Open scrollable table of contents

Print entire document

Approaching 260 weeks of workers compensation payments

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

Introduction

Under workers compensation legislation, weekly payments are available for a maximum (aggregate) 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.

If you are approaching the end of a total of 260 weeks (five years) of weekly payments, read the 'for workers' section for general information on what you need to know and do.

If you are an insurer, lawyer, service provider or medical professional, read the 'for professionals' section to help you understand the legislation and how it applies to workers.

This information does not apply to exempt categories of workers (such as police officers, paramedics or fire fighters, coal miners or volunteers).

SIRA support and information service - 13 10 50

The support and information service is available on 13 10 50. This telephone and email resource can help workers, employers, insurers and other stakeholders affected by the operation of section 39.

This resource also connects workers to services offered by HSNet and Ability Links NSW.

The support and information service can provide tailored support depending on your individual needs and circumstances, including:

  • answering specific questions or scenarios relating to entitlements, how your entitlements may be affected and what this means to you
  • providing guided support as you cease entitlement to weekly payments, and transition to other government support services
  • remaining on hand for as long as you need and offering a follow-up service
  • helping you, your immediate family or support network, find and connect to local community support providers and services offered by HSNet and Ability Links NSW
  • if identified programs or services are not free, assisting you to apply for funding through Community Connect.

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 impacted by section 39, such as financial counselling.

You can access Community Connect funding of up to $1,000 for programs or services identified through the support and information service, your insurer or by a service provider. See community support services for more information.

Anyone can contact the support and information service. No referral is required. Simply call 13 10 50 or email transitionsupport@sira.nsw.gov.au.

However, only workers affected by section 39 are eligible for Community Connect funding.

For workers

You may have already been contacted by your insurer in regards to the impact of section 39 on your claim. If you haven't, talk to them or give us a call on 13 10 50 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 with 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 your insurer if you are an existing recipient for the purposes of the above.

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.

For all eligible workers

You will receive lifetime entitlement for crutches, artificial members, eyes or teeth and other artificial aids or spectacles, including hearing aids and hearing aid batteries, home or vehicle modifications.

Secondary surgery is also available to you if the surgery:

  • is directly consequential to an earlier surgery and affects a part of the body affected by the earlier surgery, and
  • is approved by the insurer within two years after the earlier surgery was approved (or the surgery is approved at a later date due to a dispute that arose within the two years).

If you have 0 to 10% permanent impairment

You are entitled to a further two years of medical or related treatment from the date your weekly payments ceased.

If you have 11 to 20% permanent impairment

You are entitled to a further five years of medical or related treatment from the date the your weekly payments ceased.

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.

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 apply to Centrelink up to 13 weeks in advance of the cessation of your weekly 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.)

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 us - contact@sira.nsw.gov.au / 13 10 50, or the Workers Compensation Independent Review Office (WIRO) on 13 94 76.

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:

  • request a review by the insurer
  • contact the Workers Compensation Independent Review Office (WIRO) on 13 94 76
  • lodge 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 help with getting back to 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 Funding

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.

How to apply

Either you or the service provider gives details of the proposed service and related costs to the insurer.

The insurer will arrange payment of up to $1,000 for the proposed Community Connect service(s), and ensure costs are paid promptly.

Participation in Community Connect is voluntary and you can withdraw from a service at any time.

You can use Community Connect more than once, as long as the total costs do not exceed $1,000 and program requirements are met.

Further information

Workers should contact the insurer for information relating to their claim and section 39, however if they are are unable to resolve their enquiry they may seek assistance from SIRA:

State Insurance Regulatory Authority (SIRA)
Customer Service Centre

Workers can contact their union representative, a lawyer, or the Workers Compensation Independent Review Office (WIRO) on 13 94 76.

For professionals

We have developed a range of information that explains what section 39 means, how it impacts workers, and how you can provide the right advice and support.

