Workers Compensation in NSW: 10 Questions Injured Workers Often Ask

Workers compensation can be difficult to understand until you suddenly need it.

If you’ve been injured at work, you may find yourself trying to understand weekly payments, medical expenses, insurance decisions and your ability to return to work, all while dealing with the injury itself.

Robert Bryden has spent more than 40 years helping injured people navigate compensation claims. Over that time, he’s heard just about every workers compensation question there is.

And while every person’s circumstances are different, there are certain questions that come up again and again.

So, we’ve answered 10 of the questions injured workers often ask us about workers compensation in NSW.

Am I Eligible for Workers Compensation in NSW?

If you’re a worker who suffers an injury or illness arising out of or in the course of your employment, you may be eligible for workers compensation in NSW. Your eligibility will depend on your individual circumstances and the type of injury involved.

One thing Robert has seen throughout his career is that people don’t always recognise what has happened to them as a potential workers compensation matter.

A workplace injury isn’t necessarily a dramatic accident that happens on a construction site or factory floor. You might hurt your back lifting something at work, injure yourself in a fall or develop a condition gradually because of the work you’ve been performing.

If you’re unsure whether your injury could be covered, don’t rule yourself out before you’ve had the chance to understand your rights.

What Can Workers Compensation Actually Pay For?

Workers compensation isn’t simply about receiving a payment while you’re unable to work.

Depending on your circumstances, you may be entitled to support including:

• Weekly payments for lost income
• Medical and hospital treatment
• Specialist appointments
• Medication
• Physiotherapy and other approved treatment
• Rehabilitation and return-to-work support
• Certain travel expenses associated with approved treatment
• Lump sum compensation for permanent impairment where the eligibility requirements are met

This is an area where we find people can underestimate what their claim may involve.

You might initially be focused on replacing your lost wages, particularly if you’ve suddenly found yourself unable to work. But your treatment, recovery and the longer-term consequences of your injury can also be important.

Part of our job at Robert Bryden Lawyers is making sure you understand the bigger picture, not just the payment that’s arriving this week.

How Much Will I Receive in Weekly Workers Compensation Payments?

There isn’t one standard workers compensation payment that applies to everyone.

Your weekly payments can depend on factors including your pre-injury average weekly earnings (PIAWE), your current capacity for work, how long you’ve been receiving payments, whether you’ve returned to work and what you’re currently able to earn.

This means two people with similar injuries won’t necessarily receive the same amount. Your insurer should tell you how your weekly payment has been calculated if your claim for weekly payments is accepted.

If the amount doesn’t look right or you don’t understand how the insurer arrived at it, ask questions. That’s something Robert has always encouraged clients to do. Don’t be afraid to ask why.

If you believe your weekly payment has been calculated incorrectly, there are processes available to seek a review.

Do I Have to Be Completely Unable to Work to Receive Workers Compensation?

No. Workers compensation isn’t necessarily an all-or-nothing system.

You may be able to perform some work while still being entitled to weekly payments. For example, your doctor might determine that you can work reduced hours or perform modified duties but aren’t yet capable of returning to your normal role.

This is generally referred to as having current work capacity.

Your Certificate of Capacity provides information about what you’re medically able to do, while your weekly payments can take into account your capacity for work and the income you’re able to earn.

We’ve represented many people over the years whose situation hasn’t been as simple as “able to work” or “unable to work”.

Recovery can happen gradually. Your capacity can change. That’s why it’s important that the workers compensation process reflects what’s actually happening with your injury.

How Long Can I Receive Workers Compensation Payments?

There isn’t one answer that applies to every injured worker.

How long weekly payments continue can depend on your injury, your capacity for work, the degree of any permanent impairment and how your claim progresses over time.

For many physical injury claims, weekly payments of compensation are generally available for a maximum of 260 weeks, or five years, where the worker continues to have an incapacity for work up to that point.

However, the five-year limit does not apply in the same way to workers with more than 20% permanent impairment, or to certain exempt workers. In these circumstances, weekly benefits may continue on a longer-term basis, subject to the relevant eligibility requirements.

It’s also important to remember that eligibility requirements can change at different stages of a claim. This is why we tell our clients not to assume that because they’re receiving a certain payment today, it will automatically continue in the same way indefinitely.

If you’ve been told that your weekly payments are going to change or stop, find out why and what that decision means for you before assuming there’s nothing you can do about it. If you’re unsure, this is a good time to get advice about your ongoing entitlements.

Can I Choose My Own Doctor?

Your nominated treating doctor plays an important role in your workers compensation claim and recovery. Your doctor can assess your injury, recommend treatment and complete your Certificate of Capacity, which records information about your capacity for work.

