Background to WA Workers Compensation Payments
Under the Workers Compensation and Injury Management Act 1981 workers who have an accepted workers compensation claim are entitled to:
- reasonable medical and allied health treatment expenses
- compensation for loss of wages
- reasonable workplace rehabilitation expenses
- travel and other expenses
Upon settlement you may also be entitled to a benefit representing the extent of the permanent impairment to your body.
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Medical review regarding permanent impairment
Before settlement of a workers claim it is recommended that workers undergo review by an Approved Medical Practitioner. A full list of these doctors and specialists can be found on the WorkCover website.
If you would like to arrange a medical review with an Approved Medical Practitioner you should provide them with Form AMS 1 Request for Assessment by Approved Medical Specialist of a Worker’s Degree of Permanent Impairment (See Common Law forms section) well before your appointment. The Approved Medical Practitioner will provide you with a notice that your condition has not yet stabilised or an assessment of your permanent impairment.
An assessment of permanent impairment is very relevant to your claim. It states that a certain part of your body is impaired to a certain degree, (e.g. 5% Permanent loss of the full efficient use of the back (including thoracic and lumbar spine)). If the report indicates that a part of your body is impaired as a result of your work injury, this is multiplied by the percentage in the ‘prescribed amount’ schedule to indicate how much money you should be paid for permanent impairment to your body.
Workers compensation payouts
The amount that you can receive in workers compensation statutory benefits is limited, and is altered by WorkCover WA each year. This is called the ‘prescribed amount’. In some circumstances the prescribed amount can be extended as we have described below. At present the prescribed amounts are as follows:
- ‘Maximum Payment’ (see explanation below): $206,742.00
- Medical Expenses: $62,023.00
- Rehabilitation Expenses: $14,472.00
The Maximum Payment comprises compensation for loss of wages (weekly payments) as well any payment you are entitled to for your permanent impairment. Some workers have a severe injury where they can not return to work and in limited circumstances the maximum payment can be extended. Extensions may also be available to the prescribed amount for medical expenses.
Getting the most out of your WA workers compensation claim
Permanent Impairment / Schedule 2 Benefit
The assessment of permanent impairment is very relevant to your claim. If you are assessed as having a whole person impairment of 15% or more you may be able to bring a negligence common law claim against your employer. If you can make out a common law claim the amount you will receive is generally more than you will receive in the ‘no fault’ workers compensation system.
It is important to choose the right doctor to assess your permanent impairment. In the writer’s view, insurers choose the doctors they will use based on the fact that those doctors provide a relatively low assessment of permanent impairment. Your ability to negotiate a more favourable settlement will increase if you are assessed at a higher level of permanent impairment.
It is often the case that the only medical evidence that workers have is from the doctors that their employer’s insurer has sent them to. As we have said above, these doctors have been selected as their views will often accord with the views of their instructing insurers.
At the very least, you should obtain a medical report from your general practitioner or treating specialist before you consider settling your workers compensation case. If your general practitioner says that you are unfit for work or partially unfit this provides you with a negotiating tool, where in other circumstances you would have had nothing.
It is important to get your general practitioner and appropriate specialist to set out their views regarding what will be needed by way of treatment in the future. If you have any expenses that were not paid for by your employer’s workers compensation insurer, then you should produce the invoices and receipts.
If you have not undergone any rehabilitation at the time of settlement, or you are in the process of being rehabilitated you should bring up rehabilitation expenses as something that will be incurred in the future.
Many workers do not know that they are entitled to their reasonable travel expenses associated with their claim. Travel expenses can be significant if the worker lives in a rural or remote location.
Obtaining legal advice
If you have made a workers compensation claim, Foyle Legal strongly recommends that workers obtain independent legal advice regarding the settlement of their workers compensation claim. Remember, your employer’s workers compensation insurer is trying to settle your claim for the least amount of money possible.