Overview

Under workers compensation legislation, weekly payments are available for a maximum (aggregate) period of 260 weeks (five years). This applies unless the worker has been assessed as having a permanent impairment of more than 20 per cent.

Calculating 260 weeks of entitlement

What does aggregate mean?

When calculating an aggregate period of 260 weeks of weekly compensation, this could either be consecutive or non-consecutive weeks.

What is an entitlement week?

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.

When does an entitlement week start?

A ‘weekly payment of entitlement’ commences on the day of the worker’s first incapacity (total or partial) from a work related injury that results in a weekly payment of greater than $nil. A week is counted over the following seven-day period.

What constitutes a week will vary for each worker; there is no set period (i.e. Sunday to Saturday).

Example: a worker has no current work capacity as a result of an injury, and receives weekly payments of compensation commencing from Wednesday. The worker’s week will therefore commence from Wednesday, to the following Tuesday.

When does the 260 entitlement week count?

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 workers first day of incapacity.

How will a worker be informed of the total number of weeks paid?

The insurer will continue to communicate with the worker regarding their entitlements to weekly payments.

Communications should clearly inform the worker how the insurer has counted the entitlement weeks so that it can be easily understood by the worker. The information provided should include:

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

Where there are queries or disagreement as to the number of entitlement weeks paid (or payable), these should be discussed directly with the 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.

Centrelink

Centrelink assess each application based on individual circumstances, and the worker is encouraged to do their own research by visiting the website or contacting the Centrelink call centre on 13 24 68.

Note: before Centrelink are able to process an application, both the worker and insurer must agree on the number of entitlement weeks paid (or payable).

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

This information is based on the Workers Compensation Act 1987.

Cessation of weekly payments after 260 weeks (five years)

What does this mean?

Any week in which a payment of weekly compensation has been made (or is payable) to a worker, including part of a day or a full day, is counted as one week of entitlement. After a worker has received a total of 260 weeks (five years) of entitlements, their weekly payments of compensation will cease.

Workers will however continue to receive reasonably necessary medical treatment and services as follows:

Entitlement to medical and related expenses

All eligible

workers

Lifetime entitlement for crutches, artificial members, eyes or teeth and other artificial aids or spectacles, including hearing aids and hearing aid batteries, home or vehicle modifications.

All eligible

workers

Secondary surgery is available for all eligible workers. Surgery is secondary surgery if:

  • the   surgery is directly consequential to an earlier surgery and affects a part of   the body affected by the earlier surgery, and
  • the   surgery is approved by the insurer within two years after the earlier surgery   was approved (or the surgery is approved at a later date due to a dispute   that arose within the two years).

0 to 10 per cent

permanent impairment

A further two years of medical or related treatment from the date the worker’s weekly payments ceased.

11 to 20 per cent

permanent impairment

A further five years of medical or related treatment from the date the worker’s weekly payments ceased.

Everyone’s circumstances are different. Workers should speak to the insurer and/or treating health provider regarding their situation.

The injury management plan must be kept updated at all times to reflect the current rehabilitation, treatment and return to work goals of the worker. Support service programs specific to the worker’s needs will continue to be identified and made available.

What happens next?

The insurer will contact the worker and treating doctor or health professionals (where appropriate), to ensure the necessary steps are fully understood and the required level of support continues to be provided.

Re-eligibility

Where a worker has ceased entitlement to weekly payments under section 39, there are some limited circumstances where the worker may become re-eligible to weekly payments. Workers should contact the insurer directly to discuss their claim and eligibility.

When will weekly payments re-start?

Entitlement to weekly payments re-commences from when the worker was first assessed as having permanent impairment of more than 20 per cent.

If a worker once again becomes eligible to weekly payments, then the insurer will need to determine the worker’s entitlements in accordance with section 38 of the 1987 Act.

Note: for those workers in receipt of Centrelink payments; the worker should also liaise with Centrelink to determine the impact to their ongoing entitlements.

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 is this fact sheet is based on the Workers Compensation Act 1987.

Special provisions for existing recipients of weekly payments

What's the change?

