If you’ve been injured at work, you may be entitled to workers’ compensation. Making a claim can provide essential financial support during your recovery, covering weekly payments, medical expenses, and potentially lump sum benefits for permanent impairment.
However, before claiming workers’ compensation, it helps to understand the process and your rights. The workers’ compensation system exists to support injured workers, not to work against you, and being informed can help ensure your claim proceeds smoothly. This guide covers the key things to consider before lodging a work injury claim in NSW.
Understanding Your Rights as an Injured Worker
Workers’ compensation in NSW operates under a “no-fault” system. This means you don’t need to prove your employer was negligent to make a claim for a work-related injury. If you were injured in the course of your employment, you may be entitled to compensation regardless of who was at fault.
Your employer is legally required to hold workers’ compensation insurance. When you make a claim, you’re accessing that insurance, not taking money from your employer’s pocket. Under the Workers Compensation Act 1987 (NSW), employers must have current workers’ compensation coverage, and penalties apply for those who fail to comply.
As an injured worker, you have the right to claim compensation without fear of retaliation. It is unlawful for your employer to dismiss or disadvantage you for making a workers’ compensation claim. If you experience discrimination or adverse treatment after lodging a claim, protections are available under NSW law.
Report Your Injury Promptly
One of the most important things to consider before seeking work injury compensation is timing. You should notify your employer of your workplace injury as soon as possible after it occurs, ideally within 48 hours. When reporting your injury or illness, provide your employer with the date and time of the incident (or the period over which the injury developed), a description of how the injury occurred, and your contact details.
Your employer must then notify their workers’ compensation insurer within 48 hours of becoming aware of your injury. Delays in reporting can complicate your claim and may affect your entitlements. According to the State Insurance Regulatory Authority (SIRA), evidence indicates that delayed injury notification can delay recovery.
While you should inform your employer within two months of the injury occurring, you have up to six months from the date of injury (or from when you became aware of the injury) to lodge a formal workers’ compensation claim. In certain circumstances, such as absence from the state, honest mistake, or if the injury resulted in death or serious and permanent impairment, this time limit may be extended to three years or beyond with SIRA approval.
Seek Medical Attention and Obtain a Certificate of Capacity
After reporting your workplace injury, seek medical treatment from a medical practitioner as soon as practicable. Your doctor will assess your condition and, if required, provide a SIRA Certificate of Capacity (previously known as a WorkCover certificate). This document is essential for your claim, as it outlines your injury, your capacity for work, and any restrictions on your duties.
The Certificate of Capacity must be completed by a registered medical practitioner and forms the main channel of communication between your doctor, your employer, and the workers’ compensation insurer. To continue receiving weekly payments and treatment services, you need to maintain a valid certificate throughout your claim.
When you visit your doctor, provide them with accurate details about your injury and how it occurred at work. Even details that seem unimportant at the time may become relevant later. If there are any questions about the cause of your injury down the track, your GP’s notes about exactly how the work injury happened will be crucial evidence.
Document Everything Thoroughly
Thorough documentation strengthens your claim and helps avoid disputes. From the moment of your injury or illness, keep records of everything related to your workplace injury, including how and when the incident occurred, any witnesses present, medical reports and treatment records, receipts for medical expenses and other expenses, correspondence with your employer and insurer, and photographs of the injury or the location where it occurred (if applicable).
The more evidence you have, the easier it will be for the insurer to assess your claim fairly. If issues arise about liability or the extent of your injury, having detailed records can make a significant difference to the outcome.
What Your Insurer Will Need
When you make a claim, the workers compensation insurer will typically require your name, address, contact telephone number, and date of birth, along with your employer’s details and insurance information, your nominated treating doctor’s details, a description of the injury and how it occurred, the date and time of injury, and a copy of your Certificate of Capacity.
Providing complete and accurate information upfront helps ensure your claim is processed without unnecessary delays.
Understand What Compensation May Be Available
Before seeking work injury compensation, it helps to understand the types of benefits you may be entitled to claim. In NSW, workers’ compensation can include:
- Weekly payments to replace lost wages if you’re unable to work or have reduced capacity,
- Medical and hospital expenses for reasonable and necessary treatment,
- Rehabilitation expenses, including workplace rehabilitation provider services,
- Lump sum compensation for permanent impairment if your injury results in lasting disability,
- Death benefits and funeral expenses for dependants if a worker dies due to a work-related injury or illness.
Weekly Payments
If your injury prevents you from working or reduces your work capacity, you may be entitled to weekly payments. Once the insurer receives notification of your injury, they must start provisional weekly payments within seven calendar days unless they have a reasonable excuse not to do so.
