NSW Health Workers Compensation & Nurse Injury Lawyers

Yes, but only if the insurer decides that;

1. You were not wholly or mostly at fault and;
2. You have more a “non-threshold injury.”

The insurer is required to make this decision in writing and send it to you within 12 months of the accident, this usually happens around 9 months after the accident.

If the insurer accepts both matters, then payments can be extended as follows;

1. Income Support for up to three years (as long as you make a claim for common law damages) and;
2. Medical expenses and care for life.

You should also see a lawyer and make a common law claim for damages, this is a claim for lump sum compensation for pain and suffering and future loss of income and loss of superannuation.

This common law claim must be made within 3 years from the date of the accident.

Yes.

Weekly payments may be suspended, reduced, or stopped by the insurer as a result of the following:

i.    Failure to provide documents

If you fail to provide a Medical Certificate of Capacity, then the insurer will stop making weekly payments of compensation.

ii.    Comply with the return to work obligations

If you fail to comply with reasonable request to return to suitable employment, weekly payments may be suspended

iii.    The insurer issues a work capacity decision

The insurer can stop or reduce weekly payments if they disagree with your certificate of capacity and believe you have a greater capacity for work.

iv.    The insurer declines liability for the claim

The insurer can stop payments if they believe your injury is no longer work-related.

v.    After 130 weeks of weekly payments

A worker has no entitlement to weekly payments of compensation after 130 weeks unless:

(a)    The insurer has assessed that the worker has no capacity for employment; or

(b)    The worker has the capacity for work and has applied to the insurer for a continuation of weekly payments; and

(c)    The worker is working 15 hours or more per week; and

(d)    The worker is earning at least $173.00 per week; and

(e)    The worker has been assessed by the insurer as incapable of undertaking further employment to increase their earnings.

If you can work and are not working at least 15 hours per week (and earning at least $173.00 per week), weekly payments will be stopped.

vi.    After 260 weeks (5 years) of weekly payments:

Weekly payments will stop for all workers after 5 years unless you have greater than 20% whole person impairment.

If your impairment is greater than 20%, then payments will continue if:

• You are unable to work; or
• You have some capacity for work and are working at least 15 hours or earning more per week and earning at least $173.00 per week

vii.    Your entitlement ceases under the Workers Compensation Act due to your age.

Weekly payments of compensation will also cease on the anniversary of your statutory retirement age, usually age 68.

In each of these circumstances, the insurer must notify you in writing, giving the reasons why your payments have been stopped, reduced or suspended.  They must provide you with all reports or other documents they rely upon in stopping, reducing, or suspending the payments of weekly compensation.

If this happens to you, please contact us immediately.

You continue to receive weekly payments and medical expenses, paid directly to you by the workers compensation insurer instead of through your employer.

Your ongoing entitlements to workers compensation may vary and depends on many factors but can include the following:-

Weekly payments of compensation to cover loss of earnings
Payment of medical expenses
Lump sum compensation for permanent impairment. This is known as a claim for whole person impairment.
A claim for Work Injury Damages, this is a claim for damages when you sue your employer for negligence.

If you did not make a claim for workers compensation prior to being made redundant or your employment being terminated, you are still able to make a workers compensation claim.  You should make the claim as soon as possible.

You need to obtain a workers compensation Certificate of Capacity from your general practitioner and forward this to your former employer.  Your employer is required to send the claim form to the workers compensation insurer who will make a preliminary determination of your claim.

Workers compensation claims should be made within six months of the date of the injury, but can be lodged up to three years later, depending on the circumstances of the injury.

The simple answer is no. The NSW Government has adopted a legal aid type scheme known as ILARS. This service pays for all legal costs associated with making a worker’s compensation claim. Your lawyer will make an application to ILARS for funding to pay for your legal costs.

There are many different types of disputes which can arise in a motor accident claim.

Generally, if you do not agree with the insurer’s decision, you will need to request an internal review within 28 days of receiving the decision. The insurer will provide you a form to complete. Lawyers are not paid to assist with internal reviews.

