All You Need to Know about Workcover WA Schemes and Claims: Workers Compensation Benefits, Coverage and Examples

If you have been injured on the job, it is important to know that workers’ compensation benefits can help. In this blog post, we will discuss what workers’ compensation is in Western Australia and how workers are eligible for these benefits. The goal of this article is to provide you with all you need to know about workover schemes and claims in WA.

Types of workers compensation claims

The first thing to know about workers compensation in Western Australia is that there are many types of injuries that qualify for workers’ comp. This includes physical injuries such as back pain or a broken arm, mental injuries such as PTSD from an assault at work or anxiety brought on by traumatic events at work like shootings or other violence, and psychological trauma caused by bullying or harassment while working.

How much does WorkCover pay?

WorkCover WA does not pay compensation to the injured workers. The only circumstance that WorkCover pays workers compensation to injured workers is when the employer is uninsured and doesn’t make payments to the injured workers.

If you are claiming workers compensation payments and your claim is accepted by the insurer. It is the workers’ compensation insurer who is paying for your workers’ compensation benefits.

If your workers’ compensation claim is not accepted by the worker’s compensation insurer, then WorkCover WA, as the dispute resolution authority, has the power to order an employer (and its insurer if applicable) to make payments of workers compensation.

Once a worker’s compensation claim is accepted, injured workers are entitled to weekly payments of compensation, reimbursement of medical expenses and rehabilitation expenses up to the prescribed amount. In the year commencing 1 July 2021, the prescribed amount for workers compensation is as follows:

• Weekly payments of compensation and money for permanent impairment: $239,179.00
• Medical Expenses: $71,754.00
• Rehabilitation Expenses: 16,743.00

These amounts can be extended in limited circumstances. The amount for weekly payments of compensation can be extended in circumstances where a person is permanently totally incapacitated for work, and the social and financial circumstances justify it. An extension to the amount for medical expenses is also available in various circumstances. In our experience, high pay FIFO workers on workers comp with high WPI often requires an extension.

Is superannuation paid on workers compensation?

Workers on workers’ compensation are not entitled to superannuation under the workers’ compensation legislation, but they may be able to receive such benefits if there is a specific provision in their award or contract of employment.

There has been some ambiguity about this point and whether it was an oversight when originally drafting the workers’ compensation legislation is unclear.

Who is eligible for workers compensation laws benefits?

In general terms, a person is eligible for workers compensation if they are a “worker” who suffers an “injury” in the course of their employment. Some exceptions do apply.

The 2 most common myths about who is eligible for workers compensation benefits are:

Myth #1 – an injured person must show their employer is at fault in order to claim workers’ compensation

In WA, the workers compensation and injury management scheme is a no-fault system. This means the injured person does not have to show that his or her employer was at fault in causing the injury as they would if the claim was a negligence claim. Foyle Legal’s free online worker’s compensation claim checker can help you to establish if you meet the injury requirement to make a workers comp claim in WA.

Myth #2 – all workers meet the definition of “worker”

The term “worker” is defined in the Workers Compensation and Injury Management Act 1981 and relevantly includes:

1. any person who has entered into or works under a contract of service or apprenticeship with an employer, whether by way of manual labour, clerical work, or otherwise and whether the contract is expressed or implied, is oral or in writing;
2. any person to whose service any industrial award or industrial agreement applies; and
3. any person engaged by another person to work for the purpose of the other person’s trade or business under a contract with him for service, the remuneration by whatever means of the person so working being in substance for his personal manual labour or services.

But the term “worker” does not include:

1. a person whose employment is of a casual nature (the case law indicates a person with ongoing employment will be covered, the word ‘casual’ refers to transient employment, for example, a worker who agrees to paint a person’s house for one day).
2. employment that is not for the purpose of the employer’s trade or business;
3. a police officer or Aboriginal police liaison officer appointed under the Police Act (unless they suffer a work related injury and die from that injury).

In our experience, workers compensation for construction contractors and farm workers’ entitlement to workers compensation are tricky areas. If you are a construction worker, farmworker or contractor, it’s best to consult a workers compensation lawyer to have your claim properly assessed.

What qualifies as a work-related injury?

The term “injury” is defined in the Workers Compensation and Injury Management Act 1981 and relevantly includes:

(a) a personal injury by accident arising out of or in the course of the employment, or whilst the worker is acting under the employer’s instructions; or

(b) a disease because of which an injury occurs under section 32 or 33; or

(c) a disease contracted by a worker in the course of his employment at or away from his place of employment and to which the employment was a contributing factor and contributed to a significant degree; or

(d) the recurrence, aggravation, or acceleration of any pre-existing disease where the employment was a contributing factor to that recurrence, aggravation, or acceleration and contributed to a significant degree; or

(e) a loss of function that occurs in the circumstances mentioned in section 49,

but does not include a disease caused by stress if the stress wholly or predominantly arises from a matter mentioned in subsection (4) unless the matter is mentioned in paragraph (a) or (b) of that subsection and is unreasonable and harsh on the part of the employer;

In summary, the definition of work-related injury in the worker’s compensation legislation includes an accident arising out of or in the course of the employment, a disease contracted by workers in the course of their employment at or away from their place of work, including pre-existing conditions that were exacerbated because of this employment.

What are examples of workers compensation schemes?

Below are three examples of workers compensation claims but the names and other identifying features have been changed. It is very important to note that every worker’s compensation claim is different. In some cases, the accident may be the same but you are never just dealing with an injury, you’re also dealing with a specific person who has sustained it. The amount of workers compensation payout you received will also be variant depending on how your worker’s compensation claim is managed and progressed.

