If your workers’ compensation claim is accepted, you are entitled to be compensated for loss of wages, reasonable medical and allied health treatment expenses, reasonable workplace rehabilitation expenses, and travel and other expenses.
Note: If your claim has been pended or not accepted, you are responsible for your expenses. Keep all receipts and records of payments made, in case the insurer ultimately accepts liability – in which case you will be reimbursed for payments.
Loss of wagesThere are two methods of calculating weekly workers’ compensation payments, depending on whether or not you work under an award agreement (including enterprise orders, collective agreements and enterprise bargaining agreements). Your current employment contract should outline whether you work under an award agreement or not. Alternatively, your employer should be able to confirm this.
Workers under an industrial awardFor the first 13 weeks:
- you will receive the rate of weekly workers’ compensation payments payable under your industrial award
- you will receive any over-award or service payment paid to you on a regular basis
- you will receive the overtime bonuses and allowances paid to you over the 13 weeks prior to your incapacity
From week 14 onwards:
- you will receive the rate of the weekly workers’ compensation payments payable under your industrial award
- you will receive any over-award or service payment paid to you on a regular basis
- you will receive any other allowance prescribed by the regulations
- you will not receive any other allowances, overtime or bonuses
For the first 13 weeks:
- you will receive an average of the payments (including overtime, bonuses and allowances) paid to you over the 12 months prior to your injury, and in the employment in which you were injured
- if you have been employed for less than a year, your earnings will be averaged over the lesser period
From week 14 onwards:
- your weekly payments will ‘step down’ to consist of 85 per cent of your average weekly earnings.
For information about the calculation and receipt of your weekly payments, contact your insurer.
For more information about your entitlements, contact Advice and Assistance on 1300 794 744.
There is a limit on the amount of weekly payments you can receive when you are on workers’ compensation. The maximum weekly amount is set at twice the ‘average weekly earnings’ as calculated by the Australian Bureau of Statistics and this amount is reviewed each year.
A limit also applies to the amount of compensation you can receive in total. The maximum amount of compensation you can receive during the life of your claim, in terms of weekly payments for loss of earnings, is called the Prescribed amount. An extension may be available to some workers permanently unable to work.
Your weekly payments may be reduced or cease if:
- you have returned to work on full capacity
- you give your consent in writing for them to stop
- your treating doctor has certified you totally or partially fit to return to work
- your workers’ compensation claim is finalised through a settlement
- you register to pursue a common law claim
- you have reached the maximum limit on your entitlement to weekly payments.
Your employer may lodge an application with the Workers’ Compensation Conciliation Service to temporarily suspend weekly payments if you:
- do not comply with your Return to Work Program
- fail to attend a medical review arranged by your employer or their insurer
- are in custody or serving a term of imprisonment.
If you have any concerns about your weekly payments being discontinued, suspended or reduced, contact Advice and Assistance on 1300 794 744.
If you are injured at work, you may claim for a range of reasonable medical expenses, including:
- first aid and ambulance
- medicines
- medical or surgical attendance
- treatment by specialists
- dental
- physiotherapy
- chiropractic
- charges for hospital treatment
- other approved treatment, including osteopathy, clinical psychology, occupational therapy, speech pathology, and exercise physiology.
If you require treatment from an alternative health provider, for example a naturopath, you should check with your employer’s insurer to ensure that the cost will be reimbursed prior to commencing treatment.
Right to choose
You also have the right to be treated by a doctor or allied health provider of your choice.
Reimbursement of medical expenses
It’s important to check with your employer’s insurer before commencing any treatment to ensure it will be reimbursed.
Generally, you will need to pay for your medical invoices after a consultation or treatment and be reimbursed by your employer’s insurer. However, arrangements can be made for treatment invoices to be issued directly to your employer’s insurer.
'Gap' payments liabilityThe insurer will only pay medical accounts up to the medical and allied health provider rates set by WorkCover WA. If your provider charges more than this rate, you will be responsible for the extra portion of the account (the ‘gap’).
Check the charges with the provider before making an appointment.
The amount you can receive to cover your medical expenses over the life of your claim is limited.
The insurer will notify you once 60 per cent of the maximum amount for medical expenses has been reached. For more information see the Prescribed amount.
Extension of medical expenses
In certain circumstances, you may lodge an application with the Workers’ Compensation Conciliation Service (WCCS) for an extension of the medical expenses amount. WCCS will take into account your social and financial circumstances and your reasonable financial needs when considering your eligibility for an extension.
If you exhaust the medical entitlement, an additional $2000 for medical and related expenses will be available while you pursue an extension.
If you meet exceptional medical circumstances criteria and have a whole of person impairment of not less than 15 per cent, a Conciliation Officer in the Workers’ Compensation Conciliation Service or Arbitrator in the Workers’ Compensation Arbitration Service may grant an extension of up to $250,000 beyond the additional $50,000 for medical expenses.
Note: If you accept exceptional circumstances payments, you automatically waive your right to pursue common law damages.
For more information, download the Exceptional Circumstances Medical Payments Brochure (PDF – 1.04mb).
You are entitled to claim for reasonable workplace rehabilitation expenses, but there is a limit to your entitlement. For more information, go to Prescribed amount.
Workplace rehabilitation providers are approved by WorkCover WA and their costs are covered up to an approved percentage of the prescribed amount in every workers’ compensation claim. Costs may vary according to the services they provide, but the maximum amount they can charge is determined by WorkCover WA and reviewed annually.
Where you are required by your employer, their insurer or a medical practitioner to travel from your home to a medical appointment or rehabilitation provider, you can claim the cost of reasonable travel expenses.
Travel expenses incurred by a worker in obtaining an assessment by an approved medical specialist can also be claimed.
Regional workers
For workers in regional areas, reasonable costs may also include reasonable meals and accommodation expenses.
What you should do
Payment of travel costs is best arranged through your employer or their insurer. Keep a record of your travel by recording vehicle kilometres, appointment dates and times, and any public transport tickets or receipts.
Note: Insurers will only pay the rates set by WorkCover WA for travel, board and lodging expenses. See the ‘prescribed allowances’ within the Prescribed amount for more details on these rates and expenses.
