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WORKERS COMPENSATION ENTITLEMENTS EXPLAINED – Weekly Benefits

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WORKERS COMPENSATION ENTITLEMENTS EXPLAINED – Weekly Benefits

A worker who suffers an injury arising out of or in the course of employment may be entitled to weekly benefits when that injury results in a reduced capacity for work. Hence, it is important to report an injury or illness to your employer and the insurer at the earliest opportunity. It is also important that you attend your GP to discuss your condition and any treatment needs, and obtain a Certificate of Capacity if necessary.

After the insurer has been notified of the injury, they will contact you to discuss the notification and support available.

 

How are weekly benefits calculated?
Weekly benefits are calculated based on pre-injury average weekly earnings (PIAWE). For injuries that occurred on or after 21 October 2019, PIAWE is the weekly average of a worker’s gross earnings over the 52 weeks prior to their date of injury. If the PIAWE exceeds the maximum prescribed weekly benefit amount under the Workers Compensation Act, then a rate of $2,282.90 will apply.

Below is a brief explanation of weekly benefits during the various entitlement periods.

 

(a) Weekly Benefits During First Entitlement Period – 0 to 13 Weeks
The first entitlement period comprises of the first thirteen (13) weeks, whether consecutive or not, where a weekly benefit is payable to the worker. A worker who has no current capacity to work, as stipulated on the Certificate of Capacity completed by a doctor, is entitled to weekly benefits at 95% of PIAWE. If a worker who has some current work capacity, they are entitled to weekly benefits at 95% PIAWE, less the value of the worker’s earning capacity. The capacity to earn is determined by what a worker can earn on the open labour market, considering the worker’s skills, regardless of whether he or she has a job.

 

(b) Weekly Benefits During Second Entitlement Period – 14 to 130 Weeks
The second entitlement period comprises of weeks 14 to 130, whether consecutive or not, where a weekly benefit is payable to the worker. A worker who is certified to have no current capacity to work is entitled to weekly benefits at 80% of PIAWE. A worker who has some current work capacity and who has returned to work for at least 15 hours per week is entitled to weekly benefits at 95% of PIAWE, less the value of the worker’s earning capacity. A worker who has some current work capacity and who has not returned to work for at least 15 hours per week (or who has not returned to work) is entitled to weekly benefits at 80% of PIAWE, less the value of the worker’s earning capacity.

 

(c) Weekly Benefits after the Second Entitlement Period – 131 to 260 weeks
Where a worker has not had a whole person impairment assessment or that assessment is 20% or less, weekly benefits are payable after the second entitlement period only if the worker is assessed by the insurer to have:
a) no work capacity and has been assessed by the insurer as likely to continue with no work capacity indefinitely; or
b) some current work capacity, and:
i. the worker has applied for ongoing weekly benefits, and
ii. the worker has returned to work for at least 15 hours per week, and
iii. the worker is earning at least $155.00 per week (a prescribed amount as indexed), and
iv. the worker has been assessed by the insurer as being unlikely to be able to undertake further additional employment to earn a larger amount indefinitely. If a worker is accepted as having a whole person impairment of more than 20% and has no work capacity, weekly benefits will continue at 80% of PIAWE. If a worker is accepted as having a whole person impairment of more than 20% and some current work capacity, weekly benefits will continue at 80% of PIAWE less the value of the worker’s earning capacity.

 

(d) Weekly Benefits after 260 weeks
No weekly benefits are payable to a worker after 260 weeks (whether consecutive weeks or not) unless the worker has sustained permanent impairment of at least 21%. If the worker is entitled to weekly benefits, payment is made at the same rate as set out above, i.e. after the Second Entitlement Period.

 

(e) Weekly benefits Highest Needs Workers
If a worker is accepted to have a whole person impairment greater than 30%, they are considered a worker with highest needs. A worker with highest needs is entitled to the greater of a weekly benefit of $840.00 (as indexed) or 80% of PIAWE.

 

Retirement Age
If you’re receiving weekly benefits and reach retirement age, pending the above, you may be entitled to receive weekly benefits for a further period of 12 months. Retirement age is defined in the legislation as the age at which the person would, subject to otherwise qualifying, be eligible to receive an aged pension.

 

 

Frequently Asked Questions about Weekly Benefits:

Do I receive superannuation payments whilst on workers compensation?
Superannuation is usually not payable while an employee is on workers compensation however there are exceptions. Some Modern Awards and registered agreements require employers to make superannuation contributions whilst employees are away from work and in receipt of workers compensation insurance. It is important to check the award or agreement if such provisions apply.

Are weekly benefits taxable?
Yes. Weekly benefits are considered assessable and taxable income, regardless of whether you are paid periodically or in a lump sum. Workers compensation payments are a substitute for taxable income and so take on the same character.

Do I need to continue getting a Certificate of Capacity if I am a worker with high needs or highest needs?
Yes. An injured worker is required to continue to provide the insurer with a valid Certificate of Capacity until they are no longer entitled to payments.

What happens if I am injured at work on or after retiring age?
If you receive an injury on or after retiring age, you may be entitled to weekly benefits during the 12-month period that starts from the date of your first incapacity.

I do not agree with my PIAWE, is there anything that can be done?
If you do not agree with your PIAWE, you can contact the insurer and complete a PIAWE Review Form.

If you need help understanding your workers compensation entitlements or you need advice about your matter, please call Brazel Moore Compensation Lawyers on (02) 4324 7699.