Workers Compensation Survival Kit – Part 3

In Part 3 of the Workers Compensation Survival Kit, Adelaide injury lawyer Mal Byrne writes about the decision to pursue a workers compensation claim.

In Part 1, we discussed the process of lodgement of the claim.  Part 2 dealt with the investigation of the claim.  Now, the investigations have been completed and it is time for the compensation authority to make a decision.  The claims agent is supposed to determine claims promptly once it has obtained all of the relevant factual and medical evidence.  However, some case managers are more efficient than others.  If you feel that your case manager has delayed in making the determination, you can file or preferably instruct a lawyer to file an Application for Expedited Decision with the South Australian Employment Tribunal.  Once the Tribunal receives the application, it will be assigned to a Conciliation Officer who will promptly seek an explanation from the claims agent on why the claim has not been determined.  If the claims agent does not determine the claim immediately, the Tribunal will schedule a conference for the parties to discuss the matter to see whether it can be resolved.  Often, an Application for Expedited Decision will prompt a rapid determination from the claims agent before the parties ever get to the Tribunal.

When your claim is determined, you should read the determination with extreme care.  If your claim has been accepted, you should check that you will be compensated for all the time off work that you have taken and that the rate of pay is correct.

If you have had to take time off work due to your work injury, you will receive 100% of your pre-injury weekly earnings for a period of 52 weeks.  If you are still unable to work after those weeks, the rate drops to 80%. There is no logic to this law.  It is just a means of placing workers under financial pressure to coerce them into returning to work.  All that it usually achieves is to put the worker in financial difficulty, inhibit his or her rehabilitation and sometime leads to claim for psychiatric injuries.

When you read the determination of your claim, you may not be happy with the notional weekly earnings rate.  Sometimes, the calculation of notional weekly earnings rate can be complex.  It is straightforward for a worker on a net salary.  However, it becomes more complicated for casual workers whose hours and rates of pay vary and where a worker works overtime.  For casual workers, payslips will be sought and average earnings calculated over a period of time.  Sometime, this can lead to unfair results and you should see a lawyer for advice if you think that the decision is unfair.

In addition to weekly payments, you will be entitled to have your reasonable medical expenses paid. You are also entitled to claim travel to and from your treatment providers at a per kilometre rate. You should submit your accounts for medical expenses and your schedule of travel regularly to your case manager. Make sure that you write your claim number on everything to ensure that it gets to your case manager promptly and keep copies in case the documents go missing.

If your claim is rejected out of hand, you should see a lawyer urgently.  If your claim is rejected completely or you are unhappy with any aspect of the decision such as the rate of pay or the period for which the claim is accepted, a Notice of Dispute has to be lodged with the SA Employment Tribunal within 30 days of receipt of the decision.  Hence, time is of the essence and if you are unhappy with the decision, you should see a lawyer immediately.

Part 4 will deal with the rehabilitation of injured workers and the obligations of both the worker and EML/ Gallagher Bassett with respect to performing and providing work duties.

For a free initial interview about your workers compensation claim, contact us. TGB assists workers in South Australia, Western Australia and Northern Territory.