You may have been told you can make a workers’ compensation claim, but understanding what that means in practice, and what benefits you can access, isn’t always straightforward. 

In South Australia, workers’ compensation is governed by the Return to Work Act 2014 (SA) (RTW Act). The Act sets out a range of statutory entitlements designed to support injured workers financially while they recover. However, access to those entitlements often depends on meeting specific legal thresholds and time limits, as well as understanding how different benefits interact with one another. 

Below is an overview of the key entitlements available to injured workers under the RTW Act and when they may apply. 

Making a workers compensation claim 

 To access any entitlements, a worker must: 

• report their injury, and 
• lodge a claim form with their employer or the employer’s workers’ compensation insurer. 

This must generally occur within six months of the date of injury. 

The worker must also establish that: 

• they suffered an injury, 
• the injury arose out of or in the course of employment, and 
• employment was a significant contributing cause of the injury. 

If the insurer accepts the claim, the worker may be entitled to the benefits outlined below. 

Weekly payments of income maintenance 

Accepted workers may receive weekly payments of income maintenance for up to two years while they are incapacitated for work. 

In practice: 

• First year: up to 100% of the worker’s Average Weekly Earnings (AWE) (subject to statutory caps) 
• Second year: up to 80% of AWE. 

When calculating a worker’s AWE under South Australia’s Return to Work scheme, insurers will look at the 12 months of pay leading up to the injury. They review payslips and calculate an average weekly amount, which then forms the basis for weekly compensation payment.  

Why checking your AWE matters 

It is important to make sure your Average Weekly Earnings (AWE) have been calculated correctly. Mistakes do happen. Insurers may leave out regular overtime, penalty rates, second jobs, allowances or other benefits. Even small errors can reduce your weekly payments. 

You have the right to ask for a review of the insurer’s decision about your AWE. If you think your earnings have been assessed incorrectly, getting legal advice can help you secure the payments you are entitled to. 

To remain eligible, the worker must demonstrate an incapacity for work, usually through Work Capacity Certificates completed by their treating doctor. If a worker cannot establish ongoing incapacity, the insurer may lawfully reduce or stop weekly payments before the two-year period ends. 

Example: How weekly payments are calculated 

Sarah works full-time at Coles and earns $1,500 gross per week. She earned the same amount consistently in the 12 months before her injury. 

After suffering a back injury at work, Sarah is certified totally unfit for work. Her Average Weekly Earnings (AWE) would therefore be $1,500 per week. 

For the first 52 weeks, she would generally receive income support at 100% of her AWE – $1,500 per week. After that, her payments reduce to 80% of her AWE, which is $1,200 per week. These payments can continue for up to two years from the date of injury, provided she meets the eligibility requirements under the Return to Work Act. 

Medical Expenses 

An injured worker is entitled to have reasonably necessary medical expenses paid by the insurer, provided those expenses relate to the accepted work injury. 

Medical expense entitlements generally continue: 

• while the worker is receiving weekly payments, and 
• for a further 12 months after weekly payments cease. 

Lump Sum Compensation for Permanent Impairment 

Once an injury has stabilised, a worker may seek an assessment of permanent impairment. This is a critical stage of a claim and one where legal advice is often essential. 

Key points to be aware of: 

• a worker is entitled to only one permanent impairment assessment 
• the assessor must be chosen from Return to Work SA’s accredited list 
• the assessment determines the worker’s whole person impairment (WPI). 

If a worker is assessed as having at least 5% WPI, and other statutory requirements are met, they may be entitled to lump sum compensation in two forms: 

1. Non-economic loss (section 56)
   The assessed impairment percentage corresponds to a lump sum amount set out in the Return to Work SA Schedule of Sums. 
2. Economic loss (section 58)
   This amount is calculated using a statutory formula based on the worker’s age, level of impairment, and average weekly hours. 

Seriously Injured Workers 

Workers assessed as having: 

• 35% or more WPI, or 
• 30% or more WPI for psychiatric injuries 

are classified as seriously injured workers. 

This classification carries significantly expanded entitlements, including: 

• weekly payments until retirement age 
• medical expenses for life 
• access to lump sum compensation. 

There are several common mistakes workers make when undergoing a permanent impairment assessment. Because this can be quite complex and it is so critical to get it right, we have drafted a separate blog that covers this in a lot more detail – you can read that blog here. 

Why Legal Advice Matters 

A work injury often brings sudden financial pressure, uncertainty and stress. The Return to Work scheme is highly technical, and decisions made early, especially around work capacity, impairment assessments, and lump sums, can have long term consequences. 

At Tindall Gask Bentley, our experienced workers’ compensation lawyers help injured workers understand their rights, challenge insurer decisions where necessary, and ensure they receive their full statutory entitlements under the RTW Act. 

To arrange a free initial chat about your situation, complete this brief online form and one of our team will be in touch soon.