All About Workers Compensation A Guide for Employees

Transcription

1 All About Workers Compensation A Guide for Employees Page 1 of 23

2 Table of Contents Disclaimer 4 Introduction 4 Who is this publication for? 4 What does the Fleetmaster scheme cover? 4 About Fleetmaster: 4 Fleetmaster Contact Details: 5 Where do I send information? 5 What Do You Do If You Injure Yourself At Work? 6 Report your injury: 6 Make a claim for compensation: 6 What claims are not paid? 6 Checklist for making a compensation claim: 7 Plan your Return to Work ( RTW ) 7 Who Does What? 8 RTWC the person at your work who helps you RTW: 8 Rehabilitation Provider the person who co-ordinates your RTW: 8 NWCCM the person you speak to about RTW: 8 NWCCM the person you speak to about benefits: 8 Medical Providers the people who co-ordinate your health care: 9 What Help Can You Get? 10 Supporting your RTW: 10 Occupational rehabilitation: 10 How do I request rehabilitation? 10 Supporting better health: 10 Medical treatment: 10 How do I claim for medical treatment? 11 Checklist for claiming medical treatment: 12 The cost of medical treatment: 12 Travel to attend medical treatment: 12 How do I claim for travel to medical treatment? 13 Checklist for claiming travel to medical treatment: 13 Supporting you at home: 13 Household services: 13 How do I claim for household services? 14 Checklist for claiming household services: 14 Attendant care: 14 How do I claim for attendant care? 15 Checklist for claiming personal care: 15 Alterations, modifications, aids or appliances: 15 How do I claim for alterations, modifications, aids and appliances? 15 Checklist for claiming for alterations, modifications, aids and appliances: 16 Page 2 of 23

3 Income Support 17 What is a weekly payment? 17 How are my periods of incapacity added up? 17 What happens if I require short-term compensation leave? 17 What happens if I require long-term compensation leave? 17 What about when I reach age 65? 18 Other factors: 18 How do I claim weekly payments? 18 When are my weekly payments updated? 18 How does the payment of compensation leave affect the accrual of other leave? 19 Checklist for claiming weekly payments 19 Redemption payment 19 How do I claim for a redemption payment? 20 Permanent impairment payment 20 How do I claim for permanent impairment? 20 Checklist for claiming for permanent impairment: 20 What happens if I die while receiving compensation? 21 How to claim for death benefits 21 What Happens Once I Make Any Type Of Claim? 22 How long will it take for Fleetmaster to make a decision? 22 What if I do not agree with Fleetmaster s decision? 22 How does Fleetmaster protect my privacy? 22 Access to your Fleetmaster records: 22 What if I want to travel overseas? 22 What if I take legal action against my employer or another third party? 23 What changes should I let Fleetmaster know of? 23 Do you want any further information? 23 Page 3 of 23

4 Disclaimer Fleetmaster Services Pty Ltd This publication is intended to provide only a summary and general overview of matters of interest. It is not intended to be comprehensive and is not a substitute for independent professional advice. Please contact an appropriate qualified professional person before relying on the contents of this publication. Fleetmaster Pty Ltd ( Fleetmaster ), its officers, employees and agents expressly disclaim liability and responsibility in respect to, and accept no responsibility for, the consequences of anything done or omitted to be done to any person in reliance, whether wholly or partly, upon this publication, including but not limited to the results of any action taken on the basis of the information in this publication and the accuracy, reliability, currency or completeness of any material contained in this publication. Introduction Who is this publication for? Fleetmaster has provided this Booklet for their employees who are injured in the workplace after 1 April It explains what help is available and outlines how to make a claim. If you were injured before 1 April 2009, you should contact Fleetmaster for information regarding your claim. (See below for contact details) What does the Fleetmaster scheme cover? Fleetmaster safety, rehabilitation and compensation scheme provides help with: returning you to work; costs of medical treatment; income support; support at home; and death benefits. About Fleetmaster: Fleetmaster oversees safety, rehabilitation and compensation services for employees under the provisions of: The Occupational Health and Safety (Commonwealth Employment) Act The Safety, Rehabilitation and Compensation Act 1988 ( SRC Act 1988 ). Page 4 of 23