Unlawfully Ceased Weekly Payments

James worked as a nurse in rural Western Australia. He worked on a fly in fly out basis. On his way home he experienced barotrauma (which is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with, the body, and the surrounding gas or fluid) whilst on the aeroplane.

James made a claim for workers compensation by completing a claim form and first medical certificate and his claim was accepted. The insurer stopped paying weekly payments of compensation. James engaged Foyle Legal which made an application to WorkCover on the basis that the insurer unlawfully ceased weekly payments of compensation. The insurer essentially argued that James needed to show his claim should be accepted again. WorkCover ruled that was not the case and Foyle Legal helped James to settle his claim.

Suspension of Weekly Payments

Tim was employed as a labourer near Bunbury, WA. He suffered a back injury in the course of his employment. He made a workers compensation and liability was accepted.

The pain from Tim’s back injury was terrible. Tim used prescription medication but it did not prove enough from him. He started taking illegal drugs. Tim had a girlfriend and young child but the relationship broke down and his girlfriend left him, and he did not see his young child anymore. He tried rehabilitation for his drug addiction, but he was unable to complete it.

The workers compensation insurer said Tim was not engaging in vocational rehabilitation and applied for a suspension of his weekly payments of compensation and he had failed to attend an independent medical review. Tim continued to struggle with his drug addiction and his ability to commit to anything was very limited.

Foyle Legal helped Tim to organise another review with the independent medical review arranged by the insurer so that was no longer an issue. Close to the arbitration date, Foyle Legal helped Tim organize a return to work with a relative. Tim managed to settle his case on favourable terms just before the Arbitration hearing.

Disputed WorkCover Stress Claim

Paula was an administrative assistant and she was subject to continuing and constant bullying by her manager. She made a workers compensation claim and like most psychological claims liability for her claim was not accepted. Paula did not know what to do and came to Foyle Legal to help her with her claim.

Foyle Legal helped with the cost of obtaining medical reports regarding Paula’s claim and brought an application through WorkCover WA. The insurer offered Paula a lump sum at Conciliation but it was not enough for her. Foyle Legal helped Paula get more records (medical notes and a Psychiatrist report) regarding her case and Paula settled her claim on favourable terms at a pre-arbitration conference.

Un-disputed Workers Compensation Claims

1) John is a crane operator who was injured while at the work site. He sustained a work-related injury to his back and arm which meant he had limited movement in both areas. The workers compensation claim involved specialist medical reports, hospital records, rehabilitation documents and other assessments including psychological evaluation of John’s limitations.

2) Mary is a retail assistant who was injured when she fell from the ladder while working in her store. The workers compensation claim involved medical reports that showed Mary had sustained an injury to her back which meant she would not be able to return to work.

3) Tony is a construction worker, fell from a ladder and sustained fractures to his right arm. He was treated in hospital for the fracture and then released home with workers compensation benefits covering all of his medical expenses.

4) Nina slipped on some wet tiles at work while carrying groceries. She suffered severe lower back pain and a sprained wrist, for which she was prescribed medication.  The worker’s compensation claim for Nina involved a report from the treating doctor, and also from an independent Medical Practitioner. Foyle Legal helped Nina to successfully settle her claim for her permanent impairment

Workers Compensation Common Law Claim

Tom is a painter who sustained a work related injury to his shoulder when he slipped and fell on the floor while carrying paint in his bucket. Tom had surgery which helped with some pain but not all of it and he also developed anxiety and depression due to his injury. The worker’s compensation claim involved an internal investigation which showed Tom was exposed to a dangerous set of circumstances at the workplace and that he had been unsafely using equipment on site. We were able to settle the worker’s compensation claim for workers’ compensation benefits.

Management of WorkCover Claims

If you have loaded a workers compensation claim with WorkCover WA. You must lodge your WorkCover WA claim with your employer. Once you lodged the claim with the employer, they must then submit the claim to your worker’s compensation claim insurer.  According to the WorkCover Code of Practice, the employer and the insurer must operate within a tight deadline to provide you with a liability decision. Your employer’s workers’ compensation insurance company determines if or not your WorkCover claim will be accepted, pended or rejected based on your workers’ compensation coverage.

Workcover Management Plan

WorkCover manager plan is often referred to as a case management plan that your claim officer put together in order to efficiently manage your workcover claim. This version of the WorkCover management plan often consists of steps to resolve your claim as soon as possible.  The focus of this workcover management plan is to manage the risk and exposure for your employer’s insurance company. If you are an injured worker and never made a claim before, it is important to note that your insurance company’s WorkCover manager plan is not necessarily the plan that best represents your interest!

Legal Assistance for Claiming WorkCover – No Win, No Fee

Foyle Legal is one of the leading worker’s compensation lawyers in Perth. We have been helping injured workers in WA for years. We have the team and expertise to help you win your workcover claim, as well as other types of personal injury benefits you may be entitled to. If you or a loved one are facing a worker’s compensation claim in Western Australia, we can provide all of the resources necessary to ensure that you get what is rightfully due from your employer. From medical care reviews to negotiations with employers and insurance companies, our legal team will be there every step of the way to make sure that you receive fair treatment in line with Western Australian laws on Workers Compensation claims. If you have made a personal injury claim in WA? Contact Foyle Legal today at 0408727343.

More Information about Personal Injury Law

For more information about the personal injury claim process and what to expect from your injury compensation claim, please check out of Workers Compensation FAQ and Personal Injury FAQ page.