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Accidents happens.  Unfortunately, all too often these accidents occur at work or are related to work and result in physical injury.  Quite apart from the physical aspects, an injury resulting from a workplace accident can have a severe impact on your quality of life, your relationships and your finances.  The purpose of the workers compensation scheme is to protect workers.  The scheme is designed to ensure that injured workers receive appropriate support and medical care and are assisted in managing their rehabilitation and timely return to work.

Workers compensation claims are not, however, simply limited to accidents.  Claims can also be made in relation to the aggravation, acceleration, exacerbation, deterioration or recurrence of an injury or medical condition.  Indeed, even injuries or conditions such as heart attack, cancer, depression and stress can form the basis of a workers compensation claim where they are caused by, or are connected with, your work.

The most important factor to consider when you are considering whether to make a claim for workers compensation is that there must be a link between the injury or condition and your work.  Once your claim has been accepted by WorkCover (the government body administering the workers compensation scheme in South Australia), you may be entitled to various payments.  These payments may include:

• income maintenance;
• medical expenses; and
• lump sum payments (in cases of permanent impairment).

NOTE: While a majority of workers in South Australia will be covered by WorkCover, some workers may be covered by ComCare and some large organisations may have self-managed workers compensation insurance.

Income maintenance

If you are unable to work at all or are working fewer hours than you were working previously because of your injury or condition, you are entitled to income maintenance payments to replace or “top-up” your average weekly earnings.  In the case that you are unable to work at all, income maintenance payments should be equivalent to the average weekly earnings that you would have earned had you not been injured.  Regular overtime, entitlements and allowances are included when calculating average weekly earnings.  If you normally receive income from a second job, that income is also eligible for income maintenance.  If you are partially incapacitated and cannot work your normal number of hours or carry out your normal duties, your income should be “topped-up” to the amount you were previously earning.

While most workers are able to return to work fairly quickly, some are not so lucky.  Following severe injuries, income maintenance is payable at a rate of 100 per cent of your pre-injury level for the first 52 weeks of incapacity.  After that, payments are reduced to 80 per cent .  Further adjustments are be made if your incapacity exceeds 104 weeks.

Medical expenses

Medical expenses that arise as a result of a workplace injury are generally payable.  You will generally be entitled to payment of all reasonable medical expenses related to your injuries.  As a general rule, “reasonable” includes all treatment recommended by your medical practitioner/s.  Common examples of eligible medical expenses include costs arising out of treatment by medical practitioners (including doctors, specialists and hospitals) and costs relating to medicine and other prescription items.  In addition, you are entitled to claim expenses associated with travel to and from medical treatments and rehabilitation services.

It is important to ensure that the medical practitioner/s treating you knows that your injury or condition is work-related.  Further, you should not claim any treatment costs from Medicare or your private medical insurer.

Lump sum payments for permanent impairment

If your injury or condition results in a permanent impairment, you are eligible to receive a lump sum disability payment.  This is the case even if you have returned to work.  These payments are separate from other entitlements; income maintenance entitlements and payments relating to medical expenses do not affect these payments.

A permanent disability assessment must be performed by a doctor nominated by WorkCover.  You will be required to consult with that doctor, however you can and should consult your own doctor/s.  When you are having your injury or condition assessed, you should inquire as to what part of the body the injury is being attributed to for the purposes of the assessment and what options there are.  Sometimes an injury or condition can be assessed as relating to more than one part of your body.  For example, if you have suffered a shoulder injury it can be assessed as either an arm injury or a shoulder injury.  The maximum amount for an arm assessment is different to that for a shoulder assessment and you have the right to choose which assessment you want.

Compensation for workplace injury is a tightly regulated area and your entitlements as a worker can often be both complex and confusing.  Before making a claim you should contact Andersons Lawyers in order to ensure that the choices you make result in the most beneficial outcome.