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For workers

What you need to know about approaching the end of a total of 260 weeks (five years) of weekly payments.

You should have already been contacted by the insurer about the impact of section 39 on your claim. If you haven't, talk to them or give the Workers Compensation Independent Review Office a call on 13 94 76 for more information.

Calculating 260 weeks (five years) of weekly payments

Weekly payments are available for a maximum aggregate period of 260 weeks (five years). Aggregate means what is counted as a week includes consecutive and non-consecutive weeks.

For example, any week in which a payment of weekly compensation has been made or is payable (including part of a day, or a full day) is counted as one week of entitlement.

There is no set start day for a week. If your weekly compensation payments commence on a Wednesday for example, your week is then Wednesday to Tuesday.

Under workers compensation legislation, your weekly payment count start date depends on when you were injured and 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.

How will I be informed of the total number of weeks paid?

Your insurer will communicate with you regarding your entitlement to weekly payments, how many weeks of payments you have already received and when your weekly payment count started.

These communications should clearly show how your insurer has counted your entitlement weeks.

The information provided should include:

  • a summary of all payments made
  • how many entitlement weeks have been paid, or are payable
  • when your weekly payments are expected to cease.

If you have a question or disagreement about the number of entitlement weeks paid (or payable), discuss it directly with your insurer as soon as possible.

It is important that all matters are fully resolved well in advance of 260 weeks when entitlement to weekly payments ceases. See resolving a dispute for more information.

Permanent impairment

Most workers will not need a permanent impairment assessment. However, you do need to find out your level of permanent impairment in order to receive lump sum compensation and to find out if you can receive weekly payments beyond 260 weeks.

If you have not recently been assessed, or you have been assessed and your injury has deteriorated since, speak to your insurer.

If you are assessed as having a degree of permanent impairment of 20 per cent or less, you are not entitled to payments beyond 260 weeks (five years) and the insurer will notify you of the remaining number of weekly payments to take you up to your 260 week limit.

If you were in receipt of weekly payments immediately before 1 October 2012 you are considered to be an 'existing recipient'. You may:

  • be able to undertake a further assessment of your level of permanent impairment
  • in limited circumstances, be excluded from the five year cap on weekly payments (eg where the insurer is satisfied that your degree of permanent impairment is over 20 per cent).

Ask the insurer if you are an existing recipient for the purposes of the above.

If you have an enquiry or complaint about your claim and your assessed level of permanent impairment contact the insurer in the first instance. If you have been unable to resolve your enquiry or remain unhappy with the outcome  you may contact WIRO on 13 94 76 for information and assistance.

Am I eligible for a further permanent impairment assessment?

Workers are usually limited to one assessment of their degree of permanent impairment. Workers compensation legislation currently provides that:

  • only one assessment may be made of the degree of permanent impairment of a worker
  • only one claim can be made for permanent impairment compensation resulting from an injury.

However, there are a couple of exceptions to this rule.

Firstly, workers who made a claim for lump sum compensation before 19 June 2012 are eligible to make one further deterioration claim and to receive an additional assessment of their degree of permanent impairment. A claim for lump sum compensation should only be made when your injury has reached maximum medical improvement.

Secondly, if you are an 'existing recipient' of weekly payments (ie you were in receipt of weekly payments immediately before 1 October 2012), you may be eligible for a further assessment under transitional provisions in the Workers Compensation Regulation 2016.

Ask the insurer if this applies to you.

When should I seek legal advice?

Before you accept an assessment of your degree of permanent impairment, you should seek independent legal advice to understand your rights and the impact of these assessments on your entitlements.

The Workers Compensation Independent Review Office (WIRO) oversees the independent legal assistance and review service (ILARS). ILARS provides funding to external lawyers acting for workers to resolve disputes about workers compensation entitlements.

Information regarding legal funding, including the Section 39 Fast Track ILARS Grant Application Form is available on the WIRO website.

If you require more information please contact:

Workers Compensation Independent Review Officer
T: 13 9476 or email contact@wiro.nsw.gov.au

Medical treatment after 260 weeks

After you reach your maximum 260 week (five year) limit for weekly payments, you will continue to receive reasonably necessary medical treatment depending on your level of impairment.

The insurer will contact you, your treating doctor or health professional (where appropriate) to ensure everyone understands the next steps and your required level of support continues to be provided.

Your injury management plan must be kept up to date at all times to reflect your current rehabilitation, treatment and return to work goals. Work with the insurer to make sure they update your injury management plan to reflect your medical and recovery needs.

Also ask your insurer about available support services and programs specific to your needs.

If you have any enquiries regarding your claim or have been unable to resolve a complaint with the insurer, you may contact WIRO on 13 94 76.

