WorkCover claims and lump sum compensation

If you’ve suffered an injury at work and lodged a WorkCover claim, you may also be entitled to a lump sum compensation payment even if no one was at fault for your injury. This is referred to as a permanent impairment claim.

We often speak with injured clients who are not aware of their entitlements in relation to lump sum payments. They suffer an injury at work, have some treatment and time off work initially but then get back to work and think their WorkCover entitlements are over. This is not the case.

In addition to a claim for permanent impairment, you may also be entitled to make a common law claim if someone else (for example your employer or a third party) was to blame for your injury. That is, their behaviour involved negligence which contributed to your accident and subsequent injuries.

This article will only deal with a WorkCover claim for permanent impairment benefits.

To be entitled to compensation under this type of claim, you need to establish the following:

1. That you have sustained an injury arising out of or in the course of your employment. For more information, see our article “WorkCover claims when it’s not clear if you were ‘working’ at the time of injury”.
2. That your injury is stable. This means that your injury is unlikely to improve or deteriorate with further treatment.
3. Your injury is assessed by a qualified doctor as meeting the minimum threshold. This is different depending on the injury:
   1. For musculoskeletal injuries – 5% whole person impairment
   2. For other physical injuries – 10% whole person impairment
   3. For psychological injuries – 30% whole person impairment

Unsure about your eligibility to claim WorkCover? We can provide you with advice. It costs you nothing to find out where you stand.

Your level of whole person impairment will be assessed by an independent qualified doctor chosen by the WorkCover agent. This doctor will assess you pursuant to a particular guideline published by the American Medical Association.

Your treating doctors cannot perform this assessment for you.

The amount of compensation is calculated by using a formula prescribed by the legislation that deals with WorkCover benefits.

Factors such as when you suffered your injury, the type of injury and level of whole person impairment will determine the amount you receive.

For example, if you sustain a shoulder injury in July 2018 and receive a whole person impairment score of 7%, you will receive a permanent impairment benefit of $17,216.  If you suffer a back injury in April 2017 and receive a whole person impairment score of 25%, you will receive an impairment benefit of $72,471.

As a general rule, the amount of compensation increases by about $2,000 to $2,500 for every extra percentage point of whole person impairment, up to 30%. It steps up differently from there.

The maximum compensation payable for an impairment benefit, as at August 2019, $623,950.

There is no time limit to make a claim for impairment benefits.

However, you only have 6 years from the date of your injury to bring a common law claim, so it’s important to obtain legal advice about your entitlements as soon as possible after your workplace injury.

You are not required to engage a lawyer but a suitably qualified personal injury lawyer will assist you to maximise your compensation by ensuring you have considered and claimed for all relative injuries and that the assessment performed by the WorkCover agent’s doctor is adequate.

You can only make a claim once for each WorkCover incident, therefore, if you leave out an injury or accept an entitlement that was inadequately assessed, you cannot go back later and make a further claim.

At Polaris, we are experts in WorkCover compensation claims. For advice or assistance, please get in touch with a member of our team.

Remember, it doesn’t cost you anything to find out if you have a claim.