After the internal review, the insurer makes a further decision. If you still disagree, you need to make an Application to the Personal Injury Commission for an independent decision, usually this needs to be made  within 28 days.

You can use the assistance of a lawyer to make an application to PIC in certain circumstances.

Disputes can arise concerning: –

• Whether the death or injury has resulted from a motor accident in the state of NSW
• Whether the motor accident concerned was caused by the fault of another person
• Whether the motor accident was caused by the injured person (contributory negligence)
• Whether the claimant has suffered threshold injuries and is not entitled to statutory benefits after 52 weeks of the date of the accident
• Whether a serious driving offence was committed (no statutory benefits)
• Whether the claimant has given full and satisfactory response for non-compliance with a duty or a delay (E.g., not making a claim within the statutory time frame or not reporting the accident to the police within the statutory time frame.
• Whether the motor accident verification requirements have been complied with.

There are many other types of disputes which can arise, and you should contact a lawyer for assistance.

Negligence claims are finalised by one of two ways:

• Agreement with the negligent party (or its insurer) or;
• An order of a NSW court.

It is normal to give notice of a claim for negligence to the party you consider has been negligent and to negotiate with them (or usually the insurer) a resolution of the claim prior to the commencement of court proceedings. Often claims can be resolved by agreement with an insurance company prior to commencing any court proceedings.

If, however you are unable to resolve a claim by way of agreement then you must file a claim in a NSW court which has jurisdiction to deal with your matter.

Filing a Statement of Claim in the Court commences a formal claim and will after about 10 months (if you have still not been able to reach an agreement) determined by a Judge. The Judge will hear all the evidence and determine if the defendant was negligent, and if so, how much compensation you are entitled to receive.

If you have any aspect of your claim for workers compensation declined by an S.78 Notice, your lawyer will make an application to the Personal Injury Commission (PIC) to appoint an independent Member to hear and determine the issues in dispute.

The process is as follows;

1. Your lawyer files an Application for Dispute resolution with the PIC, which includes all evidence used in making the decision.
2. The Insurer or its lawyer must file a reply with their evidence within 28 days.
3. The matter is reviewed by the PIC, and a telephone conference is usually appointed 28 days later.
4. The PIC notifies you of the date and time of the telephone conference.
5. You should attend the telephone conference in person  via the telephone.
6. At the telephone conference, the Member will discuss the matter and the issues in dispute. The Member will attempt to resolve the matter by agreement. If not, the Member will make orders for further preparation of the claim and list the matter for a face to face Conciliation/Arbitration Conference. Your lawyer will do the majority of the talking at the telephone conference.
7. Your lawyer will then confirm in writing the date and time of the Conciliation/Arbitration Conference, which is usually 28 days following the telephone conference.
8. If further preparation is necessary, your lawyer will contact you for details.
9. The Conciliation/Arbitration Conference has two phases;

• The Conciliation phase – the Member, will discuss the issues and see if the parties can reach agreement if no agreement can be reached the matter proceeds to;
• The Arbitration phase – the lawyers are asked to make submissions outlining what the outcome of the claim should be, and occasionally questions are requested by the Member about the claim. The Member then makes a written decision within 21 days.

10. The members decision is final and binding on both you and the insurer unless the Member has made an error of law.
11. The outcome is confirmed by the PIC 28 days later.
12. The insurer will then pay the compensation awarded to you.
13. Usually, 10% of that lump sum is deducted and sent to Medicare as a deposit until it is determined if Medicare is owed any money.

If you have made a common law claim, your lawyer will obtain all necessary evidence to prove your entitlement to claim;

1. Non-economic loss, that is, pain and suffering and;
2. Loss of income and superannuation, both past and future.

Your lawyer will attempt to reach an agreement with the insurer, usually at a settlement conference, as to the amount of compensation payable as a lump sum. If an agreement can be reached, the claim resolves,  payment is usually made in about 6 weeks.

If an agreement cannot be reached, your lawyer will make an Application to PIC to appoint an independent Member who will act like a Judge to hear and determine how much compensation you are entitled to receive.