5 Fleetmaster Contact Details: National Workers Compensation Claims Manager Phone: (02) Office hours: 8.30am to 5.00pm AEST Monday to Friday After hours: Mobile Postal address: PO Box 5111, Port Macquarie NSW Jindalee Road, Port Macquarie NSW address: Where do I send information? You should send all information and claims to: Workers Compensation Insurance Department ( WCID ) Fleetmaster Services Pty Ltd PO Box 5111 Port Macquarie NSW 2444 Page 5 of 23

6 What Do You Do If You Injure Yourself At Work? Report your injury: You should report any accident or injury to: Amanda Allen Jan Riley RTW Co-ordinator ( RTWC ) National Workers Compensation Claims Manager ( NWCCM ) Phone: Phone: Mobile: Mobile: Make a claim for compensation: You can claim compensation if your injury occurred while: you were at work (including normal work breaks such as lunch on the worksite); attending work related activity associated with employment; travelling on an approved work activity; at a place of education (except while on leave without pay); while travelling between place of work and a place of education; obtaining a medical certificate (for the purpose of this Act); or receiving medical treatment for an injury or undergoing a rehabilitation program or undergoing a medical examination or rehabilitation assessment (provided under this Act). You can claim compensation for a disease that was contributed to a significant degree by work. What claims are not paid? Although most work-related injuries or diseases are payable under the SRC Act 1988, it does not cover: disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner in respect of the employees employment; wilful and false representation; an injury that occurred during travel between the employees residence and the employee s usual place of work; travelling to or from, or attending a place of education whilst on leave without pay; an injury that is self-inflicted; an injury that is caused by your serious and wilful misconduct (except where the injury results in death or serious and permanent impairment); and voluntarily and unreasonably submitting to an abnormal risk of injury. (Note: a person who is under the influence of alcohol or a drug, other than a prescribed drug correctly taken, shall be taken to be guilty of serious and wilful misconduct.) Page 6 of 23

7 Checklist for making a compensation claim: 1. Notify your Supervisor and/or your RTWC; 2. See a medical provider; 3. Get a medical certificate, stating a precise diagnosis, from your medical provider*; 4. Get a claim for workers compensation form from your Supervisor or RTWC; 5. Complete the form and attach your medical certificate; and 6. Give the form to the WCID. *If you are only claiming for medical treatment by a treating registered chiropractor, osteopath, physiotherapist, masseur, occupational therapist, optometrist, psychologist or speech therapist, a medical certificate from a doctor is not required. In such a case, a certificate from the provider is enough for a claim to be compliant. If you wish to claim other benefits, such as incapacity payments or permanent impairment, you will need to provide appropriate medical evidence from a doctor. Plan your Return to Work ( RTW ) You should start planning your RTW as soon as possible following your injury. The RTWC will help you. Your RTWC will work with you in formally planning your RTW. A Rehabilitation Provider may also be involved. Remember, if you need help to complete your claim form you can ask your Supervisor or RTWC. Page 7 of 23

8 Who Does What? RTWC the person at your work who helps you RTW: Fleetmaster Services Pty Ltd Your RTWC s job is to help you get back to work. If you have been, or are likely to be, away from work for more than 5 days, the NWCCM may arrange for a Rehabilitation Provider to do an assessment for a return to work program ( RTW Program ), and then organise a RTW Program if necessary. Your RTWC will put any decisions in writing for you about a rehabilitation assessment or return to work plan ( RTW Plan ). Your RTWC will work with you, your treating doctor, your Supervisor at work and your Rehabilitation Provider to make sure you are given suitable duties. Rehabilitation Provider the person who co-ordinates your RTW: The Rehabilitation Provider is engaged by WCID to provide expert services like a rehabilitation assessment and a graduated RTW Program. They provide objective advice to your RTWC about your needs and assess the value and type of RTW Plan. They are health professionals who have specialised in occupational rehabilitation. They include occupational therapists, occupational physicians, rehabilitation counsellors, psychologists, physiotherapists, speech pathologists and social workers. Your Rehabilitation Provider may consult with your treating doctor to assist your return to suitable duties. Your Rehabilitation Provider must be approved by Fleetmaster to provide rehabilitation services. This means they are familiar with the Fleetmaster RTW model and are subject to standards imposed by Fleetmaster to provide a high quality service. NWCCM the person you speak to about RTW: Your NWCCM is to assist RTWC s and the injured employee RTW as soon as possible within the limits of their medical restrictions. The purpose of all rehabilitation treatments is centred towards an RTW Plan that will have you back to full time employment in your pre-injury position. NWCCM the person you speak to about benefits: Your NWCCM s job is to make sure you receive your correct entitlements under the SRC Act It is important to note that your NWCCM has no role in deciding what treatment you should or should not receive for your injury. This is the role of your treating medical practitioner. Your NWCCM s role Page 8 of 23

