Workers compensation for medical expenses
January 6, 2021
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When does a worker become eligible to claim lump sum compensation?

In New South Wales, when a worker sustains an injury during the course of employment, physically or psychologically, he/she can claim compensation for losses arising from the injury. Workers compensation benefits that an injured worker can claim include income support for lost earnings, medical and rehabilitation expenses, and in certain circumstances lump sum payment.

Lump sum payment is achievable when the worker’s injury results in a permanent impairment that is assessed being at 11% or greater. For primary psychological injuries and illnesses caused or aggravated by work, permanent impairment should be assessed at 15% or more. A lump sum claim cannot be made for secondary psychological injuries. For exempt workers (police, firefighters, and paramedics) lump sum compensation for physical injuries can be made as long as the injury has given way to some level of permanent impairment.

Exempt workers may be entitled to make more than one lump sum claim for their work-related injuries. Other classes of workers can make more than one lump sum claim only if they made a claim for permanent impairment before 19 June 2012 and their condition has deteriorated.

Assessments for permanent impairment should be carried out by a qualified medical specialist who is trained in the use of the guides and listed on the State Insurance Regulatory Authority (SIRA) website. Workers must go through the maximum medical improvement in order to be eligible for receiving assessment, that is, their condition has stabilised and is unlikely to change within a year or without treatment. SIRA advises those workers who are not unsure whether they reached maximum improvement to consult their doctors or specialists.

Workers can claim lump sum compensation while making a claim for other benefits like weekly payments and medical expenses. Otherwise, they should complete and submit a Permanent Impairment Claim Form that can be found on SIRA’s website.

Upon receiving the worker’s claim form, the insurer should either accept or dispute liability within one month. This time frame can be extended if the insurer demands additional information from the worker.

Other facts about lump sum payment for workers compensation

  • For claims made on or after 19 June 2012, lump sum compensation for pain and suffering is not payable.
  • If a worker sustains both physical and primary psychological injuries in the same accident, the compensation for permanent impairment will be determined based on the greater amount payable.
  • If multiple physical injuries are sustained as a result of the same accident, they will be assessed together for determining the degree of permanent impairment while physical and psychological injuries will be considered separately.
  • When a work accident results in the worker’s death, his/her dependents may be entitled to lump sum compensation in addition to weekly payments and reasonable funeral expenses.

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