Weekly payments

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 their work related 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.

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. A worker's capacity for work 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 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 first 13 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 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: A 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 15 hours or more 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 $155¹ per week (as indexed). 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 table 4 of 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 amount was $788.32 per week in 2012, and is indexed twice each year (refer to table 7 in the Workers compensation benefits guide for the current amount). 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, if shift allowance or overtime amounts were included in their PIAWE calculation. After 52 (cumulative) weeks of weekly payments, overtime and shift allowances are removed from the worker’s 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 can be found in table 5 of the Workers compensation benefits guide.

Starting weekly payments

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:

• where one or more reasonable excuses have been applied (see 'Delaying provisional payments')
• where liability has been disputed (see 'Resolving complaints and disputes').

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.

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 period of 260 weeks (five years).

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, 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.

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 in respect of the injury requiring surgery 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 $155¹ a week (as indexed)
• the worker must not have had their benefits stopped due to retirement (refer to section 52 of the 1987 Act).