How Do I Make a Successful Workers Compensation Claim?

14 September 2022

Injury and Rehabilitation, Workers Compensation

A yellow forklift on a warehouse floor surrounded by stacks of pallets and boxes

Workers compensation exists in NSW to provide a safety net if you’re injured on the job. Unfortunately, the process isn’t always a straightforward one, and it can hard to know how to apply for workers compensation. Claims are not always approved, treatment costs are often denied, and people are regularly unaware of lump sum payments that they’re entitled to.

A successful claim can offer stability during a difficult period and relieve the financial and emotional burdens of recovering from an injury sustained at work.

The process can be daunting, especially when dealing with the existing complication of being injured in the first place. Continue reading to find out of if you’re eligible for the reimbursement of medical fees, treatment costs, or even a lump sum payment.

Applying for workers compensation – what you need to know.

The more evidence you have supporting your claim, the more likely it is to be successful. This is especially true of injuries that develop over time like strains, or psychological injuries. Most importantly, an insurer denying your claim is not the end of the road and having a specialised personal injury law firm on your side can completely alter the outcome and increase your chances of a successful claim.

With a successful claim, you may be entitled to weekly payments, the cost of medical expenses, and even lump sum payouts to cover damages. If you’re injured while completing a task that benefits your employer, then it’s classified as a workplace injury. This includes slipping and falling in the break room, and generally all incidents that occur on the employer’s property. It also includes working from home, as you’re still fulfilling your duties as an employee. Workers compensation doesn’t apply in cases where the employer can’t reasonably be considered to be at fault – like if you fall over while running for a train on your way to work.

If you’re not sure where to start with a workers compensation claim, you can call 13 15 15 and get free legal advice. And if you’re entitled to compensation, Law Partners can fund all the medical reports needed to support your claim.

How do I apply for workers comp?

These steps will guide you on how to apply for workers compensation to make the most out of your claim and access everything you may be entitled to.

Step 1. Seek medical treatment

You should see a doctor to determine the extent of what has happened and obtain a full assessment of all existing and potential injuries. This helps you understand what your injuries are and how to care for them, and establishes a timeline and official account of what happened to you. This is particularly important for a successful claim as it provides evidence of impairment or injury.

To apply for workers compensation, you’ll need a NSW certificate of capacity issued by a doctor every 28 days. This should include:

Your diagnosis and its relationship to employment
Medical treatment required
Your capacity for any work (such as how much and what type of duties you can perform)
If a referral to a workplace rehabilitation provider is needed
Any delays in your recovery
Details of previous related injuries
Expected return to work date

Step 2. Report injury

If you’re injured in a work accident, such as being struck by something falling or slipping on a spill, you need to notify your employer as soon as possible. It’s then their responsibility to alert their insurer within 48 hours of finding out. This is the main timeframe that needs to be met when dealing with a workers compensation claim. The sooner an injury is reported the better, as it’s more likely your claim will be successful if it’s reported within the first eight weeks. If the injury occurred over time, then the date that you first had to take off or seek medical treatment acts as the starting point for the time frame. If you suffered an injury a while ago and you’re not sure if you’re able to claim, contact a lawyer for some advice. It’s more likely a claim will be successful if followed up within three years, but there can be exceptions in some circumstances.

In the case of an issue developed over time, such as degraded joints or back pain, there often isn’t a specific incident which caused the injury. This doesn’t mean that the claim is invalid, it provides context of repetitive strain that has led to injury. Continue to the next step.

Step 3. Keep track of everything

Having a record of your doctor’s visit through a certificate of capacity is a great start, but you should keep track of everything relating to your injury to strengthen your claim. This would include any communication with your employer, previous complaints about working conditions that might be relevant to your injury, or requests for support that weren’t followed up.

It might all be clear at the time, but the details can get confusing, so having an accurate written record is an important step in making a successful workers compensation claim. Keep it somewhere easily accessible, you could even email it to yourself to have a time and date stamped version.

