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Section 59A of the workers compensation Act 1997 limit on payment of medical expenses
Section 59A is an important section of the Workers' Compensation Act as it deals with an injured workers' ongoing entitlement to medical expenses.
Importantly, medical expenses can cease to be payable under Section 59A but then can recommence at a later time if a worker is again paid weekly payments of compensation.
For example, if a worker is assessed as having a whole person impairment of say 10%, the worker is entitled to payment of medical expenses for a period of two years from the date of injury or two years from when they last received weekly payments of compensation.
That period may end, and the worker is therefore no longer entitled to medical expenses.
It should be kept in mind that weekly payments are only payable for a maximum of five years if your whole person impairment is 20% or less.
Medical expenses are payable to an injured worker for the following periods:
- If an injury has resulted in the degree of permanent impairment assessed to be 10% or less, then medical expenses are payable for a maximum of two years commencing on:
- The date on which the injury occurred; or
- The last date on which weekly payments of compensation are made to the injured worker, whichever is the latter.
- If an injury has resulted in a degree of permanent impairment assessed to be more than 10% but not more than 20%, then medical expenses are payable for a maximum of five years commencing on:
- The date on which the injury occurred; or
- The last date on which weekly payments of compensation are made to the injured worker, whichever is the latter.
- If an injury has resulted in a degree of permanent impairment assessed at more than 20% then medical expenses are payable for life.
However, if the worker then needs to undergo some surgery in relation to injury and that surgery requires the worker to go off work, the worker again becomes entitled to be paid weekly payments of compensation. If the worker receives weekly payments of compensation, then the injured worker is entitled to payment of medical expenses for a further period of two years.The entitlement to medical expenses is therefore revived and medical expenses are again payable.
Therefore, it is important to remember that should an injured worker after the period under Section 59A expires be entitled to payment of weekly compensation because they are either totally or partially unfit for work (even for one day), then an injured worker is again entitled to payment of medical expenses for either two or five years depending on the extent of the assessment of whole person impairment.
If your medical expenses have ceased under Section 59A, all you need to do is make a claim for weekly payments of compensation because you are unfit for work and medical expenses again become payable.
This section creates great uncertainty as to whether a worker is entitled to ongoing medical expenses and there is often a fight with the insurer about whether such expenses are payable and/or when a worker’s entitlement to medical expenses is ceased. It is a provision that needs urgent reform and more clarity.
To find out more about Section 59A under the Worker’s Compensation Act, the Garling & Co team can help you. Contact us via the following:
- Ph: (02) 8518 1120
- Email: info@garlingandco.com.au
- Or complete our FREE Confidential Case Assessment here
