Active claims, worker entitlements and payments FAQs - Workers
Active claims, worker entitlements and payments FAQs - Employers
Active claims, worker entitlements and payments FAQs - Workers
Who pays my wages during the time that I am on workers compensation?
Generally, the first two weeks of your salary are paid by the employer. After this date if you are still being paid income maintenance, your employer will be reimbursed by WorkCover. In some cases, the claims agent will pay you direct.
I was about to go on leave before I got hurt, what happens to WorkCover payments if I go overseas or interstate?
The Act lays down conditions about travel out of South Australia. While this does not mean that you cannot leave the State, you must discuss this with your claims manager prior to leaving the state.
Is my usual overtime calculated as part of the WorkCover payment?
Income maintenance payments are based on the amount the injured worker earned in the 12 months preceding the disability. This includes basic wages, overtime (if overtime was likely to have been ongoing), allowances and non-cash benefits not retained (such as a motor vehicle).
I am a casual worker, how is my average weekly earnings calculated?
Your average weekly earnings will be based on the amount you earned in the 12 months preceding the disability. This can be complex if you have had fluctuating earnings and your case manager will discuss this with you before making a decision.
I had a work car as part of my package. Is this calculated in my weekly compensation payments?
Amounts such as this will be included on the basis that it formed part of the amount that you earned in the 12 months preceding the disability.
Is my uniform allowance included in the rate you pay me?
The legislation provides for the exclusion of prescribed allowances. However no allowances have been prescribed to date so all allowances are included in the calculation of your average weekly earnings.
I was about to retire before I got hurt. What happens with my pension?
A Commonwealth Government aged pension is payable on the basis of age. In general, therefore as set out in the Workers Rehabilitation and Compensation Act, workers compensation payments cease at the time you would have normally retired. Medical expenses relating to the injury may be payable after retirement.
Do workers compensation payments affect my partner's income tax?
For taxation purposes, workers compensation payments are income. WorkCover can't give advice about your taxation obligations-you should approach the Australian Taxation Office.
Do I receive a payment summary (group certificate) for compensation payments?
Yes, you will receive a payment summary for your income maintenance earnings.
I am employed by more than one employer. Will your sum take this into account?
The average weekly earnings calculation will take into account all income earned as a worker.
My apprenticeship was nearly up at the time I was injured. Do you calculate based on my rate as an apprentice or as a qualified tradesman?
If you are permanently incapacitated, the average weekly earnings amount is calculated as if you had completed your apprenticeship. If your incapacity is not permanent, the average weekly earnings amount is based on what you were receiving at the time of the disability.
Do I claim costs on Medicare or on my own private health insurance?
If you have already been reimbursed for medical costs by Medicare or private health insurance, you need to tell your claims manager about it. Medicare or a private health insurance company may seek reimbursement from WorkCover for these expenses. All claims-related costs must be directed through your case manager.
Do I ever have to pay for my own medical bills?
If the claim has been accepted, all costs reasonably incurred by the worker as a result of having suffered a compensable disability will normally be paid. Reasonable costs will be determined by the claims agent. Although the Act does not define the term 'reasonably incurred', it means that the worker acted reasonably in obtaining the service and in engaging themselves to pay the amount charged.
A worker is not obliged to choose the cheapest or most conventional available treatment, and generally speaking where a worker acts upon apparently reputable medical advice, the worker will be considered to be acting reasonably even if the advice is wrong or incompetent.
However where a worker incurs a cost for a service which the worker knew would be of little or no benefit, or where the same benefit could have been obtained much less expensively, the worker may not be considered to have acted reasonably in procuring the service and undertaking to pay the cost.
When do I need a solicitor to deal with my claim?
Usually only if you have an unresolved dispute with the claims agent/WorkCover. You may also be eligible for support through your union.
Can I get a copy of my WorkCover file?
Under Freedom of Information (FOI) you can apply to see or ask for a copy of your records. There may be some documents that will be exempt under FOI. You can also apply under Section 107B of the Workers Rehabilitation and Compensation Act for access to your records.
Does WorkCover pay for using an advocate if the worker needs assistance eg, if they have an intellectual disability?
WorkCover's Service Improvement Unit is available for people who need advice with regard to disputing a decision. If an independent advocate is needed to assist on other matters, we would provide the person with information on disability advocacy services.
WorkCover continues to provide advice to injured workers and employers on entitlements, claim decisions, disputes and scheme navigation through the Service Improvement Unit. Call 8233 2463 for free, confidential advice.
The delivery of advocacy and representation services on behalf of injured workers are now provided by SA Unions and Business SA.
I live in rural SA, what support can you offer me?
Regardless of where you live, the level of service you receive should be the same. In remote areas, you may have to travel to receive some services and WorkCover will pay for such travel.
What do I do if I'm not happy with my case manager?
If you have a legitimate complaint about the way you are being treated by your claims manager, approach the case agent with details. If you are still not satisfied, approach WorkCover's Service Improvement Unit or contact us to make a complaint.
It seems like everyone has access to personal information about me. How is it controlled?
The Act is very specific about disclosure of information. WorkCover and our claims agent have strict policies about who is entitled to access information. Other providers are also bound by the Workers Rehabilitation and Compensation Act and the Privacy Act.
Active claims, worker entitlements and payments FAQs - Employers
Can I sack someone while they're away from work on workers compensation payments?
When a worker is injured at work, the employer must provide alternative duties (where possible) and work cooperatively with the claims agent. In certain circumstances a worker's employment can be terminated but you should seek advice from your claims agent before doing so.
Who pays the first two weeks' wages and is there a time limit to pay this?
Unless they have taken out the Buy Out Option with WorkCover, the employer pays the first two weeks' wages - which they must do within 14 days after the date of the claim, unless the claim is being disputed.
What happens if the worker has more than one employer?
A worker in this circumstance is entitled to all income earned as a worker.
Are superannuation payments included in average weekly earnings calculations?
Any contribution paid or payable by an employer as part of a salary sacrifice arrangement between the employer and employee to a superannuation scheme are included in the average weekly earning calculation.
Is annual leave and leave loading included in WorkCover weekly payments?
Under the Workers Rehabilitation and Compensation Act, both annual leave and compensation may be paid for the same period during the first year of incapacity. After the first year, the worker is deemed to have taken any annual leave that might otherwise have accrued. Leave loading is the responsibility of the employer.
Do you treat contractors the same as other workers when calculating their weekly earnings?
Yes, providing they were working under a contract of service. However, this issue is complex and you should seek direct advice from your claims agent.
How do we deal with long-service leave if someone is on WorkCover?
A worker is entitled to be paid long-service leave in addition to being paid income maintenance for the same period for the first year of incapacity. If the incapacity continues for more than a year, whether long-service leave will continue to accrue or not would probably be governed by any award that may apply. The employer is responsible for paying the long-service leave wages.