Your weekly payments have stopped but you are still injured

weekly-payments

WorkCover weekly payments can be stopped for many reasons. If you receive a Notice from your workcover case manager/insurer stating that your weekly payments (income maintenance) are to be terminated you should seek  legal advice as soon as possible, bearing in mind that there are strict time frames within which a dispute can be lodged.

Your weekly payments have stopped but you are still injured

Some common reasons for termination of weekly payments

  • The injured worker has returned to work and is now earning more than their pre-injury average weekly earnings (PIAWE)
  • The injured worker has failed to attend medical appointments, including IMEs; refused to undertake suitable duties when certified fit; or been sacked from their job as a result of serious and/or willful misconduct
  • The injured worker has reached the end of the “third and last entitlement period” (that is, the worker has been unable to work for a period over 130 weeks) and has a limited capacity for work but is not actually working
  • The injured worker has turned 65 years of age (in most states)
  • The injured worker is residing outside of the state where they were originally injured, or has travelled and remained outside of their state for more than 2 months (generally).

If you receive a Notice from the workcover insurer stating that your payments are to be terminated you should seek immediate legal advice.  There are strict time frames within which a dispute needs to be lodged and the sooner you seek legal advice the better.

In most cases when weekly payments are terminated, an injured worker is still entitled to have any reasonable medical expenses ( incurred) for treatment as a direct result of their work related injury paid for by the insurer.  If the workcover insurer refuses to pay for medical treatment then you may be entitled to challenge their decision (i.e. conciliation, arbitration, Workers Compensation Tribunal).

Needless to reinforce the importance to seek legal advice if the insurer refuses to pay for your medical expenses related to your workplace injury.

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5 Responses to “Your weekly payments have stopped but you are still injured”

  1. If payments are terminated you should immediately make a claim with centrelink because delay will mean that they more than likely will only accept your claim from the time you contact them.

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    • There is a waiting period with Centrelink since your last payment before you can apply for pension.

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      Xchangingvictim July 14, 2014 at 8:03 pm
    • Great advice CGU Suck! The date you first contact them counts as your commencement date in most cases, whether you need to serve waiting periods or not if you’ve recently been paid etc. it’s still best to get onto it asap so you don’t miss out as the benefits are measly as it is without a delay on top of it!

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  2. In NSW the WC Compensation Act which was amended and made law towards the end of 2012, introduced S59A. Despite a review in mid-2014 this has not been repealed. Medical treatment is still capped at 12 months for those who have less than 21% WPI (changed from 30% post review).
    I was injured in Feb 2013 , surgery for my left knee was requested on in early December 2013. It took the insurer till the end of March 2014 to approve surgery. I am now recovering from a full-knee replacement completed in the first week of July 2014. I received no weekly payments prior to surgery.
    Due to 59A I was denied any treatment prior to the surgery. Any physio I needed I paid for myself.
    I have been told by Allianz TMF that once my weekly payments cease because I am back at work full-time, I will have no access to treatment. This is despite the fact that it for this type of surgery the short-term recovery is 12-16 weeks and longer term 6-9 months. Once back at work I have a physically demanding job that involves long periods of standing and managing many external stairs to get from one place to another.
    I know my specialist who is on the board of the AMA says that they have informed the government that the 12 month caps an unrealistic timeframe for any injury that requires surgical intervention. I would have to agree.
    Also, shockingly whilst ‘act in good faith’ and ‘a duty of care’ are written in to The Insurance Company Act, they are not within the WC Act. As a result, my insurer Allianz TMF failed to inform me of S59A and this has had a huge impact on my claim- one surgery requested was 9 days outside the 12 month limitation and denied on this ground. Injured workers should have access to fair and reasonable medical treatment- it unjust to create an arbitrary cut off period. It is discriminatory at there very least.

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    • Alina, have you spoken to a lawyer in regards to your treatment as I have been told a lot more about the recent changes as opposed to your treating surgeon even if he is on the board of AMA etc.
      Also is the WCC-Workers Compensation Commission still accepting cases? are you in NSW?

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