9 is to decide whether payment for such treatment should be reimbursed to you as part of your compensation claim. Medical Providers the people who co-ordinate your health care: There are two groups of medical providers defined under the SRC Act The first group are legally qualified medical practitioners. This group includes general practitioners, specialists (such as orthopaedic surgeons, neurologists and psychiatrists) and dentists. Legally qualified medical practitioners provide and refer you for treatment. They can also assess your capability to RTW, provide advice on alternative duties or workplace modifications, and certify you unfit for work. The second group of medical providers includes physiotherapists, chiropractors, osteopaths, dieticians and massage therapists. These providers are able to provide treatment, but are unable to certify you as unfit to work. Page 9 of 23

10 What Help Can You Get? Supporting your RTW: Fleetmaster supports your RTW by paying the cost of approved occupational rehabilitation programs. It is a requirement of the SRC Act 1988 that the NWCCM, in conjunction with the RTWC at your current place of employment, manages the overall rehabilitation process. If you are no longer employed, Fleetmaster is still responsible for supporting your rehabilitation. Occupational rehabilitation: Occupational rehabilitation is a process undertaken by a professional Rehabilitation Provider. It is aimed at maintaining you in, or returning you to, suitable employment. The NWCCM will engage the professional provider. A Rehabilitation Provider must be approved under the Safety, Rehabilitation and Compensation Act The Rehabilitation Provider will discuss your RTW Program with you, your doctor and your employer. If you are involved in a RTW process you must follow the course set out in the written RTW Plan. How do I request rehabilitation? You should first discuss your RTW prospects with your medical provider. If they agree that you have the ability to RTW you should then contact your employer requesting a rehabilitation assessment. The NWCCM should co-ordinate your assessment and provide you with a written advice about any rehabilitation program proposed. Supporting better health: You should discuss your medical treatment needs with your medical provider to establish a treatment plan. Such a plan sets out what types of treatment you should seek, how often and for how long. Fleetmaster aims to support you to achieve better health if you suffer from a work-related injury or illness. Fleetmaster helps by reimbursing reasonable medical, hospital, pharmaceutical and other treatment costs that are related to your work-related injury or illness. Medical treatment: The range of medical treatment that Fleetmaster may approve payment for is quite broad. The most usual is medical treatment provided by a legally qualified medical practitioner (your doctor). It is also treatment, examinations or tests, like pathology or x-rays, done under their supervision or at their direction. Page 10 of 23

11 Medical treatment includes surgery, hospitalisation and the prescription of medicines or medical aids such as glasses, orthopaedic shoes or artificial limbs which are directly related to your work-related injury or illness. Medical treatment covers treatment performed by dentists. It also includes treatment given for the purpose of easing the work-related injury or illness by registered physiotherapists, osteopaths, chiropractors or masseurs. However, if you get physical therapies, Fleetmaster will not usually pay for such treatments from two or more medical providers at the same time. As a general rule, Fleetmaster does not pay for physical treatment for nonphysical injuries. You must obtain Fleetmaster approval before you are admitted to hospital for an operation. How do I claim for medical treatment? Fleetmaster has no role in deciding what treatment you should or should not receive. Our role is simply to decide whether Fleetmaster should reimburse you for such treatment as part of your compensation claim. There are three factors that guide Fleetmaster in making a decision relating to the payment of medical treatment: whether the treatment constitutes treatment as defined by the SRC Act 1988; whether it is reasonable; and whether it is related to your work-related injury or illness. Your treating medical provider should outline a treatment plan aimed at alleviating your condition. This should include the: treatment needed; frequency of treatment; how long you will need this treatment for; and relationship of treatment to your work-related injury or illness. You should forward the treatment plan to Fleetmaster. Most doctors will include the treatment you require on their medical certificate. Your NWCCM will write to you if items included on the treatment plan do not fit under the SRC Act You or your medical provider can send invoices for approved medical treatment directly to Fleetmaster. Fleetmaster will usually make payments within 28 days from receiving the invoice. You will receive a written notice if Fleetmaster will not meet the costs of the medical treatment. You will have to pay for any medical treatment you receive that Fleetmaster decides is not payable under the SRC Act Page 11 of 23