Two new transitional provisions have been introduced into the Workers Compensation Regulation 2016,which may allow eligible workers to access ongoing entitlement to weekly payments beyond 260 weeks (five years).

These provisions provide that certain workers:

  • may be excluded from the five year cap on weekly payments
  • are able to undertake a further assessment of the level of permanent impairment.

These provisions take effect from 1 October 2012 and apply to workers who were in receipt of weekly payments immediately before 1 October 2012 (‘existing recipients’).

Certain workers may be excluded from the five year cap on weekly payments

A new transitional regulation provides that section 39 of the Workers Compensation Act 1987 (1987 Act) does not apply to a worker (‘existing recipient’) if the injury has resulted in permanent impairment and:

  • an assessment of the degree of permanent impairment is pending and has not been made because an approved medical specialist has declined to make the assessment on the basis that maximum medical improvement has not been reached and the degree of permanent impairment is not fully ascertainable, or
  • the insurer is satisfied that the degree of permanent impairment is likely to be more than 20 per cent (whether or not the degree of permanent impairment has previously been assessed).

Further assessment

Workers compensation legislation currently provides that:

  • only one assessment may be made of the degree of permanent impairment of a worker - section 322A of the Workplace Injury Management and Workers Compensation Act 1998, and
  • only one claim can be made for permanent impairment compensation resulting from an injury - section 66(1A) of the 1987 Act.
Note: workers who made a claim for lump sum compensation before 19 June 2012 are eligible to make one further deterioration claim. A claim for lump sum compensation should only be made when the worker has reached maximum medical improvement.

An amending transitional regulation now permits one further assessment of the degree of permanent impairment in respect of existing recipients, that is, workers in receipt of weekly benefits immediately before 1 October 2012.

Note: the further permanent impairment assessment is for the purposes of Part 3 of the 1987 Act. Accordingly, access to other compensation benefits including reasonably necessary medical treatment and services will also be dependent on the further assessment, and the degree of permanent impairment.

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

This information is based on:

  • The Workers Compensation Act 1987
  • The Workplace Injury Management and Workers Compensation Act 1998
  • The Workers Compensation Regulation 2016

Legal advice

Workers should seek independent legal advice to properly understand their rights and impact on entitlements prior to accepting an assessment of the degree of permanent impairment.

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 enable resolution of disputes about workers compensation entitlements.

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

Should you require more information please contact:

Workers Compensation Independent Review Officer
T: 13 94 76 or email contact@wiro.nsw.gov.au

Centrelink - Department of Human Services

In cases where the worker will no longer be entitled to receive weekly payments under the Workers Compensation Act 1987, there may be an entitlement to Centrelink payments.

Workers should be fully informed and prepared as to what Centrelink payments and services may be available.

Centrelink assess each application based on individual circumstances. Workers are highly encouraged to take the necessary time to undertake their own research by visiting the Centrelink website or contacting their call centre on: 13 24 68.

If not already completed, the worker will need to:

  • ensure they have created a MyGov account
  • complete a self-assessment on line to determine the type of benefits that may be available to them.

Centrelink are generally unable to assess eligibility for payment support until a claim is lodged by the worker.

To assist with the assessment process, workers can apply to Centrelink up to 13 weeks in advance of cessation of weekly payments by:

  • obtaining a letter from their insurer confirming the:
    • agreed total number of weekly payments paid to date
    • projected date of their last weekly payment and,
    • the reason for cessation of weekly payments
  • having an up to date medical certification and other supporting information (within last four weeks of their application) about all health conditions
  • having relevant financial information available (including details of any lump sum amount and date of payment, spouse’s earnings etc.)

This information is correct at the time of publication, though subject to change. Refer to the Centrelink website for up to date information.

Vocational support services

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.

Exempt categories of workers

This information 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

This information is based the Workers Compensation Act 1987 and the Workplace Injury Management and Workers Compensation Act 1998.

Community support services

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.