Workers who have no current work capacity receive 95 per cent of their pre-injury average weekly earnings (PIAWE). The maximum weekly compensation amount from October 2024 is $2,523.00, indexed in April and October each year.
Lump Sum for Permanent Impairment
If your injury results in permanent impairment, you may be entitled to a lump sum payment. To qualify, you need to be assessed at 11% Whole Person Impairment (WPI) or higher for a physical injury, or 15% WPI or higher for a primary psychological injury.
Your level of impairment is assessed by a medical assessor using the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment. This assessment typically occurs once your condition has stabilised and reached maximum medical improvement.
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Know What to Do If Your Claim Is Rejected
Not all workers’ compensation claims are accepted. If your claim is rejected or disputed, don’t simply give up. You have the right to challenge the decision, and there are free services available to help you.
If the insurer disputes your claim, they must provide you with written reasons for their decision. You can then request a review of the decision. Options for disputing a rejected claim include seeking assistance from the Independent Review Office (IRO), using the free conciliation service to resolve disputes, and, if conciliation fails, taking the matter to the Personal Injury Commission.
Many legitimate claims are initially rejected or disputed. Seeking legal advice can help you understand whether challenging a decision is worthwhile and how to present your case effectively.
Be Cautious About Making Statements
One consideration that injured workers often overlook involves making statements to WorkCover investigators. You have no legal obligation to provide a statement to an insurer’s investigator. While you should always be honest, some injured workers have encountered difficulties with their claims after providing statements without fully appreciating the significance of what they were signing.
If you’re asked to make a formal statement, consider seeking advice first. Subtle differences in wording or emphasis can sometimes be interpreted differently than intended, potentially affecting your claim.
Realise That Making a Claim Won’t Work Against You
Some workers feel anxious about filing a workers’ compensation claim, worried that it might damage their reputation, lead their employer to reduce their hours, or even cost them their job. These concerns are understandable, but shouldn’t prevent you from accessing your entitlements.
The law protects injured workers who make compensation claims. Your employer cannot lawfully discriminate against you or take adverse action because you’ve lodged a claim. If you experience retaliation, legal protections are available.
The reality is that if you’ve suffered a work injury, you’re entitled to claim compensation. Taking time to rest, heal, and receive medical treatment on your doctor’s advice is likely to be better for you in the long run than pushing through and potentially worsening your injury.
Consider Whether You May Have Additional Entitlements
Workers’ compensation benefits provide important financial support, but depending on your circumstances, you may have additional entitlements beyond the standard claim.
If your injury was caused by your employer’s negligence and you have a permanent impairment of at least 15% WPI, you may be entitled to pursue a work injury damages claim. This is a common law claim for damages that can include compensation for future economic loss (lost earning capacity) and pain and suffering, and is separate from and in addition to your statutory workers’ compensation entitlements.
You may also have coverage through your superannuation policy. Many super funds include Total and Permanent Disability (TPD) insurance and income protection benefits. If your injury prevents you from ever returning to work, you may be able to claim a TPD lump sum through your super fund.
Even if the workers’ compensation insurer accepts your claim, it’s worth seeking legal advice to determine whether you’re entitled to anything else. Many injured workers are unaware of additional entitlements that could provide significant further financial assistance.
Seek Legal Advice Early
If you’ve suffered a work injury, consider seeking legal advice at the earliest opportunity, even if your claim is straightforward. A workers’ compensation lawyer can help you understand your rights and entitlements, ensure you meet deadlines and avoid common pitfalls, deal with the insurer on your behalf, challenge disputed claims or rejected decisions, and identify additional entitlements you may not be aware of.
Getting advice early doesn’t mean you have to take legal action. It simply ensures you have accurate information about your situation and options. Many workers’ compensation lawyers offer free initial consultations to help you understand where you stand.
Key Takeaways
- Report your workplace injury to your employer as soon as possible and lodge your claim within six months to protect your entitlements.
- Obtain a Certificate of Capacity from your doctor and keep detailed records of your injury, treatment, and expenses to support your claim.
- Workers compensation is a no-fault system and your employer is insured, so making a claim won't disadvantage you and protections exist against workplace retaliation.
- Seek legal advice early to understand your full entitlements, including potential additional compensation for permanent impairment or employer negligence.
Speak to the Experts in Workers' Compensation
Navigating the workers’ compensation system can feel overwhelming, especially when you’re also dealing with an injury or illness. Understanding your rights and the process before making a claim can help things proceed more smoothly.
If you have questions or need assistance with your work injury compensation claim, contact Burke Mead Lawyers for personalised support. Our experienced team can guide you through the process and help ensure you receive the compensation you’re entitled to.
