WorkCover Injury Claims Victoria

If an injury, illness, or condition you have suffered is in any way connected to your work then you may be entitled to WorkCover Benefits. If an injury happens due to the duties that you perform at work on a specific day then it is easy to see that an injury is work related.

Often injuries do not arise on a single day but build up over time due to the work that you do from day to day. “Over the course of employment” injuries are very common. Sometimes your Doctor will be able to identify whether your injury is due to the type of work that you can do. A lawyer can assist you in completing your WorkCover Claim Form to clearly indicate that your injury has occurred over time.

Sometimes workers are required to do work duties outside of normal work hours and the usual place of business, but if those duties are work related and you are injured you are still entitled to WorkCover. A classic example is getting work tools or other items out of your car at home.

• Report the injury to someone in authority at work.  If there is an Injury Register at work, make sure you report it there.  Whatever you do, make sure the report is in writing and get a copy of the written report.  The report should be made within 30 days.
• See your doctor, and obtain a WorkCover medical certificate for up to 14 days if you cannot work.
• Complete a WorkCover claim for compensation, and give it to your employer. Claim forms are available from post offices, from us and from the Victorian WorkCover Authority at worksafe.vic.gov.au.

Weekly Payments
A weekly wage calculated on what you were earning prior to injury is payable.

There are different rules that apply to the rates of pay that are payable and for the length of time that you can receive payments after injury.

Medical Expenses
Medical expenses for medical appointments, treatments and medication, provided they are reasonable and are related to your injury, are payable. Other costs that you may have (such as gardening, home help, car modification, and the like) may also be paid by WorkCover following injury.

Lump Sum Compensation
If your injury is long term WorkCover may pay a lump sum of compensation to you.

You may be entitled to an Impairment claim and, if your injury is “serious” and someone else is responsible for it, you may be entitled to a common law payment for pain and suffering and loss of income.

Your lawyer can help you with these benefits.

Special rules apply for workers injured while working casual hours. It’s important that the rate of pay is done correctly at the start of a claim as the rate of pay assigned by Workcover is the base figure applied to all weekly wages received from Workcover.

The rate of pay is known as PIAWE or pre-injury average weekly earnings.

A PIAWE calculation for casual workers can be difficult to determine or check whether WorkCover has calculated it fairly.

You must have all wage slips/payment summaries and pay rates that you can find for the 12 months before injury when calculating the correct rate that should apply. If you have worked for less than 12 months with your employer then you need just those that cover the period of time before an injury.

Second jobs should also be included, though the number of hours they allow per week can be capped.

Shift allowance and Overtime

These wage supplements should also be included in a PIAWE calculation, with the average of each over the 12 months previous being included in the PIAWE rate of pay.

Incorrect calculation

Workcover get PIAWE calculations wrong regularly. If a rate of pay is wrong it is very easy to appeal and your lawyer can assist with this.

If you have a long term injury you may have a Permanent Impairment. What level of Impairment you have directly correlates to how much compensation you are entitled to.

Firstly, you must wait at least 12 months after your injury to see what Impairment you may have.

Once you make a claim WorkCover will first assess your Impairment in accordance with prescribed Guides. You are entitled to appeal this Impairment rating.

Arnold Dallas McPherson are experts in advising as to appropriate Impairment ratings taking into account the symptoms and treatment a client has had and how the Guides relate to them. We strongly recommend you seek advice of experts in this area when pursuing an Impairment Claim.

If you have a “serious injury” then yes, you can.

Where injuries are long term and serious you can make a claim for loss of income and pain and suffering damages. But you must be able to prove that your injury was someone else’s fault, either your employer or someone else.

You need Specialist Legal Advice to pursue a claim against someone for compensation. Arnold Dallas McPherson can advise you of your chances of making a successful claim and guide you through the process.

Insurers often simply don’t respond to a request you or your Doctor has made to them.

It is very frustrating when they simply won’t get back to you. Following these easy steps will ensure any delay in responding will not be protracted –

– Make sure any request you or your Doctor make of the insurer, such as for treatment or home help, is done via fax or email.
– Keep a copy of the request and confirmation that it was received.
– Diarise for 28 days to see if there has been a response.
– If there has been no response lodge a Conciliation request.

A non-response Conciliation request usually is enough to prompt the Insurer to attending to the request, but you must be able to prove that they got the request in the first place.

Conciliation

Any decision made by a WorkCover insurer may be referred to conciliation. Conciliation is meant to be a process controlled by the independent conciliator which allows discussion of the dispute. The conciliator helps you to find a way to resolve the dispute, but has only limited powers to make a binding decision.

You do not need a lawyer to go to conciliation, but you may find it helpful. You may want to take a friend with you.

What you need to do is:

1. Within 60 days of the decision being notified to you, complete a Request for Conciliation form.
2. Send the form and any medical reports supporting you, and a short written summary of what should happen and why, to the Accident Compensation Conciliation Service.
3. A date for a conciliation meeting will be set, and you will be notified.

We can assist you:

• to lodge the conciliation request;
• to obtain all relevant material and file it with the Conciliation Service;
• by attending conciliation with you.

If you are not happy with a conciliation outcome, seek legal advice. You may be able to take the dispute to court for a decision.

Can I appeal to Court?

Yes. If conciliation is unsuccessful, you may issue proceedings in the Magistrates Court or County Court.

Sometimes medical questions are referred from conciliation or Court to a Medical Panel. A Medical Panel is made up of a number of doctors who will read the documentation, examine you and make a decision on the medical question which is then binding on the parties and on the Court.