Within seven days of lodging a claim the Insurer (EML, Allianz, QBE, GIO, iCare & Others) may start making provisional payments to you as a claimant without accepting formal liability for your claim.
- Insurers can accept liability for medical expenses on a provisional basis and pay up to $10,000 before making a formal determination of liability.
- Provisional payments enable insurers to start paying medical expenses while fully assessing your claim.
- If the insurer does not accept your claim, you won’t be required to pay back the provisional payments.
- Provisional payments can include weekly payments for up to 12 weeks and it also extends the time allowed for the insurer to make a decision on liability.
Idea behind provisional payments is so that you have access to early medical treatment and income support and hopefully recover quickly. iCare has reported that most injuries resolve within the first 13 weeks of the injury.
Contact Grieve Watson Kelly Lawyers’ workers compensation lawyers to discuss you workcover claim before you lodge the iCare claim form or certificate of capacity.
What if my injury has caused me to be off work for longer than 12 weeks?
If your injury has caused you to be unable to work for more than 12 weeks or your workers compensation claim has been denied you may want to consider what your entitlements are past 13 weeks:
- Weekly payments are made to workers who are incapacitated (either totally or partially) and/or losing earnings due to incapacity.
- If you can’t work due to injury, you may receive up to 95% of your pre-injury average weekly earnings (PIAWE) for the first period of entitlement 13 weeks.
- After 13 weeks you enter the second period of entitlement 14 to 130 weeks where is you are still totally unfit you can receive 80% of your PIAWE.
- The amount is based on your weekly earnings before the injury or a maximum weekly compensation amount (currently $2,423.60 gross from October 2023 to March 2024). The amount is indexed every 6 months.
What about medical expenses?
Under section 59A of the Workers Compensation Act 1987:
- If your degree of permanent impairment is 10% or less, you can claim medical, hospital, and rehabilitation expenses for two years after weekly payments stop. this means if you are certified fit for pre-injury duties from the day you are reading this, you still have two years of medical coverage from that date. The medical expenses still have to be reasonably necessary as a result of the workplace injury.
- If your degree of permanent impairment is 11% to 20%, you can claim expenses for five years after weekly payments stop.
- If your degree of permanent impairment is 21% or above, medical expenses are payable for life.
- If you never received weekly payments, the period commences from the date of claim .
What other entitlements do I have?
Remember that these entitlements are designed to protect injured workers and ensure they receive appropriate support during their recovery and return to work. If you have any specific questions or need legal advice, arrange conference with Grieve Watson Kelly Lawyers workers compensation lawyers to discuss your claim or provisional payments.
