How do I make a successful workers compensation claim?

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Workers compensation provides a safety net if you’re injured on the job. But unfortunately, claiming workers compensation in NSW doesn’t always go as smoothly as it should. Claims aren’t always approved, treatment costs are often denied, and many people are unaware of lump sum payments they’re entitled to.

So although a successful claim can provide financial relief while you recover from a work injury, the claim process can add stress you really don’t need.

In this article we demystify the workers compensation claim process and explain how you can successfully claim back your lost wages, medical and treatment costs, and in some cases a lump sum payout.

Applying for workers compensation – what you need to know.

If you’re injured completing a task that benefits your employer, then it’s classified as a workplace injury. This includes accidents like slipping and falling in the break room, and generally all injuries that occur on the employer’s property. It also includes working from home, as you’re still fulfilling your duties as an employee.

However, workers compensation doesn’t apply in cases where the employer can’t reasonably be considered to be at fault – like if you fall over running for a train on your way to work.

The more evidence you have to support 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.

With a successful claim, you may be entitled to weekly payments, the cost of medical expenses, and even lump sum payouts to cover damages.

How do I apply for workers compensation?

Follow these steps to apply for workers compensation and access everything you’re entitled to:

Step 1. Seek medical treatment

You should see a doctor to get a full assessment of all your 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 and renewed 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 your injury

You need to notify your employer about your injury as soon as possible. It’s then their responsibility to alert their insurer within 48 hours. This is the main timeframe that needs to be met 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, like back pain or RSI, then the date that you first had to take off work or seek medical treatment is 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 it’s followed up within three years, but there can be exceptions in some circumstances.

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 includes 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

It makes sense to get advice from a specialist workers compensation specialist lawyer to make sure you understand everything you’re entitled to. This can be the difference between a denied and a successful claim.

You can call Law Partners on 13 15 15 and get free advice over the phone from a workers compensation lawyer .

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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 cause some degree of 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 will determines any lump sum payments you might be entitled to.

If my claim is rejected, what can I do?

If the insurer denies your claim, that doesn’t have to be the end of it. They’re required to provide you with a section 78 notice that explains 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?

If you dispute an insurer’s decision to deny your claim, you’ll need to lodge all the relevant documentation at once, and it can take up to three months to compile everything. 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.

But the good news is the right personal injury lawyer can speed up this process considerably by pre-empting potential disputes and planning for the possibility of a section 78, so they’ll have the documentation ready to go from the outset.

You can talk to a Law Partners workers compensation lawyer for free, personal advice on your claim.

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

If your claim is successful, you’re likely 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 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’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.