WorkCover payments after 130 weeks

Workcover payments after 130 weeks

There are two different WorkCover payments that a person can be receipt of post 130 weeks.

The first is a continuation of your weekly payments at the 80% rate.

The second is top up payments if a person has returned to work, but not to the extent they were working pre injury.

This page will explore the relevant tests that must be met in order for a person to obtain weekly payments post 130 weeks.

Note: the tests to obtain weekly payments post 130 weeks were adjusted recently for injured workers who reach the 130 week mark on or after 31 March 2024. This page includes the updated tests, in addition to the ‘old’ tests.

Continuation of weekly payments at the 80% rate

What happens prior to the 130 week mark?

In the weeks leading up to the 130 week mark, if you are in receipt of weekly payments you’ll find that the insurance company will likely organise an assessment of your capacity for employment.

This involves you being assessed by a vocational assessor or similar – someone who can provide an opinion as to what your capacity for work currently is and is likely to be into the future.

The assessor will likely determine whether you can do certain jobs.

If the insurer can identify suitable employment options for you and if they believe you have a work capacity, then the insurer will likely terminate your entitlement to weekly payments.

2024 addition to the above test

If the 130 week mark occurs prior to April 2024, then the relevant test to stay in receipt of weekly payments focuses on your work capacity only.

That is, if you have no work capacity and that is likely to continue indefinitely, you have an entitlement to stay in receipt of weekly payments post 130 weeks.

However, if the 130 week mark occurs on or after 31 March 2024 then not only do you need to satisfy the above test, you also need to been assessed as having a 21% or more whole person impairment rating,

So even if you do not have a work capacity and that is likely to continue indefinitely, if you haven’t been assessed as having a 21% or greater whole person impairment rating, the insurer can terminate your weekly payments.

Similarly, if you have been assessed as having a 21% or greater whole person impairment rating but you do have a capacity for some employment, the insurer can terminate your entitlement to weekly payments.

What do I do if I disagree with the decision to terminate weekly payments?

If you disagree with the decision to terminate your weekly payments post 130 weeks,  then you can contest that decision.

We generally recommend doing so by pursuing the matter to conciliation. You can initiate conciliation via the lodgement of a conciliation request.

Conciliation is a process whereby you and your representative, and a representative from the insurance company will try and negotiate a resolution of the matter.

The conciliation will be chaired by a representative from the Workplace Injury Commission.

If the insurer withdraws their decision at the conciliation, then that means you will be entitled to weekly payments on going and you may have an entitlement to be back paid any weekly payments that you missed out on, post termination.

Another potential conciliation outcome is to settle your matter for a limited period of weekly payments.

For example, you may come to an agreement with the insurance company to settle your weekly payments on the basis that you be paid three months of weekly payments.

Keep in mind that if you do settle your matter for a limited period of weekly payments, then generally speaking this will resolve any entitlement that you have to weekly payments in the future.

That is, your payments will end and you’ll no longer be entitled to any weekly payments moving forward.

If your matter doesn’t resolve at conciliation then the next step in the process is to go to either the medical panel or court.

The medical panel is a medical assessment where you would be assessed by a number of doctors in the one sitting. These doctors will then provide a written opinion that comments on your work capacity and whether you are likely to have a work capacity moving forward.

If the medical panel finds in your favour then you will be entitled to weekly payments ongoing and back paid to you.

The second option is to go to the Magistrates Court to have the matter determined. If the matter runs to a hearing in the Magistrates Court, it will be heard before a Magistrate who will decide on the matter.

Many times however what happens is that the matter resolves between the parties by way of negotiation – without the need for the matter to run at court.

Another thing that can happen is that the matter can be referred to the medical panel from the Magistrates court. This is usually done by the lawyers that represent the insurance company. As mentioned above, the medical panel is then tasked with providing an opinion on your work capacity.

Top up payments after 130 weeks

The first way to get payments in additional 130 weeks is to show that you do not have a work capacity and that this is likely to continue indefinitely.

There is however a second way to obtain weekly payments in addition to 130 weeks – even if you have some work capacity.

If you have returned to work and you are working at 15 hours or more per week, earning more than $228 per week (indexed annually), then it is possible that you will be entitled to claim top up payments from the WorkCover insurer.

You must have medical support from a doctor (usually your treating GP or specialist) confirming that you are currently working to your full capacity, and that you’re not likely to be able to increase your work hours.

If you reached the 130 week mark on or after 31 March 2024, you must also in addition to satisfying the above criteria, also have a whole person impairment rating of 21% or greater.

In order to lodge a claim for payments an additional 130 weeks if you are working at least 15 hours per week, you need to complete a particular form. You can contact the WorkCover insurer and ask them for a copy of the relevant form.

Please note that if the insurer knocks you back, you can appeal the decision via conciliation if you feel there is merit in doing so.

Conclusion

There are two ways you can obtain weekly payments post 130 weeks.

The first way to remain on weekly payments is at the 80% rate, provided you satisfy the following test:

  1. That you have no work capacity and that is likely to continue indefinitely.
  2. That you are assessed as having a 21% or grater whole person impairment rating (only relevant for injured workers where the 130 week mark arises on or after 31 March 2024).

The second way to remain on weekly payments post 130 weeks is if you have returned to work and you are working at least 15 hours or more per week, earning more than $228 per week. If you satisfy this test, then it is possible that you will be entitled to claim top up payments from the WorkCover insurer.

If you reached the 130 week mark on or after 31 March 2024, you must also in addition to satisfying the above criteria, also have a whole person impairment rating of 21% or greater.

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.

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

Written by the Work Injury Site team