FAQs

General questions

What is section 39 of the Workers Compensation Act 1987 (the 1987 Act)

Under section 39, entitlement to weekly payments is available for a maximum (aggregate) 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.

Where a worker is assessed as having a permanent impairment of more than 20 per cent, entitlement to ongoing weekly payments will be subject to section 38 of the 1987 Act.

What is an entitlement week and when does it commence?

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.

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

An entitlement week commences on the day the worker is first incapacitated (total or partial) due to a work related injury and that results in a weekly payment of any amount. A week is counted over the following seven-day period.

When does the 260 entitlement week count commence?

Where an injury occurred and a claim was made before 1 October 2012 (known as ‘existing claims’), the 260 week count commences on 1 January 2013.

Note: an ‘existing claim’ refers to a claim for compensation in respect of an injury made before 1 October 2012 (Part 19I of Schedule 6 to the 1987 Act).

Where a claim is made on or after 1 October 2012, the 260 week count commences from the date of the first entitlement week.

This is in accordance with Schedule 8, Part 1, Clause 4, of the Workers Compensation Regulation 2016, and Schedule 6, Part 19H, Clause 13, of the 1987 Act.

After entitlement to weekly payment ceases due to section 39, can a worker again become eligible for weekly payments? If yes, when would weekly payments commence from?

Where a worker has ceased entitlement to weekly payments under section 39, there may be some limited circumstances where they may again become eligible to weekly payments, although this would be an unusual scenario.

Entitlement to weekly payments would commence from when the worker was first assessed as having permanent impairment of more than 20 per cent.

If a worker once again becomes eligible to receive weekly payments then the insurer will need to determine the workers’ entitlements in accordance with section 38 of the 1987 Act. Workers should contact the insurer directly to discuss their claim and eligibility.

Impact on medical entitlements questions

What happens to medical entitlements once weekly payments cease?

After weekly payments cease, workers will continue to be entitled to receive reasonably necessary medical treatment and services as follows:

Entitlement to medical and related expenses

All eligible

workers

Lifetime entitlement for crutches, artificial members, eyes or teeth and other artificial aids or spectacles, including hearing aids and hearing aid batteries, home or vehicle modifications.

All eligible

workers

Secondary surgery is available for all eligible workers. Surgery is secondary surgery if:

  • the surgery is directly consequential to an   earlier surgery and affects a part of the body affected by the earlier   surgery, and
  • the surgery is approved by the insurer within   two years after the earlier surgery was approved (or the surgery is approved   at a later date due to a dispute that arose within the two years).

0 to 10 per cent

permanent impairment

A further two years of medical or related treatment from the date the worker’s weekly payments ceased.

11 to 20 per cent

permanent impairment

A further five years of medical or related treatment from the date the worker’s weekly payments ceased.

More than 20 per cent

Entitlement to reasonably necessary medical treatment and services for life.

Note: workers will need to contact the insurer to establish their eligibility.

Support services questions

Are there support services a worker can access when returning to work with a new employer?

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.

A number of vocational programs are also available to assist workers to return to work outlined in the 'Support services' section above.

Are there community support services that can assist the worker?

Yes, there are a range of additional support services within the community. Depending on the workers’ circumstances, they may be eligible for assistance outlined in the 'Community support services' section above.

Workers and insurers can contact SIRA’s advisory services on 13 10 50 for information on section 39 and community support services available to assist the worker.

Permanent Impairment questions

If a worker has entered into a complying agreement with the insurer agreeing to permanent impairment of more than 20 per cent, can that complying agreement be relied on for the purposes of section 39?

Parties may reach agreement as to the degree of permanent impairment and enter into a complying agreement. Where the degree of permanent impairment is agreed to be more than 20 per cent, this can be relied upon for the purposes of section 39. In this instance, the worker’s entitlement to weekly payments will continue after 260 weeks (five years), subject to the requirements outlined in section 38 of the 1987 Act.

What special provisions are there for existing recipients?

