Comcare Compensation Claims: Steps for Injured Workers

TGB’s Victoria Bell lists important steps for injured Commonwealth workers seeking compensation.

 What should I do if I sustain an injury at work under the Safety, Rehabilitation and Compensation Act (SRCA)?  

– Immediately report to your direct manager (preferably in writing as well as verbally).

– Fill out any relevant incident report forms.

– Attend you normal treating general practitioner to report your injury.

– Obtain a workers compensation medical certificate should you be required to take time off work.

– Ensure your incident report form notes the exact description of the injury as provided by your doctor.

– Fill out the relevant claim forms and immediately lodge them with your employer. It is important to do this as soon as possible, as a delay may jeopardise their claim.  

If my claim is accepted what are my entitlements? 

– Firstly, the compensating authority (your employer or Comcare) must accept liability for the injury, that is, agree that the injury has been caused or contributed to by workplace duties. This depends on the type of condition – “injury” or “disease” – which we discuss in this blog.

– If liability is accepted, medical and rehabilitation expenses such as doctors’ appointments, surgeries, physiotherapy, chiropractic care etc. are potentially covered under section 16 of the Act. There must be medical evidence to support that the treatment needed relates to the claim. This is why it is important to talk to as general practitioner as soon as possible.

– You will receive payments for lost income. For the first 45 weeks you receive 100% of your usual income minus earnings in employment, and after that 75% of your income if totally incapacitated. If you have a partial incapacity and are performing modified duties then the compensating authority will top up to amounts between 75% and 100% depending on how many hours you are able to work.

– Payments for lost income should continue as long as the medical evidence supports that your ongoing incapacity relates to your workplace injury. 

Rehabilitation assistance 

– If you are left with a permanent impairment as a result of any physical or psychological injury, you may be entitled to a once off lump sum payment which does not impact on your income payments or medical expenses (your condition must have stabilised before this can be assessed).

– A relevant accredited specialist must assess your level of Whole Person Impairment (WPI) in accordance with the Comcare Guide to the Evaluation of Permanent Impairment (Edition 2.1).

– If you have a 10% WPI for each injury or more you will be entitled to compensation both for the actual impairment and in addition an amount for non-economic loss, also referred to as “pain and suffering”. You do not receive compensation for pain and suffering unless you reach the 10% threshold.

– It is important to seek legal advice when considering a claim for permanent impairment and non-economic loss.  

What if a decision is made that I am not happy with?

– When a decision is received in writing, if you are unhappy with the outcome you must seek a reconsideration of the decision. You and/or your lawyer can write directly to the decision maker and ask them to reconsider along with your submissions and any relevant information. Usually, this must be done within 30 days of the decision.

– If the reconsideration is received and the compensating authority does not agree with it then an application for review must be filed at the Administrative Appeals Tribunal (AAT), usually within 60 days.

– The time limits need to be strictly adhered to or the claim may be jeopardised.

– When an application is lodged at the Tribunal the compensating authority will have to provide all documents on the claim relevant to the dispute.

– The AAT will then list the matter for a preliminary conference (either in person or over the phone) at which all the issues are identified and the parties outline what, if any, further information is needed.

– Once all information is obtained a more formal conciliation conference will be listed in order to facilitate settlement discussions.

– If it doesn’t resolve at conciliation then the matter is referred to a hearing in front of a member of the AAT.

– Legal costs are not paid unless the applicant is successful with their claim.

– It is crucial to obtain legal advice to discuss merits of an application to the AAT for review of a decision and to have the assistance of a lawyer experienced with Commonwealth claims through the dispute process. 

 This is a simple overview of the compensation process for Commonwealth employees injured at work and it is important to seek advice specific to your personal circumstances.

To arrange a free initial interview about your claim, contact Victoria at your local TGB office or register online here.