Claims management other

When weekly payments end

Workers are not entitled to weekly payments after a combined period of 260 weeks (whether or not consecutive), unless they have been assessed as having a degree of permanent impairment of more than 20 per cent.

Approaching 260 weeks

Insurers should start preparing well before the 260-week end of weekly payments. This will ensure appropriate support is provided to workers in a timely manner.

As a minimum, SIRA expects all insurers to proactively communicate with workers and stakeholders (as required) verbally and in writing, at least 13 weeks before the cessation of benefits.

Calculating 260 weeks of entitlement

The 260 weeks of entitlement may be consecutive or non-consecutive.

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

If a worker has not received a payment of weekly compensation in a particular week, that week should not be counted as an entitlement week.

A week of entitlement starts on the day the worker is first incapacitated (total or partial) due to a work-related injury, and results in a weekly payment greater than $0.00.

A week is counted over the seven-day period from that day. There is no set period, and what constitutes a week will vary for each worker (for example, a week will not necessarily run from Sunday to Saturday).

Insurers must communicate regularly with workers and stakeholders throughout the life of a claim. Communication should be proactive, collaborative and transparent to ensure workers are informed and clear about their entitlement to compensation, including when entitlements may/will cease.

Communication must always consider the worker’s individual circumstances and support requirements. These requirements may become more critical in the lead-up to the end of the entitlement period and in setting up access to ongoing support thereafter.

Where there are queries or disagreement as to the number of entitlement weeks paid (or payable), these should be resolved with the worker before the end of the 260 weeks.

Permanent impairment and weekly payments after 260 weeks

If a worker is assessed as having more than 20 per cent permanent impairment, they may be entitled to weekly payments beyond the 260-week limit.

Insurers should engage with the worker well before this deadline so they can determine whether a permanent impairment assessment is required, and make any necessary arrangements.

The insurer must communicate the outcome of the permanent impairment assessment to the worker. They must also explain what it means for the worker’s entitlement to weekly payments, as well as reasonably necessary medical treatment and services thereafter (see 'Threshold entitlements').

The insurer should make every effort to ensure that the worker is fully informed of their rights to seek independent legal advice.

Centrelink

Insurers should (where relevant) encourage workers to be fully informed and prepared as to the Centrelink payments and services that may be available to them.

Centrelink assesses each application based on individual circumstances. Workers should do their own research by visiting the Centrelink website or calling 13 24 68.

Support services

There is a range of community and government-based support services available for the worker. These services can be used to:

• help the worker to remain in the workplace during their recovery, or
• return to work sooner, following a work-related injury.

Vocational programs

There are a number of SIRA vocational programs available to workers while they are still entitled to receive weekly payments.

Refer to 'Return to work assistance' and 'SIRA funded programs' for more information.

NSW Government services

Workers can also access two free government services to help them with their change in circumstances when entitlement to weekly payments has ceased:

• HSNet (Human Service Network) is a comprehensive online directory for essential support services in NSW. It has general information, location and contact details for a range of services related to health, welfare, community, education, disability, aged care, legal, housing and more.
• Ability Links NSW helps people with a disability (aged 7 to 64), their families and carers, to achieve a particular outcome or goal. This might include setting personal goals and planning for the future, building confidence, education, and developing support networks.

Community Connect

Community Connect provides funding for eligible workers to access local community services to help adjust to their changing circumstances.

A worker is eligible to access Community Connect if they have been notified by their insurer that they will cease to receive weekly compensation payments on a specific date prior to June 2018.

Community Connect provides workers with up to $1,000 in funding for an item or service to help manage any barriers or needs that are preventing them from adjusting to these changed circumstances.

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

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

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

Read the Community Connect guidance material for more information.