WorkCover payments after 130 weeks
Anyone that’s injured in Victoria is entitled to pursue a WorkCover claim for compensation.
As part of that WorkCover claim, one entitlement is weekly payments of compensation if the person cannot work or is restricted in their ability to work.
Weekly payments are paid for the first 13 weeks at 95% of your pre-injury average weekly earnings (your PIAWE).
Your pre-injury average weekly earnings is an average of what you earned in the 12 months prior to suffering the injury.
After 13 weeks, you’re paid at 80% of that rate.
The 130 weeks mark is an important mark in the life of a WorkCover claim if you’re on weekly payments.
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What happens after 130 weeks on WorkCover?
It is common for weekly payments to be terminated by the insurance company at the 130 week mark if a person is considered to have a capacity for some employment.
It is possible to obtain payments in addition to 130 weeks however. In order to do so, you need to show that you do not have a work capacity and that this is likely to continue indefinitely.
This is a very difficult test for many people to meet because you not only have to show that you cannot do your old job, but that you can’t do any job.
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 organise a vocational assessment.
This involves you being assessed by a vocational assessor to someone that is specialised in determining what your capacity for work currently is and is likely to be into the future.
The assessor will determine whether you can do some jobs out there and if so will identify these jobs in a report.
Generally the report will list 3 to 5 jobs that they believe you may be able to do.
If they can identify suitable employment for you and if they believe you have a work capacity, then the insurer will terminate your entitlement to weekly payments.
What do I do if I disagree with the decision to terminate?
If you disagree with the decision, the first thing you need to do is make sure that there is some medical support in relation to your incapacity for work.
The process to contest the insurers decision to terminate your entitlement to weekly payments at 130 weeks as follows:
The first thing that you must do is lodge a request for conciliation.
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 accident compensation conciliation service.
If the insurer withdraws their decision at the conciliation, then that means you will be entitled to weekly payments on going and you’ll be back paid any payments that you missed out on.
However keep in mind that the test to get payments in additional 130 weeks is a difficult test to meet under the law and for this reason not a lot of cases that go to conciliation in relation to this issue resolve in the workers favour.
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, 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.
WorkCover 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 additional 130 weeks if you have some work capacity.
If you have returned to work and you are working 15 hours or more, earning more than $211 per week, then it is possible that you will be entitled to claim top up payments from the WorkCover insurer.
You, as mentioned above must be working at least 15 hours per week and you must have medical support, usually from one of your treating doctors, supporting that you are currently working at your full capacity.
The capacity that you’re currently working at must be your ongoing maximum capacity for work.
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 claim form.
Please note that if the insurer knocks you back, you can appeal the decision to the conciliation if you feel there is merit to do so.