Compensation payable

Overview

A worker is entitled to compensation for reasonably necessary domestic assistance in certain circumstances.

This guidance considers the eligibility criteria for domestic assistance, the care plan and gratuitous domestic assistance.

Eligibility for domestic assistance

A worker may receive domestic assistance to help them complete daily living activities including, but not limited to cleaning, laundry, gardening and essential home maintenance.

Section 60AA of the Workers Compensation Act 1987 (1987 Act) provides that a worker is entitled to domestic assistance if:

• a medical practitioner has certified, based on a functional assessment of the worker, that it is reasonably necessary that the assistance be provided and that the necessity arises as a direct result of the injury, and
• the assistance would not be provided for the worker but for the injury (because the worker provided the domestic assistance before the injury), and
• the injury has resulted in a degree of permanent impairment of at least 15 per cent; or the assistance is to be provided on a temporary basis, and
• the assistance is provided in accordance with a care plan established by the insurer in accordance with Part 4.4 of the Workers Compensation Guidelines (the Guidelines).

Section 60AA(2) of the 1987 Act provides that assistance is provided on a temporary basis if it is provided in accordance with each of the following requirements:

• it is provided for not more than 6 hours per week
• it is provided during a period that is not longer than, or during periods that together are not longer than, 3 months
• it is provided in accordance with the requirements of the relevant injury management plan.

Determining liability for domestic assistance

An insurer may receive a claim for domestic assistance from a worker, a provider or a medical practitioner. The insurer must, within 21 days of receiving a claim for domestic assistance, either accept or dispute liability.

Gratuitous domestic assistance

Domestic assistance may be provided by commercial providers or on a gratuitous basis. Gratuitous domestic assistance is defined as domestic assistance provided to an injured worker for which the injured worker has not paid and is not liable to pay (section 60AA(6) of the 1987 Act).

Reimbursing gratuitous domestic assistance

Providers of gratuitous domestic assistance may be able to claim payment for services directly from the insurer. Compensation is not payable for gratuitous domestic assistance unless the person who provides the assistance has lost income or forgone employment as a result of providing the assistance (section 60AA(3) of the 1987 Act).

Part 4.5 of the Guidelines specifies how the performance of domestic assistance services is to be verified. Information used to verify domestic assistance might include:

• pay slips showing fewer hours of overtime or of casual work, with a supporting letter from their employer
• evidence that they have moved from full-time to part-time work
• a certified copy of the letter of resignation or termination, giving reasons.

Payments for gratuitous domestic assistance are to be made to the provider of the assistance, not to the injured worker (section 60AA(5) of the 1987 Act).

Designing a domestic assistance care plan

The insurer must establish a domestic care plan with the worker and medical practitioner, based on what is reasonably necessary (see Part 4.2 of the Guidelines) domestic assistance for the worker. This should be completed before making any payments for domestic assistance.

Part 4.4 of the Guidelines provides for the making of a domestic assistance care plan.

The insurer must establish a care plan that sets out the approved domestic assistance. As a minimum, it must clearly state the:

• task(s) it covers
• service provider’s name
• number of hours and frequency of assistance
• start and end dates for which the assistance is approved
• total cost for the duration of service
• need for the domestic assistance recommended and how this relates to the worker’s injury.

This template can be added to the worker’s injury management plan:

Number of hours and hourly rate for gratuitous domestic assistance

Insurers should carefully consider the number of hours per week and the hourly rate paid for gratuitous domestic assistance. Due regard should be had to any award or other industrial instrument relevant to the type of service provided.

Verifying and approving gratuitous domestic assistance

The person providing the assistance can make a claim and the insurer should pay for properly verified services as they are provided.

Once approved, the insurer must pay the person providing the assistance, not the worker (section 60AA(5)(c) of the 1987 Act).

Providers of gratuitous domestic assistance must submit a diary of assistance provided before the insurer approves and pays compensation. The diary must be signed by both the provider and the worker (if the worker is able to do so). As a minimum, the diary must include the date, services performed and hours worked. See Part 4.5 of the Guidelines.

The template below shows the information required.