This is what happens when WorkCover ends (Vic)

What happens when WorkCover ends graphic

This sounds like a simple question – but as is often the case with the law, we need to know more about the specifics of the case before we can dig deeper.

The first thing to ask is when you say WorkCover is ending, what do you mean?

Below we cover the common scenarios that cause someone to believe their WorkCover claim has ended or might end soon.

Depending upon what topic you fit in to below and what your particular situation is, what happens be very different.

Is it that the WorkCover insurer has stopped your entitlement to medical and like expenses?

If the WorkCover insurer has stopped your entitlement to medical and like expenses they should have sent you a decision notice that sets out the reasons for your benefits stopping and when they will stop, as well as your options for challenging their decision.

A decision to terminate medical and like expenses maybe for a specific type of treatment, such as physiotherapy, or it may be for the entirety of the entitlement.

There are always options for challenging any decision to stop your medical and like expenses, and you should always consider whether it is worthwhile to do so.

You should also note that your medical expenses being terminated does not mean that you have no further rights under the WorkCover scheme.

For example, you could be considering pursuing a common law claim when your entitlement to medical treatment is stopped by the insurer.

Even though that decision has been made, you are still able to pursue a common law claim even if the claim has not yet been lodged.

Is it that the WorkCover insurer has stopped your entitlement to weekly payments?

This is a similar situation to the above section regarding medical and like expenses.

There are certain defined points where weekly payments are usually stopped, for example for most workers they will not receive more than 130 weeks of payments.

As above, you are always entitled to challenge a decision to stop weekly payments and if the insurer does make this decision, it does not affect your ability to apply for an impairment benefit or common law claim.

It doesn’t stop your entitlement to medical expenses either (though it can make them more difficult to claim 12 months after your payments stopped).

Is it that you have been paid an impairment benefit lump sum or common law claim lump sum?

If you have been paid a lump sum on an impairment benefit claim, there will be no change to your entitlement to medical and like expenses or to weekly payments.

Often people assume that once they have received a lump sum payment from WorkCover that their claim is finished, but that is not the case.

If you are considering bringing a common law claim, it is important to note that if your claim is for both pain and suffering and economic loss (loss of earnings) then when the claim settles, any entitlement to weekly payments on that particular claim will cease and you would have no ability to have payments reinstated.

Is it that your employment has been terminated or the employer’s business has gone broke?

If your employment is terminated, it will have no effect on your entitlements or ability to apply for a lump sum, except in the very particular circumstance of if you are in receipt of “top up” payment from WorkCover after you have received 130 weeks of weekly payments, and have managed to stay in at least 15 hours of work per week, at the limit of your work capacity.

An employer going out of business does not affect your entitlement to medical and like expenses, weekly payments or an impairment benefit.

The insurer and the Victorian WorkCover Authority will continue to pay your benefits and there should be no substantial change to anything that is paid to you.

It may be that you have more contact with the insurer than you did previously as you would obviously not be able to speak to the employer directly once their business has ceased.

An employer going out of business can affect to some degree the way a common law claim for damages is brought.

This is something that your lawyer will need to address before or during your case.

There are various procedures in place that your lawyer must follow to ensure that there is an appropriate party for you to sue.

Sometimes it is possible to have the Victorian WorkCover Authority stand in place of the employer, and in other circumstances it is necessary to reinstate the company.

Even when a common more claim is settled your entitlement to medical and like expenses is unaffected.

This means that your WorkCover claim can in effect never really “end”.

The only time you would be completely out of the WorkCover system is if you resolved a common law claim for both pain and suffering and economic loss, as well as having your entitlement to all medical and like expenses terminated, and you then challenge that decision and be unsuccessful, or agree to a limited period of medical unlock expenses being payable to resolve the entire claim.

Please keep in mind that the information contained on this page should not be considered legal advice and no content on this site should replace the need to obtain advice tailored to the specific facts of your case. The facts of a case can significantly alter the advice that can provided. This site only provides general advice. Read more here.

Sidebar graphic of WorkCover benefits guide

To contact Michael or Peter call 1800 746 442 or email [email protected]

Written by the Work Injury Site team