Workers Compensation Claims in NSW

You must notify your employer within 30 days of the injury, ideally in writing (email or letter). Be specific with details. If your injury is serious, consider reporting it to SafeWork NSW,() who may investigate. Seek medical attention immediately, either via emergency services (000) or a GP, and follow treatment advice closely. Lexmens will be by your side to support you, every step on the way.

Your GP will need to complete a Certificate of Capacity (PDF).(https://www.sira.nsw.gov.au/__data/assets/pdf_file/0004/325579/SIRA08719-Certificate-of-capacity-certificate-of-fitness-for-work.pdf) You must also complete a Workers Compensation Claim Form (PDF).(https://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/forms/workers-and-claims/SIRA08684-Workers-injury-claim-form.pdf) Ensure both documents are accurate and consistent with your initial report before submitting. Lexmens will be by your side to support you, every step on the way.

You must provide both the Certificate of Capacity and the Claim Form to your employer and the insurer within 6 months of your injury. Sometimes, employers delay forwarding claims, so we recommend also sending them directly to the insurer. Lexmens will be by your side to support you, every step on the way.

Use the official icare Employer Lookup Tool (https://www.icare.nsw.gov.au/employer-lookup)to confirm the insurer handling your workplace’s compensation coverage. Lexmens will be by your side to support you, every step on the way.

If the insurer has disputed an entitlement, such as your claim for a surgery or other treatment expense, and they maintain that dispute despite further medical evidence supporting your claim, then you will likely need to speak to one of our senior solicitors about preparing to fight your dispute in the Personal Injury Commission. At Lexmens, we pride ourselves on resolving matters without the stress and uncertainty of having your matter heard and determined at an Arbitration hearing in the Personal Injury Commission. Most Workers Compensation disputes are resolved via negotiation with the insurer in the conciliation process prior to any hearing, and that’s where our expertise shines. If negotiation fails, then we confidently and competently prepare your claim for hearing.

Each claim is different, but we’ll keep you updated every step of the way. For most Workers Compensation claims in NSW, weekly payments typically begin within 7 days of the insurer accepting liability, as long as you’ve submitted the correct paperwork, including your Certificate of Capacity and claim form. The insurer may issue a ‘reasonable excuse’ notice within the 7 days, in which they decide to withhold approval of liability and payment of weekly compensation due to ongoing investigations, but provisionally agree to pay for your medical expenses up to $10,000. The insurer has 21 days from the date of any treatment claim to determine liability and approve that claim. If you're claiming lump sum compensation for permanent impairment Your injuries need to stabilise before your solicitor can organise a doctor to assess your permanent impairment. This varies on a case-by-case basis, but for physical injuries the rule of thumb is that your injuries stabilise either 6 months from the date of injury or following invasive treatment such as surgery, subject to the medical opinion along the way. Once your permanent impairment is assessed and your claim is made with the insurer, they have 2 months from the date of their own organised medical examination to determine your claim for lump sum compensation. Time limits vary base don the nature of the claim and the insurers responses to the claim, these factors often can not be controlled. What can be controlled, is your solicitors acting and responding to disputes in a prompt and diligent manner to ensure that the claim and dispute process are managed in a timely manner.

Lump sum compensation is assessed based on your degree of permanent impairment, which must be formally evaluated by an Approved Medical Specialist under the NSW Workers Compensation Guidelines. This assessment considers both physical and psychological injuries, and must meet minimum impairment thresholds (e.g. 11% for physical injuries, 15% for psychological). You can read more about impairment assessments here:(https://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/publications/health-professionals/sira-guidelines-for-the-evaluation-of-permanent-impairment) Lexmens will be by your side, evert step in your compensation journey.

This depends on various factors, importantly the extent of your Whole Person Impairment. If you are injuries are assessed with a WPI which falls under 11%: • You are entitled to weekly benefits for any medically certified partial or whole incapacity resulting from your accepted workplace injuries for a period of 130 weeks (approx. 2.5 years). You may be entitled to ongoing weekly benefits from 130 weeks to a maximum of 260 weeks (approx. years) provided you meet the required provided for by s38 of the Act. • As far as your entitlement to medical expenses is concerned, under s59A (2) (b) of the Act, you continue to be entitled to reasonably necessary medical expenses for a period of 2 years commencing on: 1. the day on which the claim for compensation in respect of the injury was first made (if weekly payments of compensation are not or have not been paid or payable to you), or 2. the day on which weekly payments of compensation cease to be payable to you (if weekly payments of compensation are or have been paid or payable to you. If you are injuries are assessed with a WPI which falls between 11% and 20%: • You are entitled to weekly benefits for any medically certified partial or whole incapacity resulting from your accepted workplace injuries for a period of 130 weeks (approx. 2.5 years). You may be entitled to ongoing weekly benefits from 130 weeks to a maximum of 260 weeks (approx. years) provided you meet the required provided for by s38 of the Act. • As far as your entitlement to medical expenses is concerned, under s59A (2) (b) of the Act, you continue to be entitled to reasonably necessary medical expenses for a period of 5 years commencing on: 1. the day on which the claim for compensation in respect of the injury was first made (if weekly payments of compensation are not or have not been paid or payable to you), or 2. the day on which weekly payments of compensation cease to be payable to you (if weekly payments of compensation are or have been paid or payable to you. If your injuries are assessed with a WPI which falls between 21% and 30%: • you are considered a ‘worker with high needs and your entitlement to statutory benefits is widened. This means you are entitled to weekly benefits for any medically certified partial or whole incapacity resulting from your accepted workplace injuries up to the 1-year anniversary of your retirement age. • As far as your entitlement to medical expenses is concerned, under s59A (2) (b) of the Act, you continue to be entitled to reasonably necessary medical expenses for life. If your injuries are assessed with a WPI which falls in excess of 30%: • you are considered a ‘worker with highest needs and your entitlement to statutory benefits is widened. This means You are entitled to weekly benefits for any medically certified partial or whole incapacity resulting from your accepted workplace injuries up to the 1-year anniversary of your retirement age. • As far as your entitlement to medical expenses is concerned, under s59A (2) (b) of the Act, you continue to be entitled to reasonably necessary medical expenses for life. • The insurer can not conduct a work capacity assessment without your consent. • You are entitled to the special statutory rate for weekly compensation as a minimum weekly compensation.

Yes. In NSW, workers compensation covers both sudden injuries and death and those that develop gradually, such as repetitive strain injuries, stress-related conditions, dust related respiratory conditions, cancers, industrial deafness and other latent conditions. These are often referred to as disease injuries or injuries sustained due to the nature and conditions of your employment. If your work has contributed to your condition, you may be eligible for compensation.

In NSW, unless you are an exempt work (police and ambulance officers etc) under the Act, which you are not, you are only entitled to one lump sum claim with respect to permanent impairment. Section 66(1A) of the Workers Compensation Act reads: 66 Entitlement to compensation for permanent impairment (1A) Only one claim can be made under this Act for permanent impairment compensation in respect of the permanent impairment that results from an injury. This means you can only make one lump sum compensation claim. You will not be entitled to bring a further lump sum compensation claim if your injuries get worse or deteriorate, so it is important you are content with the assessment report enclosed. Given that you can only make one lump sum claim it is extremely important that you ensure all your injuries from the accident were taken into account. If you settled a lump sum claim prior to 2012, you may be entitled to one further lump sum claim titled ‘ At Lexmens, we’re by your side for the long haul, even after your first lump-sum has been settled. If you were previously represented by another firm or went through the process alone, we can still step in and handle your further claim with care, diligence, and strategy.