Comcare Benefits and Entitlements

What am I entitled to? Comcare at a glance

If you are hurt or injured at work, and your Comcare claim is accepted, you are almost certainly entitled to some level of compensation.

Depending on your injury and the circumstances surrounding it, you may be entitled to various forms of compensation:

Loss of income compensation (incapacity benefits)

If you are unable to return to work, or you are partially incapacitated for work as a result of your injuries, you may be entitled to incapacity benefits.
You must submit valid medical certificates on one of the Comcare approved forms in order to claim incapacity benefits.

The table below is a guide to help you calculate your Comcare benefits:

Calculating your entitlement to incapacity benefits can be tricky. Some, but not all allowances are included. A Ryan Carlisle Thomas Comcare lawyer can provide you with advice and ensure that your incapacity benefits are being paid correctly.

Medical and like expenses

If as a result of your Comcare injuries you require treatment or assistance, you are entitled to payment of all "reasonable" medical and like expenses.

This may include:

• Surgery
• Hospital fees
• Medication
• GP visits
• Physiotherapy
• Osteopathy
• Chiropractic treatment
• Massage
• Travel to medical appointments
• Household services
• Gardening services
• Attendant care services
• Aids, appliances and modifications

Comcare lump sums and permanent impairment claims

If your work-related injury leaves you with a permanent impairment, you may be entitled to a lump sum payment under the Comcare scheme. A lump sum claim for permanent impairment is a "no fault" claim.

There are a few important things to note:

1. You cannot make a permanent impairment claim until your injuries stabilise (which is usually 6-12 months after you sustain your injury or undergo an operation).
2. In order to be entitled to lump sum compensation, your impairment must be assessed as meeting the relevant threshold. For most injuries, that threshold is 10%. Your level of impairment will be determined according to the Comcare Guides.
3. You will need to undergo a medical assessment in order for your level of impairment to be determined. Comcare and licensed employers may ask you to undergo a medical assessment by a doctor of their choosing. Remember that Comcare and licensed employers instruct lawyers to advise them. They will not necessarily offer to pay you your full entitlement at first instance. You do have a right to undergo a medical assessment with a doctor of your choosing, and there is often a significant gap between the medical assessments of their doctor and doctors we appoint.
4. Making a permanent impairment claim does not affect your right to claim incapacity benefits (loss if income compensation) or medical and like expenses. Accepting a permanent impairment lump sum does, however, extinguish your right to make a common law claim for damages resulting from employer negligence.

Calculating your entitlement to permanent impairment lump sum compensation can be tricky (see below for some examples), and resolving your claim for permanent impairment does have significant implications, so it is important to seek advice from one of an experienced Comcare lawyer about your options and rights.

How big a payout? A rough guide

Often, the first question that our Comcare compensation lawyers are asked is: "How large a sum will I get?"

Your level of impairment and other factors determine the size of a permanent impairment lump sum claim. Therefore, it is difficult to estimate how large a sum you will get, and the amounts are variable.

Here, for your use, is a rough guide to the compensation for the following levels of impairment:

• 10% – $25,000
• 15% – $40,000
• 20% – $50,000

Common Law claims and employer negligence

If your work-related injury results in death or leaves you with a permanent impairment that meets the 10% permanent impairment threshold and you can establish that your injuries were caused by the negligence of your employer or another party, you may be entitled to sue for common law damages.

Important things to note:

1. You have three years from the date of your injury within which to issue a common law claim.
2. If your work-related injury leaves you with a permanent impairment that meets the 10% permanent impairment threshold, under the Safety, Rehabilitation and Compensation Act 1988 (Cth) you will be required to choose between accepting a permanent impairment lump sum or pursuing a common law claim. You cannot pursue both claims.

Choosing between accepting a permanent impairment lump sum or pursuing a common law claim is a big decision. You cannot change your mind once a decision is made. If you are at this point, you should call us immediately for free initial advice from one of our experienced Comcare lawyers.

Compensation for death

If you are a family member of a deceased worker whose death was contributed to by their employment (and their employment is covered by the Comcare scheme), you may be eligible for a compensation payout.

The maximum lump sum compensation payment is $517,000, regardless of the size of the family. In addition to a lump sum, a weekly payment of $142 per week for dependent children may be payable, along with reasonable funeral expenses..

Can I appeal a Comcare decision?

You have a right to appeal any decision made by Comcare or your employer.

There are a number of steps in the process:

• Request reconsideration of the determination. The request must be made within 30 days of receiving the determination. At this stage, Comcare or your employer will review the determination internally.
• Wait for the reviewable decision. It is important to note that there is no time limit imposed on Comcare or your employer within which to respond.
• Lodge an application of review of the decision with the Administrative Appeals Tribunal (AAT) (if the reviewable decision affirms the original determination). The application must be lodged within 60 days of receiving the reviewable decision.
• It is important to remember that Comcare and licensed employers instruct lawyers to advise them. If you have received an adverse determination, it is vital that you contact us promptly and before the 30-day deadline. Our experienced Comcare lawyers can advise you about your potential entitlements and options, and can assist you to arrange medical assessments and gather evidence and in support of your claim.