Weekly payments

Published: 12 August 2019
Last edited: 20 December 2019

This section does not apply to exempt workers. See instead 'Weekly payments for exempt workers'.

Different rates of compensation also apply to coal miners.

Calculating weekly payments

A worker may be entitled to weekly compensation payments (referred to as ‘weekly payments’ or ‘weekly benefits’) if they are totally or partially incapacitated for work due to an injury.

Payments are calculated and paid on the basis of a weekly entitlement.

All weekly payment calculations are based on a worker’s pre-injury average weekly earnings (PIAWE). Therefore, the insurer will determine a worker’s PIAWE in order to make accurate weekly payments (see 'Pre-injury average weekly earnings').

A formula is applied using the worker’s PIAWE to determine the amount of the weekly payment. The formula used to determine this amount depends on factors such as the worker’s entitlement period and their capacity for work.

A worker’s current work capacity must be known in order to calculate correct payments. Worker capacity is assessed by the insurer and based on available evidence. This can be in the form of a properly completed certificate of capacity, or may require a more formal assessment and decision made by the insurer (see 'Work capacity assessment').

Summary table

The formulas, and when to use them, are summarised in the table below:

Entitlement period

Section of 1987 Act

No current work capacity (unable to return to work in suitable or pre-injury employment)

Has current work capacity (able to return to suitable employment but not pre-injury employment)

0-13 weeks:

1st entitlement period

36

The lesser of:

(AWE x 95%) – D

OR

MAX – D

The lesser of:

(AWE x 95%) – (E+D)

OR

MAX – (E+D)

14-130 weeks:

2nd entitlement period

37

The lesser of:

(AWE x 80%) – D

OR

MAX – D

Working less than 15 hours per week

Working 15 hours or more per week

The lesser of:

(AWE x 80%) – (E+D)

OR

MAX – (E+D)

The lesser of:

(AWE x 95%) - (E+D)

OR

MAX – (E+D)

131-260 weeks:

Special requirements after second entitlement period

38

Cessation of weekly benefits after 130 weeks of weekly payments unless:

Worker is assessed as having no current work capacity which is likely to continue indefinitely.

The lesser of:

(AWE x 80%) – D

OR

MAX - D

Worker has applied to the insurer after 78 weeks for continuation of weekly payments beyond 130 weeks, AND

is working 15 hours or more and has current weekly earnings of at least the amount specified in s 38(3)(b) (as indexed) per week, AND

the insurer has assessed the worker is, and is likely to continue indefinitely to be, incapable of undertaking additional employment that would increase the worker’s current weekly earnings

OR

worker has applied to the insurer after 78 weeks for continuation of weekly payments beyond 130 weeks, AND

worker is a worker with high needs (as defined in s 32A of the 1987 Act).

The lesser of:

(AWE x 80%) – (E+D)

OR

MAX – (E+D)

Certain circumstances don’t affect payments after second entitlement period

40

 

Worker continues to have an entitlement under s 38 even if the worker, for up to four weeks in the first 12 consecutive week period (or any subsequent period of 12 weeks of s 38 payments), has:

Worked more or less hours (even if less than 15 hours) than the hours worked at the time of making the s 38 application, or received higher or lower current weekly earnings (even if less than the amount specified in s 38(3)(b) (as indexed) per week.

Special provision for workers with highest needs

38A

If the determination of the amount of weekly payments of compensation payable to a worker with highest needs is less than the minimum amount, the amount is to be treated as the minimum amount.

Special compensation because of surgery after the second entitlement period

41

Special compensation for incapacity resulting from injury-related surgery is payable at s 37 rate:

Incapacity must not occur during the first 13 consecutive weeks after the end of the 2nd entitlement period; payable for a maximum period of 13 weeks following surgery; and only if the worker is not otherwise entitled to payment under s 38 under 130 weeks.

To be eligible the worker must have received weekly payments and had current work capacity prior to incapacity due to injury-related surgery; and must have returned to work after the initial injury for 15 hours or more and have current weekly earnings of at least the amount specified in s 38(3)(b) (as indexed) per week.

After five years (260 weeks) of weekly payments

39

Weekly payments are available for a maximum (aggregate) period of 260 weeks (five years) unless the worker has been assessed as having a permanent impairment of more than 20%.

Workers who were in receipt of weekly payments immediately before 1 October 2012 (existing recipients) may be entitled to a further assessment of permanent impairment and in limited circumstances, be excluded from the five-year cap on weekly payments (eg where the insurer is satisfied that the degree of permanent impairment is over 20%).