12 If the cost of the treatment is high, or the type of treatment is unusual, you should get written approval of payment for such treatment from Fleetmaster before undertaking the treatment. You should seek advance payment approval for treatments such as surgery, hospital admissions, costly tests like an MRI, types of treatments not usually related to your accepted condition or when you require medical aids and appliances. To obtain advanced payment approval, you will need to have your doctor or specialists provide a note outlining the: treatment needed; frequency of treatment; and relationship of treatment to your work-related injury or illness. Your NWCCM will write to you, or your doctor, within 28 days advising of a decision on payment or reimbursement of the costs or asking for further information that WCID may need. Checklist for claiming medical treatment: 1. Speak to your NWCCM or Supervisor. 2. Discuss treatment options with your medical provider. 3. Get a written treatment plan from your medical provider. 4. Send treatment plan to WCID. 5. Get written payment approval from WCID for high cost or unusual treatment. 6. Send invoices or receipts to WCID for payment or reimbursement. The cost of medical treatment: For many treatment types, WCID has established an appropriate payment limit. These payment limits are based on rates set by the various professional associations, such as the Australian Medical Association (AMA). You should ask your medical provider whether they charge more than the WCID limit. The fee details used by WCID are available on Comcare website In certain circumstances, WCID may reimburse more than the stated limit. An example of this would be where you live in a remote location and only have access to treatment practitioners who charge more than the certified limit. Travel to attend medical treatment: WCID may reimburse costs related to travel to medical treatment in the following cases. Your condition reasonably requires you to use an ambulance or public transport, including a taxi. Page 12 of 23

13 You use your motor vehicle for travel to and from medical treatment and the distance travelled for any one-treatment session is more than 50 kilometres for the round-trip. WCID will not reimburse the cost of travel in your own vehicle to treatment that is less than a 50 kilometre round trip. WCID will not normally pay for travel if the type of treatment is available from another medical provider who practises within the 50 kilometre limit. If you have used public transport to reach your medical treatment, WCID may reimburse the reasonable costs of that transport. You will need to provide receipts with your medical certificate. If you have used a private motor vehicle, WCID will pay a specific rate per kilometre travelled. This rate is updated from time to time. How do I claim for travel to medical treatment? You must give your NWCCM a medical certificate supporting the need to use public transport, and evidence of attendance at the treatment. Checklist for claiming travel to medical treatment: 1. Discuss your transport needs with your medical provider. 2. If your medical provider believes your work-related condition requires you to travel to treatment on public transport, obtain a certificate from them stating this need. 3. Send the certificate from your medical provider to your RTWC and WCID, together with evidence of your attendance at the treatment and receipts for your travel. Supporting you at home: Fleetmaster understands that a serious work-related injury may make it difficult for you to cope with home duties. To assist you, we may reimburse certain costs associated with helping you manage with day-to-day activities. The amount of reimbursement given by Fleetmaster is limited by the SRC Act Household services: Household services are services of a domestic nature needed for the proper running and maintenance of your household. Household services may include cooking, house cleaning, laundry and gardening services. They are services that you are no longer able to undertake as a result of your work-related injury or illness. Fleetmaster would not normally pay for services that it is reasonable to expect other members of the family to undertake, even if the family members did not normally undertake those tasks prior to your work-related injury or illness. Page 13 of 23

