentice or trainee may be considered a worker. Ultimately, it is the employer’s responsibility to apply the guidelines and register for WorkCover insurance accordingly.
Read More: Who Is Entitled to WorkCover in Victoria?
There are several reasons a WorkCover claim may be rejected. Reasons commonly cited for denial of WorkCover benefits include:
- The existence of the injury or illness is disputed.
- The injury or illness occurred due to a pre-existing condition.
- The injury or illness is unrelated to the employee’s work.
- There is insufficient connection between your work and the state of Victoria (e.g., your company’s head office is located outside of VIC and you were working outside of VIC when the injury or illness occurred).
- The employee does not meet the statutory definition of a ‘worker’ (see Section 3 of the Workplace Injury Rehabilitation and Compensation Act 2013).
- The employee failed to notify the employer of the injury or illness within 30 days.
Needless to say, WorkSafe Victoria, self-insurers and employers are not infallible. Just because your WorkCover claim has been rejected does not mean that you are out of options when it comes to workers’ compensation benefits.
The first thing you should do is speak to a knowledgeable WorkCover lawyer as soon as possible. A WorkCover lawyer can lodge a Request for Conciliation on your behalf with the Accident Compensation Conciliation Service (ACCS). This must be done within 60 days of your WorkCover claim being rejected.
After receiving your request for conciliation, the ACCS will schedule a conciliation conference. Your lawyer will not be able to attend the ACCS conciliation conference and instead a representative from WorkCover Assist will attend. That representative will support you at the conference and consult with us before a final decision is made.
On many occasions the insurer may decide to reverse the original decision and accept your claim, or a settlement may be offered. It is crucial to review the terms of the settlement before accepting.
Resolution of a WorkCover dispute is not always possible via conciliation. If there are questions or disagreements concerning medical issues, the conciliator may refer the matter to a medical panel.
Alternatively, the conciliator may decide that there is an ‘arguable case’ and issue a certificate stating that the dispute cannot be resolved. If a genuine dispute or unresolved certificate is issued, your WorkCover lawyer can bring your claim before the WorkCover Division of the Magistrates’ Court of Victoria.
Navigating the process of lodging a WorkCover claim can be difficult. The difficulties mount if your claim is rejected or your WorkCover benefits are suddenly reduced or terminated.
For all of these reasons, it is in your best interest to speak to a knowledgeable WorkCover lawyer as soon as possible.
Henry Carus + Associates specialise in WorkCover claims, with in-depth knowledge and understanding of Victoria’s workers’ compensation legislation. Our solicitors can assist you in multiple ways after a work-related injury or illness, including:
- Reviewing an adverse WorkCover decision on your behalf (i.e., rejection of your claim or underpayment of benefits).
- Ascertaining what WorkCover benefits you are due; you may be entitled to more than payments for medical expenses and lost wages.
- Collecting evidence to prove that the illness or injury is related to your employment.
- Reviewing your medical records to ensure that your work injury is fully documented.
- Seeking application for a Certificate of Capacity.
- Lodging a Request for Conciliation and representing you at the conciliation conference.
- Handling all communications and negotiations with WorkSafe or a self-insured employer.
- Bringing a disputed WorkCover claim before the Magistrates’ Court.
- Determining whether you have a viable common law work injury claim and taking action on your behalf.
- Exploring any additional options for recovering compensation, such as TAC accident benefits for work-related transport accidents.
- Helping you contest sudden changes in your WorkCover benefits, including termination.
Depending on the nature of your work injury or work-related illness, you may be tied to WorkCover for the rest of your life. In addition to handling your claim, Henry Carus + Associates are proud to act as your legal representatives throughout the course of your recovery and beyond.
Starting 1 July 2021, WorkCover began providing a provisional payments benefit for workers who suffer mental injuries related to their employment. Workers who experience extreme work-related stress that affects their well-being and their ability to work may qualify for provisional payments.
Provisional payments are provided for up to 13 weeks while a WorkCover claim for a work-related mental injury is being decided. Even if your claim is ultimately rejected, you can still receive provisional payments for up to 13 weeks.
The purpose of provisional payments is to enable workers with mental injuries to seek timely treatment of a psychiatric condition (as well as any physical symptoms). Provisional payments cover the reasonable costs of caring for a mental illness or injury related to a worker’s employment, including anxiety, depression, burnout, etc.
Read More: Does WorkCover Pay for Employee Burnout?
WorkCover can pay superannuation benefits directly to a worker’s super fund. The superannuation contributions benefit is only available to workers who were injured or became sick as a result of their work on or after 5 April 2010. In addition, workers must meet the following eligibility requirements:
- The worker must be receiving weekly payments (i.e., payments for partial replacement of lost wages).
- Weekly payments must be made for a minimum of 52 weeks.
- The worker must be under the age of retirement (65 if the worker was born prior to 1 July 1952; retirement age for workers born after that date varies by birth year).
- Workers born 1 July 1952 to 31 December 1953: 65 years and 6 months
- Workers born 1 January 1954 to 30 June 1955: 66 years of age
- Workers born 1 July 1955 to 31 December 1956: 66 years and 6 months
- Workers born on or after 1 January 1957: 67 years of age
- Superannuation payments cannot be provided through a ‘public sector superannuation scheme, law or industrial award’.
Superannuation payments can provide much-needed financial support if you are unable to work for an extended period of time. Such payments increase your Superannuation Fund, a much-needed financial support as you enter your retirement years.
If a work-related injury or illness results in Total and Permanent Disability (TPD), you may be entitled to payments from a superannuation fund. Super is different from WorkCover benefits.
You can access a superannuation fund regardless of whether an injury or illness is related to your employment, provided you meet the definition of TPD set forth by the insurance program.
A knowledgeable insurance lawyer at Henry Carus + Associates can help you protect your income and maximise your benefits through superannuation, WorkCover and more. Our lawyers can determine your eligibility for a Total and Permanent Disability (TPD) claim.
WorkCover is the state workers’ compensation scheme for workers who have been hurt on the job in Victoria. If you suffer a work injury, you need a lawyer who is well-versed in these claims and committed to helping you recover the full benefits and other compensation you deserve.
You Deserve More is at the heart of the service provided to clients of Henry Carus + Associates. Our team has extensive experience with WorkCover claims, and we are proud to represent workers whose claims have been wrongfully rejected and those whose benefits have been underpaid or unfairly terminated.
A serious work-related injury can lead to a lifetime relationship with WorkCover. You deserve a lawyer who will be with you every step of the way.
Please call Henry Carus + Associates at 03 9001 1318 today for a free, no-obligation consultation with a workers’ compensation lawyer. Our WorkCover lawyers serve clients in Melbourne, Brighton, Altona, Box Hill, Malvern, Dandenong, Sunshine and all of VIC.