A worker’s entitlement after 260 weeks is still subject to the requirements of s 38.

Where:

AWE is the worker’s pre-injury average weekly earnings (PIAWE)

E is the current weekly earnings (CWE) which is the value of all the worker’s gross earnings or what they could earn in suitable employment in the week.

MAX is the maximum weekly compensation amount.

D is only included in the formula for claims with a date of injury before 21 October 2019. It reflects the value of all deductible non-monetary benefits provided by the employer to a worker in the week.

Where the injury occurs on or after 21 October 2019, non-monetary benefits are instead considered as part of a worker's PIAWE. See 'Pre-injury average weekly earnings' for further information.

The SIRA Have you been injured at work? tool helps workers to understand weekly payments and other entitlements at different stages of a claim.

Entitlement periods

The entitlement period will determine the formula used to calculate a worker’s weekly payment. There are three entitlement periods:

1. The first entitlement period refers to the aggregate (accumulated) period of the first 13 weeks (not necessarily consecutive calendar weeks), where a weekly payment has been paid or is payable to the worker.

2. The second entitlement period refers to the aggregate period of the next 117 weeks (not necessarily consecutive calendar weeks) after the first entitlement period (weeks 14 to 130), where a weekly payment has been paid or is payable to the worker.

3. After the second entitlement period, workers who satisfy certain conditions may be entitled to continue receiving weekly payments after 130 weeks.

First entitlement period: 0 to 13 weeks

During the first entitlement period, the worker’s entitlements are based on whether the worker has:

  • no current work capacity, or
  • current work capacity.

Workers who have no current work capacity will receive up to 95 per cent of their PIAWE.

Workers who have current work capacity are entitled to 95 per cent of their PIAWE, less their current weekly earnings.

Note:maximum weekly compensation amount applies.

Second entitlement period: 14 to 130 weeks

During the second entitlement period, the worker’s entitlements are based on whether the worker:

  • has no current work capacity, or
  • is working more than 15 hours per week, or
  • is working less than 15 hours per week.

Workers who have no current work capacity will receive up to 80 per cent of their PIAWE.

Workers who have returned to work for at least 15 hours per week are entitled to 95 per cent of their PIAWE, less their current weekly earnings.

Workers who have some capacity to work, but are working less than 15 hours per week may receive up to 80 per cent of their PIAWE, less their current weekly earnings.

(Note: a maximum weekly compensation amount applies.)

After the second entitlement period: 131 to 260 weeks

Continuation of weekly payments after 130 weeks will depend on the worker’s capacity for work and their assessed level of permanent impairment (see ‘Assessing permanent impairment’).

To be eligible for weekly payments after week 130, workers need to fall into one of the following categories:

  1. Workers who have been assessed as having no current work capacity (and this is likely to continue indefinitely).
  2. Workers (other than a worker with high needs) who have a current work capacity and have achieved an actual return to paid employment for at least 15 hours per week earning at least $1961 per week. These workers must be assessed by the insurer as being incapable of undertaking further additional employment that would increase their current weekly earnings, and must apply to the insurer (using the Continuation of weekly payments after 130 weeks application form) in order for their benefits to continue.
  3. Workers identified as ‘high needs’ (those assessed as having between 20 to 30 per cent permanent impairment) who are assessed as having current work capacity must apply to the insurer (using the Continuation of weekly payments after 130 weeks application form) in order for their benefits to continue. See section 38(3A) of the Workers Compensation Act 1987 (1987 Act).

1This amount is adjusted in July of each year and updated in the Workers compensation benefits guide.

To determine a worker’s weekly payment entitlement for this period, the insurer will conduct a work capacity assessment (see 'Work capacity assessment'):

  • in the last 52 weeks of the second entitlement period (between weeks 78 and 130), and
  • then at least once every two years after that.

A worker is not required to have a work capacity assessment if they have been identified as a worker with ‘highest needs’ (unless requested by the worker and the insurer thinks it is appropriate). A worker with highest needs is a worker who has a degree of permanent impairment assessed at greater than 30 per cent.

Workers who are eligible to receive weekly payments after the second entitlement period will receive 80 per cent of their PIAWE, less any current weekly earnings.

Note: A maximum weekly compensation amount applies.

Special provision for workers with highest needs

Workers with highest needs who are entitled to an 'amount' of weekly compensation may be entitled to a 'special provision amount' of compensation. This is currently $845.00 per week (refer to Workers compensation benefits guide for past figures). This may be payable in addition to the worker's earnings.