Community Connect

Community Connect provides flexible funding to help you adjust to your changing circumstances, for example, to help address a barrier or need that arises as a result of being affected by section 39, such as financial counselling.

If you were affected by Section 39 before 30 June 2018, you may be eligible for Community Connect funding of up to $1,000 for programs or services identified by you, the insurer or by a service provider. Speak to the insurer for more information on Community Connect funding.

Centrelink assistance

If you are no longer entitled to receive weekly payments under the Workers Compensation Act 1987, you may be entitled to Centrelink assistance.

You can start your application for Centrelink assistance 13 weeks before your weekly payments cease by obtaining a letter from your insurer confirming the:

  • payments by obtaining a letter from your insurer confirming the:
  • agreed total number of weekly payments paid to date
  • projected date of your last weekly payment
  • the reason for the cessation of your weekly payments.

You should also supply:

  • up to date medical certification and other supporting information about your health conditions (within the last four weeks of your application)
  • relevant financial information (including details of any lump sum amount and date of payment, spouse’s earnings etc.)

Please note: While an application for Newstart can commence before weekly payments cease, to be eligible, you should not finalise your application until after the end of the entitlement period for weekly payments.

Centrelink assess each application based on individual circumstances.

Before you apply you need to complete a self-assessment online to determine the type of benefits that may be available to you. You can also call them on 13 24 68.

You will also need to ensure you have created a MyGov account.

Resolving disputes

If you disagree with a decision, there are options available to you.

A dispute about your entitlements

The Workers Compensation Independent Review Office (WIRO) oversees the independent legal assistance and review service (ILARS).

ILARS provides funding to external lawyers if you wish to dispute your compensation entitlements.

Information regarding legal funding, including the Section 39 Fast Track ILARS Grant Application Form is available on the WIRO website.

A dispute about entitlement weeks

If you disagree on the number of entitlement weeks paid (or payable), discuss it directly with your insurer as soon as possible, in advance of 260 weeks.

If your dispute cannot be resolved, you can contact WIRO on 13 94 76 or by email.

A dispute about permanent impairment

If you disagree with your permanent impairment assessment, you can initiate your own assessment.

If this results in a different outcome to that of your insurer you can dispute your permanent impairment assessment by:

  • requesting a review by the insurer
  • contacting the Workers Compensation Independent Review Office (WIRO) on 13 94 76
  • lodging a dispute with the Workers Compensation Commission

Vocational support services

SIRA provides a range of programs to help you with retraining or up-skilling.

New employment assistance

New employment assistance of up to $1,000 is available when a worker is unable to return to work with their pre-injury employer.

A cumulative total of $1,000 can be claimed for expenses involved in commencing to work with a new employer, including for example, transport, childcare, clothing, education or training, or equipment.

To be eligible, the worker must have accepted a written offer of employment for a period of three months or more with a new employer. Additionally the worker will need to confirm:

  • how the item or service will assist them to return to work
  • the amount being claimed along with supporting quotes or invoices.

Following a claim for new employment assistance, the insurer has 14 days to determine whether to accept the claim.

Note: where costs exceed the maximum $1,000, there are vocational rehabilitation programs that may be used in conjunction with the new employment assistance.

Vocational programs

A number of vocational programs are available to assist workers to return to work. These are:

Work trial

Provides opportunity for a worker to be placed with a host employer so that the worker can gain skills and improve capacity. The insurer pays any costs associated with the placement, including the worker’s travel, clothing etc.

Equipment and workplace modification

Provides funding for workplace equipment or modifications that may assist a worker to return to work.

Training

Covers costs associated with training to develop new skills and qualifications to assist return to work. This may involve formal study, short courses and licenses.

Transition to work

Provides financial assistance to a worker to assist with the costs of job seeking (Tier One up to $200) and to address a financial barrier to accepting a job with a new employer (Tier Two up to $5000). Examples of how this program can be used include relocation expenses, and child care.

JobCover placement program

Provides financial incentives to a new employer to employ a worker who cannot return to work with their pre-injury employer. This includes a financial incentive paid over a 12 month period for an amount up to $27,400.

Exempt categories of workers

The information provided in this fact sheet does not apply to:

  • exempt categories of workers (police officers, paramedics or fire fighters)
  • coal miners
  • volunteers prescribed by the Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987, or other voluntary work or unpaid employment.

Legislation

Information provided in this fact sheet is based the Workers Compensation Act 1987 and the Workplace Injury Management and Workers Compensation Act 1998.

For more detail on return to work support programs visit I'm a worker recovering at work.

Community support services

There are additional support services within the community. Depending on your circumstances, you may be eligible for assistance.