On 16 December 2016 the Workers Compensation Amendment (Transitional Arrangements for weekly payments) Regulation 2016 (the Regulation) was published and made available on the NSW Government Legislation Website (see part 2A of Schedule 8 to the Workers Compensation Regulation 2016).

This new part of the Regulation applies to ‘existing recipients’ only.

Note: an ‘existing recipient’ of weekly payments is an injured worker who was in receipt of weekly payments immediately prior to 1 October 2012 (Part 19H of Schedule 6 to the 1987 Act).

The Regulation relevantly provides that section 39 does not apply to a worker (‘existing recipient’) if the injury has resulted in permanent impairment and:

  1. an assessment of the degree of permanent impairment is pending and has not been made because an approved medical specialist has declined to make the assessment on the basis that maximum medical improvement has not been reached and the degree of permanent impairment is not fully ascertainable, or
  2. the insurer is satisfied that the degree of permanent impairment is likely to be more than 20 per cent (whether or not the degree of permanent impairment has previously been assessed).

The Regulation also provides that certain workers (‘existing recipients’) are able to undertake a further assessment of the level of permanent impairment.

If the worker requires a further assessment of the degree of permanent impairment, is the insurer required to send the worker back to the same Doctor who conducted the prior Independent Medical Examination (IME).

There is no requirement to send the person to the same practitioner who previously assessed them. The assessor must be listed on the SIRA website as a trained assessor of permanent impairment for each body system they intend assessing. An on-line tool is available to find a permanent impairment assessor.

The worker is currently living overseas and indicated that it would be too difficult to attend an Independent Medical Examination (IME) in Australia and there is no current medical evidence to indicate that the worker’s degree of permanent impairment will be assessed at more than 20 per cent. Can the insurer conduct a file review with an IME to assess permanent impairment or alternatively organise a video conference between the IME and the worker?

Where a worker chooses not to attend a medical examination and the provisions outlined in 'Special provisions for existing recipients of weekly payments – section 39' (see above) do not apply; then a current degree of permanent impairment cannot be determined. If this is the case, the workers entitlement to weekly payments will cease once an aggregate period of 260 weeks is reached.

Failing that, it is at the discretion of the insurer and trained assessor for permanent impairment to determine and endorse the signing off of an assessment that is conducted via video link. Depending on the type of injury, it may not be possible to fully ascertain the degree of permanent impairment being assessed by this method, in accordance with the NSW workers compensation guidelines for the evaluation of permanent impairment. Accordingly, there is a real possibility that the assessment will not be considered to be a valid assessment, or it may affect the weight given to the assessment by the Workers Compensation Commission.

Workers can seek independent legal advice to properly understand their rights and impact on entitlements prior to accepting an assessment of the degree of permanent impairment.

What is the process to follow if a worker indicates that they do not want to attend an updated permanent impairment assessment?

If a worker chooses not to attend the medical examination, then the insurer may not be in a position to assess their current degree of permanent impairment and the worker’s entitlement to weekly payments may cease once the 260 week limit is reached.

The insurer will provide the worker with the reasons for the appointment, and potential consequences for non-attendance. The worker should also be encouraged to seek independent legal advice to properly understand their rights and impact on entitlements.

Are parties prevented from negotiating the degree of permanent impairment in NSW?

No, the legislation does not expressly prohibit parties from reaching agreement as to the degree of permanent impairment.

What if the worker wishes to dispute an Independent Medical Assessment (IME) for the purposes of section 39 threshold?

The worker can only lodge a dispute with the Workers Compensation Commission (WCC) if there is evidence supporting an assessment of more than 20 per cent.

Seeking legal advice questions

How can a worker get legal advice?

Workers should seek independent legal advice to properly understand their rights and impact on entitlements. For instance, a worker may seek legal advice prior to accepting an assessment of the degree of permanent impairment.

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 enable resolution of 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.

Should you require more information please contact: Workers Compensation Independent Review Officer T: 13 94 76 or email contact@wiro.nsw.gov.au.