Step 4. Ask the experts – speak to a workers compensation specialist lawyer

Seeking a workers compensation specialist lawyer will ultimately give you the best understanding of what your options are. This can be the difference between a denied and a successful claim.

You can reach us online, by email, or on 13 15 15 and access expert legal advice, without locking you in to anything.

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I have lodged a claim, what happens next?

Once the claim has been lodged you should start to receive weekly payments worth up to 95% of your regular wages. If your injury is significant enough to create a Whole Person Impairment (WPI), then the percentage of impairment will be calculated eight months after your initial claim, or six months after you have surgery. This then determines any lump sum payments you might be entitled to.

If my claim is rejected, what can I do?

It’s in an insurer’s interest to pay you as little as possible, or even better for them, not at all. But that doesn’t have to be the end of it. If the insurer does deny your claim, they’re required to provide you with a section 78 notice. This must explain the exact reasons why your claim has been denied or why you’re not entitled to compensation for your injury, and a clear pathway for how you can go about requesting a review of the decision. For more information about this, see My workers compensation claim has been denied, now what?

When you dispute an insurer’s decision to deny a claim, all relevant documentation is required to be lodged at once, and it can take up to three months to compile everything needed. Once the claim is filed it can then take a further three months to be accepted, potentially leaving you without any form of income for over six months. Having a good personal injury lawyer on your side can speed up this process as they can pre-empt potential disputes and will plan for the possibility of a section 78, so they’ll have the documentation ready to go from the outset of your claim.

You can contact Law Partners for free, expert, and personal advice.

If my claim is successful, how much can I expect?

If your claim is successful, you’re likely to be entitled to have your medical expenses covered, weekly payments of up to 95% of your lost wages, and potentially an additional lump sum payment. The maximum weekly compensation amount is capped and indexed in April and October annually. The current maximum weekly claim amount (from 1 April 2022 to 30 September 2022) is $2,318.10.

On top of weekly payments and medical expenses, you may be entitled to an additional lump sum payment, ranging from $22,480 up to a maximum of $631,370*. For further information about compensation, see our Workers compensation payout guide.

*According to SIRA Open Data, April 2022

How a successful workers compensation claim can change lives.

Jennifer absolutely loved her job working in science at a high school. She was working in a lab for hours after an experiment had been conducted which left her inhaling toxic fumes, causing an injury from which she will never fully recover. Determined to push through, Jennifer returned to work just two weeks after the accident, which caused her to collapse from the stress. She hasn’t been able to work since.

Despite initially being told that everything was normal, the reaction that she suffered left her financially, physically, and mentally under enormous pressure. The settlement that Law Partners was able to secure for her has turned her life around, leaving her with the energy she needs to recover, and hopeful for whatever life holds next for her.

Jennifer's story

Being exposed to those chemicals changed my life

A freak classroom accident turned Jennifer’s world upside down and left her seriously questioning whether she’d ever get her life back on track.

Shanelle was also injured at work, her active lifestyle put abruptly on hold after being hit by an item falling from a shelf. While her insurer offered her weekly payments during the first few weeks, they denied her claim for the surgery she needed to get her normal life back. She describes feeling sick at the thought of calling a workers compensation lawyer, feeling as though she was doing the wrong thing by her employer, but now says it was the best decision she ever made.

Law Partners was able to successfully appeal and overturn the insurer’s original decision. This meant that Shanelle was able to access workers compensation and a lump sum payment, which has put her life back on track. She’s now looking forward to dancing at her stepdaughter’s wedding next year.

Shanelle's story

I didn't choose to seek compensation, I needed to

When department manager and devoted mother Shanelle was refused surgery for her injury, she turned to us for help.

“It was the best decision I’ve ever made. It’s just good to know that there are people out there who actually care that I’m injured. And that’s what Law Partners is about – they care.”

If you’re unsure about whether you’re eligible to claim workers compensation, contact us for free and personalised advice about what you could be entitled to. We can help you figure out how to make a successful workers compensation claim and access everything you need to get life back on track. You can reach us online, on 13 15 15, or request a call back.