Note: an 'amount' of weekly compensation is to be determined in accordance with sections 36, 37 or 38 of the 1987 Act and can be zero.

Weekly payments for workers with a date of injury before 21 October 2019

Amendments made to the way in which a worker’s PIAWE is determined from 21 October 2019 included minor changes to the formula used for the calculation of weekly payments.

As noted in the summary table above, the factor D, which reflects any non-monetary benefits provided to the worker, is only included in the formula for workers with a date of injury before 21 October 2019. The amendments also made changes to the definition of current weekly earnings, which now replaces “E” in the weekly payment algorithm.

Where the worker’s date of injury is before 21 October 2019, PIAWE is calculated using the methodology in place at that time. See ‘Pre-injury average weekly earnings prior to 21 October 2019’.

For claims with a date of injury before 26 October 2018, there is a legislated step-down in benefits after the worker has received 52 weeks of weekly payments. After 52 (cumulative) weeks of weekly payments, overtime and shift allowances are removed from the worker’s calculated PIAWE.

For workers with a date of injury on or after 26 October 2018, but prior to 21 October 2019, the worker’s PIAWE is calculated using the previous methodology, however there is no step-down in weekly payments after 52 weeks and their PIAWE continues to include overtime and shift allowances.

The maximum weekly compensation amount

The maximum weekly compensation amount is the maximum amount per week a worker can be paid regardless of their determined PIAWE amount and formula applied. The maximum weekly compensation amount is currently $2,177.40 (refer to the Workers compensation benefits guide for past figures).

Starting weekly payments

Insurers must begin weekly payments to entitled workers within seven calendar days of receiving a notification of injury.

These payments can be made on either provisional or full claim liability acceptance.

The only exceptions to making a payment within seven calendar days are:

Who pays the worker?

In most cases, the worker is paid directly by the employer however, in some instances the worker may be paid by the insurer.

S8. Insurer making weekly payments
Principle
The rights and responsibilities of all parties will be respected in circumstances where weekly payments will be made by the insurer.

Application to alter weekly payments

A worker in receipt of weekly payments can apply to the insurer to have their weekly payments increased or reduced. The application must be in writing and should provide the reasons for the request, including any supporting evidence.

SIRA’s Pre-Injury Average Weekly Earnings (PIAWE) form may be used for this purpose.

The insurer has 28 days from receipt of the application to approve or reject the application. If the application is rejected the insurer must provide their reasons for the decision. A copy of the decision must be provided to the worker and employer.

Weekly payments after 260 weeks (five years)

Weekly payments are available for a maximum (aggregate) period of 260 weeks (five years). The aggregate period can include consecutive and non-consecutive weeks.

This applies unless a worker has been assessed as having a permanent impairment of more than 20 per cent.

Under workers compensation legislation, the weekly payment count start date depends on when the worker was injured and made a claim:

  • for a claim made prior to 1 October 2012 (referred to as an ‘existing claim’), the 260-week count commences 1 January 2013
  • for claims made on or after 1 October 2012, the 260-week count commences on the first day of incapacity.

Workers with any questions regarding entitlement weeks should check with their insurer to confirm how many weeks of payments have been received, and when the weekly payment count started.

If the worker has been assessed as having permanent impairment of more than 20 per cent or more, their entitlement after 260 weeks is still subject to section 38 of the 1987 Act.

An insurer will contact the worker to give them sufficient notice (at least 13 weeks) when their benefits are due to cease.

See 'Approaching 260 weeks of weekly payments of compensation' for further information.

Incapacity resulting from surgery after the second entitlement period

A worker may be entitled to weekly compensation after the second entitlement period, if they undergo surgery for their work-related injury/illness.

This ‘special compensation’ is not payable:

  • in the first 13 consecutive weeks after the end of the second entitlement period, or
  • more than 13 weeks after the surgery, or
  • during any period where the worker is entitled to compensation after the second entitlement (for example, under section 38 of the 1987 Act).

To be eligible, the following requirements must be satisfied:

  • the worker must have been paid weekly benefits before and had current work capacity before the period of incapacity resulting from the injury-related surgery
  • the worker must have returned to work since the initial injury for at least 15 hours per week, earning at least $1961 a week
  • the worker must not have had their benefits stopped due to retirement (refer to section 52 of the 1987 Act).

1This amount is adjusted in July of each year and updated in the Workers compensation benefits guide.

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