During the length of your workers compensation claim, you may wonder why your weekly benefit has changed for a given week. Sometimes, you may not be given any explanation and will have to go fishing for answers.
For workers who are not a firefighter, paramedic, or police officer, here are several reasons why your pay might have (or should have) changed:
Increasing or decreasing your work hours
If you are still working while injured and obtaining weekly benefits, your pay rate should increase to 95% of your pre-injury average weekly earnings (also known as 'PIAWE') if you work 15 hours or more per week. If you drop down below 15 hours of weekly work, your pay rate will reduce to 80% of your PIAWE for that week.
The 80% rate will only apply after your first thirteen (13) weeks of payments.
Indexation
Every 1 April and 1 October of the year after your injury, the insurer is required to index your PIAWE and to adjust your pay. This means that they take your PIAWE and multiply it by a value based upon the Consumer Price Index (CPI). If your new PIAWE rate is below $1,000 the insurer must round it to the nearest $1, and if it is $1,000 or more, the insurer must round it to the nearest $10.
Whilst your pay should never decrease after indexation, but it may stay the same.
If your payments stopped and then restarted, the insurer should index your renewed payments for every 1 April and 1 October that has passed in the meantime.
Work Capacity Assessment/Decision
You may have received a letter from the insurer that advises you are the subject of a work capacity assessment or a work capacity decision. It is very important to take note of any such decision!
A work capacity decision may have the effect of reducing or even stopping your weekly benefits going forward (known as an 'adverse' decision). This can obviously have a significant impact on your financial wellbeing.
If you've been receiving weekly benefits for more than twelve (12) weeks continuously, the insurer is required to give you 3 months' notice before implementing their decision. Otherwise, they may give you 2-6 weeks' notice.
If a work capacity decision is issued, it is important that you act quickly and seek legal advice.
If you believe your weekly benefit is incorrect or has unexplained irregularities, or you're the subject of an adverse work capacity decision, feel free to reach out to us at Carroll & O'Dea Lawyers for assistance on 1800 059 278. Alternatively, you can contact Scott Dougall, Partner on 02 8661 0206 or Thomas Ryan, Lawyer on 02 8661 0220.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.