All about WorkCover payments (Vic)
How do WorkCover payments work?
The WorkCover Insurer will pay you weekly payments if you are unable to work as you were doing prior to suffering your injury. Whether that’s because you can’t work at all or because you can only do some of what you normally would. Payment amounts are based on your pre injury average weekly earnings (PIAWE).
What do I need to do to claim weekly payments?
In order to obtain weekly payments through the WorkCover insurer, you will need to obtain a certificate of capacity from your GP or other health professional.
Most health professionals that you see are able to provide WorkCover certificates, other than psychologists.
It’s always a good idea however to have your GP complete your certificates as you are likely to see them on a regular basis.
Certificates of capacity then need to be provided to the insurance company.
You need to continue to get certificates of capacity as you go along.
How are weekly payments calculated?
Weekly payments are based on an average of your wage over the 12 month period before you suffered your injury, with a few exceptions.
The average calculation is called your pre-injury average weekly earnings (PIAWE).
For the first 13 weeks of weekly payments you are paid at 95% of your average earnings.
From the 14th to the 130th weeks you are paid at 80% of the average.
If you are entitled to payments beyond 130 weeks, you are paid at the 80% rate.
If you want to calculate your PIAWE, you can use our PIAWE calculator which can be found here.
How long do WorkCover payments last?
You can get payments for 130 weeks. After 130 weeks, in order to get weekly payments you need to show that you have no work capacity, which is likely to continue into the future.
WorkCover payments after 52 weeks
Your weekly payments will be reduced after 52 weeks if your PIAWE calculation included overtime and/or shift allowances, if your WorkCover claim was made on or after 5 April 2010.
If your claim was made before 5 April 2010, you will be entitled to overtime and/or shift allowances for 26 weeks.
Is superannuation included in the calculations?
In the first 12 months that you receive weekly payments, unfortunately you will not receive any superannuation payments.
After that period however, you will start receiving superannuation payments on top of any weekly payments.
After 12 months you should ensure to check and make sure that you are receiving superannuation payments. If you don’t, you should contact the insurer or your lawyer.
What does current work capacity mean?
This means a present inability that arises from your injury, that results in you not being able to return to your pre-injury employment, but you are able to return to work in what is called ‘suitable employment’.
No current work capacity is defined to mean a current inability that arises from your injury such that you are not able to return to work either in the work that you were doing prior to suffering the injury or any suitable employment.
What does ‘suitable employment’ mean?
This means work for which you are suited, taking into regard things such as the work that you were doing prior to suffering the injury, your age education skills and work experience, where you live, the nature of your injury and what the medical material says about your incapacity, and comments made by any occupational rehabilitation services.
Suitable employment does not take into account whether the work is actually available.
What happens if I’m certified fit for modified duties?
If after an injury you are certified fit for modified duties, the employer is required to provide suitable employment to the extent that is reasonable for them to do so.
They must offer you suitable employment duties for a period of 52 weeks.
It is your job to comply with your return to work obligations and failure to do so can result in the termination of your weekly payments.
How do I get weekly payments in addition to 130 weeks?
There is a significant change in the eligibility test for payments at the 130 week mark.
In order to claim weekly payments prior to 130 weeks you need to be able to show that you can’t do your old job in an unrestricted way. This is based on your certificates of capacity.
After 130 weeks however, you need to show that you do not have a work capacity at all and this is likely to continue into the future. This is a tough hurdle to get over for a lot of people and it is the reason why many people have their payments cut off at 130 weeks.
It is important to realise however that you are able to challenge the decision to terminate your payments at 130 weeks.
Partial weekly payments after 130 weeks:
In addition to showing that you have no work capacity and that is likely to continue indefinitely, there’s a further way in which you may be entitled to weekly payments after 130 weeks.
If you have a current work capacity and if you have been entitled to weekly payments, you are able to make an application to the insurer for a determination that your entitlement to weekly payments does not cease.
In order to satisfy the relevant test, you need to prove that you’ve returned to work, whether in self employment or other employment, for no less than 15 hours a week and that you are in receipt of weekly earnings at least $166 a week.
The final thing that you must prove is that because of the injury, you are not likely to be able to undertake further additional employment or increase your weekly earnings.
If you make this application and the insurer knocks you back, you can proceed to conciliation to appeal the matter or you can make the application again down the track.
What about weekly payments being paid after retirement age?
If you’re injured within 130 weeks before after retirement age, you are entitled to weekly payments for not more than the first 130 weeks of incapacity for work.
If the above does not apply to you, but before the age of retirement you suffered an injury at work and you made a claim for compensation in relation that injury and you receive weekly payments within the period of 10 years before you hit retirement age.
And if you became incapacitated for work after retirement age as a result of treatment that you received after the retirement age when you were an inpatient at hospital for the injury and you are not entitled to weekly payments because you’ve hit retirement age, you can apply to the insurer for weekly payments in relation of that incapacity.
You can be paid weekly payments for maximum period of 13 weeks in this instance.
Will I stop getting weekly payments if I quit my job?
Your weekly payments of compensation will continue if you quit your job but make it clear that the reason you resigned was because of your injury. The law states that if you resign for reasons that are unrelated to your incapacity, then the WorkCover Insurer could possibly seek to terminate or reduce your weekly payments.
If I am on WorkCover payments can I apply for another job?
You can apply for another job while you’re on WorkCover payments but keep in mind that your WorkCover payments are based on your incapacity. So, if you’re able to work at your full pre-injury capacity, you’re not likely to be entitled to be paid weekly payments of compensation by WorkCover.
If my weekly payments are terminated what can I do?
If your WorkCover Insurer terminate your weekly payments, you’re able to appeal this decision to conciliation.
If my weekly payments are reduced and I disagree with the decision, what can I do?
If your WorkCover payments are reduced, your first port of call should be to query this with the insurer and ask them to explain why they were reduced. If you disagree with their decision, you can appeal the decision to conciliation.
Are WorkCover payments taxed?
Any weekly payments you receive from WorkCover while you have a reduced capacity for work, or are unable to work, are taxable. It is considered income and therefore you will need to declare any weekly payments to the Australia Tax Office.