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WORK COVER

Changes to the NSW Workers Compensation Scheme:        

Journey claims

• Can only be made if there is a real and substantial connection between the employment and the incident out of which the injury arose.
• Recess claims remain unchanged.
• Journey claims with a date of injury after 31 December 2012 (4.00pm) will be premium impacting including being subject to a claims excess.

Heart attack and stroke claims

• Require the nature of employment to offer a significantly greater risk of the worker suffering the injury than had the worker not been employed in employment of that nature.

Disease claims

• Now referred to as “a disease that is contracted in the course of employment only if the employment was the main contributing factor”.
• Disease injury also encompasses aggravation, acceleration, exacerbation or deterioration in the course of employment of any disease, provided the employment was the main contributing factor.
• Dust diseases continue to be exempt.

Nervous Shock Claims

• Prevents a claim for damages for nervous shock when the nervous shock is not a work injury.
• The new changes preclude claims for damages by relatives of an injured or deceased worker because their injuries are not work injuries.

Lump Sum

• Degree of permanent impairment must be over 10 per cent to have an entitlement (including industrial deafness claims) and 15 per cent for psychological claims.
• Pain and suffering payments have been abolished. 
• Payments have been simplified to one lump sum payment with no top up.

From 17 September 2012

Seriously injured claims

• Seriously injured workers (with a previous agreed assessment – or likely to have – greater than 30 per cent whole person impairment) who were receiving less than the transitional rate of $736.72 per week will begin receiving an increased benefit. 
• There will be no time cap on weekly payments, except for the Commonwealth retirement age.
• There will be no time limit on payments for reasonable medical-related expenses 

From 1 October 2012

• Weekly benefit payments will be calculated using the injured worker’s pre-injury average weekly earnings as this is more closely aligned with the worker’s real earning prior to injury.
• New timeframes and calculations for ongoing weekly benefit reviews. The maximum weekly benefit will be capped at $1,838 per week for new claimants and indexed twice a year.
• Work capacity assessments introduced for new claims except for seriously injured workers who are not required to have work capacity assessments unless they request to do so to explore their return to work options.

From 1 January 2013

Existing claims prior to the 1 October 2012 changes will be transitioned to the new legislative requirements, including work capacity assessments and a new estimating manual to support the changes. Claims will be processed under the existing legislation prior to that time.

The amendments that relate to this specific date will be communicated when they come available from WorkCover NSW.

As of 19 June 2012

• New permanent impairment threshold for physical injuries is now greater than 10%.
• Pain & Suffering (section 67) has been abolished.
• Only one assessment of permanent impairment will be paid (no further claims for permanent impairment loss).
• Journey claims will only be accepted if a “real and substantial connection between the employment and the accident” is established.
• The definition of injury in relation to the inclusion of diseases has been further defined to where employment is “the main contributing factor”.
• No compensation for heart attack or stroke unless the nature of employment results in a significantly greater risk.
• Damages for nervous shock injury to non-workers have been abolished.
• Please note there are some workers who are exempt from these changes and their claims will be exempt from 2012 amendments.  These workers include:
  • police officers, paramedics and fire-fighters
  • workers injured while working in or around a coal mine
  • emergency service volunteers (Rural Fire Service, Life Savers, SES volunteers)
  • claims made under the Workers Compensation (Dust Diseases) Act

Workers compensation changes information for employers

In June 2012 the government introduced changes to the Workers Compensation Scheme in NSW. The reforms are focused on assisting injured workers to return to work, and will return the scheme to financial sustainability without requiring massive increases in your premiums.

Focus on return to work

Evidence shows that getting injured workers back to work early is an important part of their recovery. As well as reducing the impact of an injury on your worker and their family, early, safe and durable return to work:

• gets your skilled and experienced workers back in the workplace – benefiting your business

• can lower your particular premium costs, if you are a medium or large business

• reduces the likelihood of large, scheme-wide increases to premiums to address the financial deficit.

The reforms provide incentive for injured workers to return to work. They also reinforce your obligations as an employer to help them do that – including providing suitable employment for them if they have some capacity to work.

Key reforms

Benefits

Benefits for new claims are now based more closely on an injured worker’s real earnings prior to injury – incorporating things like overtime and shift allowance, which removes the distinction between award and non-award workers.  By filling out and submitting the new Pre-injury average weekly earnings form (catalogue no: WC03303) with your injured worker’s claim, you will help ensure they receive the correct entitlement to weekly payments.

If your injured worker was claiming prior to the reforms, a ‘transitional amount’ (which is significantly higher than the old statutory rate) will be used as their deemed pre-injury earnings.

Weekly payments are now linked to return to work, with more benefits during the first 13 weeks (when 80 per cent of injured workers return to work) and thereafter if the worker works for at least 15 hours a week.

Work capacity assessments

 Your insurer now assesses your injured worker’s work capacity. This looks at their capacity to return to any type of suitable employment. A new WorkCover NSW certificate of capacity (catalogue no. WC01300) is replacing the old WorkCover medical certificate, to help doctors provide more advice on your injured worker’s capacity to work.

If your injured worker is assessed as having some capacity to work, you must (as far as is reasonably practicable) find suitable employment for them. Under the reforms, you are subject to improvement notices or fines if you do not follow through with this commitment (note that during a three month grace period from 1 October 2012 these employer improvement notices will only be applied in serious circumstances).

If you need help with identifying suitable work, please contact WorkCover. We are taking steps to work with employers to improve return to work outcomes and identify suitable duties for injured workers.

Claims and lump sum benefits

From 19 June 2012 there are new arrangements for journey claims, lump sum payments, and nervous shock, heart attack/stroke and disease injury claims.

Seriously injured workers

Seriously injured workers are exempt from time limits that apply to weekly payments, and medical and related expenses.

Implementation

The reforms have been implemented in stages from June 2012. All claims made on or after 1 October 2012 are subject to the new legislation and benefits.

If you have an injured worker who was claiming prior to the reforms then they will be transitioned to the new legislation in 2013 (or if they are seriously injured they would have received improved benefits from 17 September 2012).

More information

The information in this fact sheet is general only. If your injured worker would like to discuss the specific impact on their claim, they should contact their claim manager.

For more general information about the reforms, visit workcover.nsw.gov.au or call 13 10 50.

Please note: The workers compensation changes do not apply to some workers. The excluded groups are police officers, paramedics, fire-fighters, coal miners and workers who make dust diseases claims.