This isn’t just another medical certificate.

It can play an important role in how your recovery and return to work are managed and is required when claiming weekly payments.

Robert’s advice after decades of dealing with compensation claims is simple: be open with your doctor about what’s actually happening.

Explain how you’re feeling, what you can and can’t do, whether your symptoms have changed and how your injury is affecting your work and everyday life. Your medical records should reflect the reality of your injury, not the version you think you’re expected to present.

You should also speak with the insurer about approval requirements before commencing treatment where approval may be required.

What Happens if the Insurer Doesn’t Accept My Claim Straight Away?

An insurer doesn’t always need to make a final decision before some support can begin.

For many claims, an insurer may commence provisional payments while it continues to assess liability. Provisional liability can allow weekly payments to commence for up to 12 weeks and medical expenses to be paid up to the applicable limit before liability is formally determined.

The important thing to understand is that an insurer still investigating your claim doesn’t necessarily mean you have to wait until every issue has been resolved before any support becomes available. And if you’re receiving letters or decisions from an insurer that you don’t understand, ask.

One of the things we regularly do at Robert Bryden Lawyers is cut through the legal and insurance language and explain what it actually means for the person sitting in front of us.

What if My Workers Compensation Claim Is Rejected?

A rejected workers compensation claim doesn’t necessarily mean the matter is over.

If an insurer disputes liability, it should provide a written decision explaining the reasons.

The issue could relate to whether you’re considered a worker, whether your employment sufficiently contributed to the injury, the available medical evidence, or whether particular treatment or expenses are considered reasonably necessary.

You may be able to ask the insurer to review its decision and provide further relevant information. Workers compensation disputes can also be taken to the Personal Injury Commission.

This is one of the points where Robert strongly recommends getting legal advice.

A rejection letter can feel very final when you receive one. But before accepting the outcome, you need to understand why the insurer has made that decision and whether it can be challenged.

At Robert Bryden Lawyers, we’ll sit down with you, look at what’s happened and explain your options in plain English.

What Happens if My Injury Leaves Me With a Permanent Impairment?

Unfortunately, not every workplace injury ends with a complete recovery.

Some people are left with lasting limitations that affect their ability to work and live as they did before the injury.

Where a workplace injury results in permanent impairment, you may be entitled to additional compensation depending on your degree of impairment and whether you meet the relevant eligibility requirements.

Importantly, workers must now obtain independent legal advice before undergoing a permanent impairment assessment.

For Robert, this is one of those moments in a workers compensation claim where getting the right advice really matters.

An assessment of permanent impairment can have consequences beyond the assessment itself. You should understand what is happening, why it’s happening and what it could mean for your future entitlements before you proceed.

Do I Need a Lawyer for a Workers Compensation Claim?

You don’t necessarily need a lawyer simply to report an injury or begin a workers compensation claim.

But that doesn’t mean you need to wait until everything has gone wrong before speaking to one.

Workers compensation claims can become complicated as they progress, particularly when decisions start being made about your income, treatment, capacity for work or permanent impairment.

You may want legal advice if:

• Your claim has been rejected or disputed
• Your weekly payments have been reduced or stopped
• Treatment has been declined
• There is disagreement about your capacity for work
• You’re approaching a permanent impairment assessment
• Your injury is having a significant long-term impact
• You’re unsure whether you’re receiving your full entitlements
• You simply don’t understand what the insurer is telling you

Robert has always believed that legal advice should make things clearer, not more complicated.

Sometimes speaking with a lawyer isn’t about starting a fight with an insurer. It’s simply about sitting down with someone who knows the system, understanding where you stand and knowing what your options are.

Every Workers Compensation Claim Is Personal

It’s natural to compare your situation with someone else who has been injured at work.

A colleague might tell you what happened with their claim. A friend might tell you how much compensation they received. You might even find a story online that sounds almost identical to yours.

But that doesn’t mean the outcome will be the same.

Your earnings, injury, medical evidence, capacity for work, treatment needs and the circumstances surrounding your injury can all affect your workers compensation claim.

Robert Bryden has worked in compensation law for more than 40 years, and one thing hasn’t changed: personal injury is exactly that, it is personal.

That’s why Robert Bryden Lawyers remains a boutique, family-owned firm.

When you come to us, you’re not simply another claim number being passed through a large legal team. Robert takes a personal interest in the people who come to the firm, and our team takes the time to understand what has happened to you and how it’s affecting your life.

We can help you understand your rights, the compensation and support that may be available and what your next steps could be.