Financial support

Centrelink

Centrelink provides financial assistance to:

  • carers
  • families
  • indigenous Australians
  • job seekers
  • older Australians
  • people with disability
  • rural and remote Australians
  • students and trainees
  • visa holders

Call 13 24 68 or visit Centrelink.

Financial Rights Legal Centre

If you are concerned about your finances such as credit, banking, debt or personal insurance, you can obtain free advice and information from the Financial Rights Legal Centre. The centre is community based and specialises in providing financial advice and advocacy services, including:

  • credit and debt hotline – advice over the phone
  • financial counsellor search tool
  • face to face meeting with a financial counsellor if needed
  • self-help centre (fact sheets, guides, sample letter templates)
  • legal advice and representation.

Call 1800 007 007 or visit Financial Rights.

Housing support

Housing Pathways

If you need assistance with housing, you should consider contacting Housing Pathways for Aboriginal housing and community housing. Applications can also be made for private rental assistance or for a transfer if already living in social housing.

Call 1800 422 322 or visit Housing Pathways.

Disability support

Ability Links NSW

Ability Links NSW is a free program to assist people with disabilities aged up to 64 years, and carers and families of people with disability. 'Linkers' work closely with you to provide short-term support that achieves a particular outcome. For example you might want to participate in sport, education, volunteering, or other activities.

Visit Ability Links.

National Disability Insurance Scheme

The National Disability Insurance Scheme provides community links and individualised support for people with permanent and significant disability, their families and carers. The NDIS will be rolled out across NSW between 1 July 2016 and 30 June 2018.

Call 1800 800 110 or visit NDIS.

Mental health support

In addition to services offered by your treatment provider, you can seek additional mental health support via these providers.

Lifeline

Lifeline provides access to crisis support, suicide prevention and mental health support services 24 hours a day, seven days per week.

Call 13 11 14 or visit Lifeline.

Beyond Blue

Beyond Blue offers support services 24 hours a day, seven days a week. They provide online tools and information to assist in managing stressful situations.

Call 1300 224 636 or visit Beyond Blue.

Mental health line

Anyone with a mental health issue can call and speak with a mental health professional 24 hours a day, seven days a week. Mental Health Line can also help you find local treatment options.

Call 1800 011 511.

If you are experiencing acute mental health issues, you should contact the Mental Health Crisis Team in your local area.

Emergencies

In an emergency, call 000 or go to your local hospital emergency department.

HSNet

HSNet is a website available to anyone looking for community support services in NSW.

The database has over 65,000 support services across NSW covering health, disability, aged care, welfare, community participation, education, legal and housing support.

Each service displays detailed information including opening hours, fees, requirements for eligibility, and where the service is delivered. HSNet assists families in making informed choices about their support needs.

Each service has been validated as an authentic provider and is regularly updated by HSNet.

Ability Links

Ability Links NSW is a free program to assist people with disabilities aged up to 64 years, and carers and families of people with disability. Ability Links NSW coordinators, known as 'linkers' (or case managers) work closely with people (i.e. the worker) to provide support to achieve a particular outcome. You do not need to have a registered disability to access Ability Links.

‘Linkers’ have strong local knowledge and work alongside communities. Ability Links NSW coordinators can help you to:

  • find ways to be part of your local community
  • set goals and plan for your future
  • build confidence
  • develop your existing support networks and create new networks.

There are a number of providers around the state who can put you in touch with a linker. You can use the search functions on this website to find a linker in your area.

Community Connect

Community Connect provides funding for you to access community services in your local area.

This funding is designed to help you adjust to your changing circumstances due to section 39.

A cumulative total of up to $1,000 can be claimed for expenses involved in connecting with community based services.

Community Connect provides flexible funding for items or services for example:

  • travel costs to participate in a community program
  • a service provider to help you identify any issues, needs and goals, and link them with local community services
  • financial counselling (or similar) where you are unable to access free services.

Eligibility

You can access Community Connect funding if you have received notification from the insurer confirming that your weekly payments will cease on or before June 2018, due to section 39 of the 1987 Act.

Services and items funded under Community Connect must be fully completed within two years of the date when your entitlement to weekly payments ceases.

Read the Community Connect guidance material for more information.

How to apply

You should discuss how you want to use the funding with the insurer and advise the insurer of the supplier or service provider’s details and costs.

The insurer will provide advice on whether the proposed item or service meets the principles of Community Connect and approve payment.

Community Connect funding must be discussed with the insurer before costs are incurred.

Further information

You should contact the insurer for information relating to your claim and section 39 in the first instance, however if they are are unable to resolve your enquiry, you may seek assistance from WIRO:

Workers Compensation Independent Rview Office (WIRO)
T: 13 94 76 or email contact@wiro.nsw.gov.au.

Workers can contact their union representative, or a lawyer also.