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How to make a lump sum impairment claim under WorkCover

Many injured workers are unaware they may have a claim for a lump sum compensation payment for permanent impairment under WorkCover (the WIRC Act 2013).

Impairment claims can give rise to a lump sum payment which is tax free and without any effect on other entitlements, such as weekly payments, or payment of reasonable hospital, medical, and the like expenses.

In order to pursue an impairment compensation claim, it is necessary to seek some legal advice and obtain assistance in what is otherwise a relatively straightforward matter best handled by a lawyer experienced in relation to such claims.

Assistance is advised to ensure the claim form is properly completed and the appropriate medical material is submitted to the WorkCover claims agent along with confirmation of the stabilisation of the injury or injuries. Once the WorkCover claims agent receives all of the relevant documentation, this documentation is sent to a separate division of the claims agent (not claims management), who then arrange an examination with an independent medical examiner in order to ascertain the degree of impairment.

Assessing an impairment claim

The degree of impairment needs to be assessed under the American Medical Association Guides to the Evaluation of Permanent Impairment – 4th Edition. Multiple physical injuries can be combined to provide an overall assessment.

It is necessary to obtain a minimum impairment of 5% which is then “read up” to 10% under the Guides.

There is a set formula under the provisions of the WIRC Act 2013 which enables a calculation of the impairment. The variable relates to the date of injury and the degree of impairment.

How large are the lump sums?

The size of lump sum payments therefore vary according to the severity of the impairment or injury. Here are some examples:

  • A worker injured within the last five years with a minimum impairment of 5% whole person under the Guides referred to can receive upwards of approximately $20,000.
  • More serious injuries can give rise to an entitlement between $100,000 and $600,000.
  • A significant shoulder injury sustained in 2017 which gave rise to a 22% whole person impairment, would result in a lump sum payment of $57,304.

Regrettably, impairment claims in relation to anxiety, depression or post-traumatic stress are more difficult to pursue as it is necessary to obtain a minimum permanent assessment of 30% pursuant to the Guides appended to the WIRC Act 2013.

In some cases, disputes as to the degree of impairment can be referred to the Medical Panel for a final and impartial decision as to the degree of impairment. Such actions are not costly to pursue if the worker’s claim is accepted which is the normal situation.

Such claims are usually resolved within 120 days once the application has been lodged.