If you have been injured, you may be entitled to workers’ compensation benefits to provide you with financial and medical support during your recovery. The maximum time that a person can stay on workers’ compensations benefits is 5 years. However, staying on benefits for this long is rare. Most claims do not continue for more than two years and many finish within a much shorter period. This is because workers’ compensation benefits are not designed to be a long-term income replacement but rather a temporary measure to assist with your recovery and rehabilitation.
The length of time you are able stay on workers’ compensation benefits depends on several factors including the severity of your injury, the treatment recommended and your ability to return to work.
Generally, the more serious your injury is the longer that you will stay on workers’ compensation benefits.
Benefits Payable
Once your workers’ compensation claim is accepted the Insurer is required to pay you the following benefits:
- For the first 6 months of incapacity: 85% of your normal weekly wage (which means your normal weekly earnings from employment in the 12 months immediately before your injury);
- From 6 months to 2 years after your incapacity: 75% of your normal weekly wage or 70% of the average weekly ordinary earnings of a Queensland adult in the previous financial year (whichever is the greatest).
- From 2 years to 5 years after your incapacity:
- In most cases, an amount equal to the single pension rate.
- If you can demonstrate that your injury is relatively severe (which means you are assessed as having a degree of permanent impairment of greater that 15%), continued payment at 75% of your normal weekly wage or 70% of the average weekly ordinary earnings of a Queensland adult in the previous financial year (whichever is the greatest).
In addition, the Insurer is required to fund reasonable treatment expenses during your statutory claim.
When will your benefits stop?
Your workers’ compensation weekly payments will stop when the first of one of the following occurs
1. Your incapacity from your injury stops and you return to work
If you make a full recovery from your injury the workers’ compensation Insurer will close your claim.
Sometimes there can be differing medical opinions over whether you are able to return to work or not. In these circumstances, the Insurer may send you to an “Independent Medical Examination”, which is an assessment with a doctor from the Insurer’s panel who will provide an assessment and written report on your capacity to return to work. The Insurer will issue a decision to close your claim if they are of the opinion that your incapacity has ceased and you can return to work. If you wish to dispute the Insurer’s decision, you have three months to lodge an appeal with the Workers’ Compensation Regulator.
2. Your injury reaches maximum medical improvement
Maximum medical improvement (also referred to as your injury becoming stable and stationary) means that, although you have ongoing symptoms and/or functional impairment, your injury is now in a permanent state and unlikely to improve with further treatment.
Before closing your claim, the Insurer should send you to a final assessment with an independent medical examiner to assess your degree of permanent impairment. After that assessment the Insurer will issue you with a Notice of Assessment assigning a percentage of permanent impairment to your injury and including a lump sum offer of compensation. It is important that you seek legal advice before responding to a Notice of Assessment. This is a very important legal document and acceptance of a lump sum offer will, in most circumstances, stop you from commencing a claim for common law damages which compensates you for pain and suffering, past and future loss of income and superannuation and past and future treatment needs.
3. You have been receiving weekly payments for five years
If you have been in receipt of weekly payments for five years your claim will be closed. In practice, staying on benefits for more than 2 years is rare. A claim will usually be closed based on reasons 1 or 2 above.
4. The total compensation paid to you reaches the maximum amount
The maximum amount is defined under the relevant legislation to mean 216.15 times the average weekly ordinary earnings of a Queensland adult in the previous financial year.
What you should do
It is essential to keep in touch with your treatment providers and your Insurer case manager during your statutory claim to ensure that your providers and case manager are aware of the progress of your condition and can make and approve appropriate recommendations for treatment.
If the Insurer sends you for an independent medical examination, it may be an indication that the Insurer considers that you have reached maximum medical improvement and are planning on closing your claim. If this occurs it is a good idea to seek legal advice. When the Notice of Assessment is received, you will need to decide whether to accept any lump sum offer of compensation or instead pursue a common law claim for damages against your employer. This is an important decision which should be made following legal advice.
If you receive a decision from the Insurer closing your claim and you disagree with this decision, you should seek legal advice. You only have three months to dispute the decision.
If you have any questions about your workers’ compensation statutory claim or your prospects in pursuing a common law claim for damages please get in touch with one of our experienced lawyers at L&H Injury Lawyers for a free 30 minute consultation.