14 Payment for household services is subject to two limits. The first is a weekly maximum limit. This limit is updated annually. The second is a maximum hourly rate payable to providers of the service. WCID will let you know the amount if household services are approved. How do I claim for household services? You will need a medical certificate from your treating doctor confirming your need for this help. WCID provides a form for you and your medical provider to complete. You can get this form from WCID. In some cases your NWCCM may ask an occupational therapist to carry out an assessment in your home. WCID will provide a written approval setting out the number of hours and types of help that have been approved. Fleetmaster will not reimburse you for the following services: painting and decorating; washing, servicing, repairing or maintaining family vehicles; repairing fences, doors and windows; plumbing; or electrical repairs. Checklist for claiming household services: 1. Get the home help form from your RTWC. 2. Take the form to your medical provider and discuss your requirements. 3. Have your medical provider and Rehabilitation Case Manager complete the form. 4. Return the form to your RTWC. 5. Once you have received written approval from WCID you can send the invoices or receipts to WCID. Attendant care: In some circumstances, you may be eligible for help with the cost of attendant care services. These are services of a personal nature and include things like help with washing and dressing. The personal help must be needed as a result of your work-related injury or illness. Payment for attendant care is subject to a weekly maximum limit. This limit is updated annually. Page 14 of 23

15 How do I claim for attendant care? You will need to get a medical certificate from your treating doctor confirming your need for this help. Fleetmaster also provides a form for you and your medical provider to complete. In some cases WCID may ask an occupational therapist to carry out an assessment in your home. WCID will give you a written approval setting out the number of hours and types of help that have been approved. Checklist for claiming personal care: 1. Get the attendant care form from your RTWC 2. Take the form to your medical provider and discuss your needs. 3. Have your medical provider complete the form. 4. Return the form to your RTWC. 5. Once you have received written approval from WCID you can send the invoices or receipts to WCID. Alterations, modifications, aids or appliances: WCID will consider financial help with essential home, workplace and car modifications. These must be needed as a result of your work-related injury or illness. WCID may also meet the cost of providing, repairing or replacing any aid or appliance that you reasonably need as a result of your work-related injury or illness. Aids and appliances can include items such as backrests, telephones for the visually impaired, door openers and angled writing boards. General household items such as toasters, food processors, vacuum cleaners and dishwashers are not considered to be aids and appliances payable by WCID. For WCID to consider this type of help, you must be undertaking, have completed or have been assessed as not capable of undertaking a rehabilitation program. How do I claim for alterations, modifications, aids and appliances? You should first discuss your needs with your medical provider and Rehabilitation Provider (if you have one). Fleetmaster also provides a form for you and your medical provider to complete. As the costs associated with alterations or aids can be high, you should get approval before going ahead with any purchase. To get advance approval from Fleetmaster you will need to write to WCID outlining your needs and have your doctor or specialist provide a note outlining: the modification or aid needed; and Page 15 of 23

16 the relationship to your work-related injury or illness. Your NWCCM will write to you or your doctor within 28 days advising of a decision or asking for more information. You will need to give WCID two or three quotes from builders or suppliers. WCID will then examine the quotes and will let you know the cost that has been approved. In some cases WCID may decide that suitable alternatives are available and that the cost of the alternatives will be met. WCID s responsibility for modifications or aids ends with payment of the reasonable cost. You, your builder or supplier is responsible for obtaining any approvals, permits or permission before undertaking any modifications or purchases. Checklist for claiming for alterations, modifications, aids and appliances: 1. Get the aids and appliances claim form from your RTWC. 2. Take the form to your medical provider and discuss your needs. 3. Have your medical provider complete the form. 4. Return the form to your RTWC. 5. Once you have received written approval from WCID for the aid, appliance or modification, obtain quotes and send them to WCID. 6. Obtain any other approvals, permission, permits or permission needed for the modification, aid or appliance. 7. Purchase the aid, appliance or modification. 8. Send invoices or receipts to WCID. Page 16 of 23

17 Income Support Fleetmaster Services Pty Ltd Under the SRC Act 1988 you may be entitled to receive income support while you are unable to work as a result of your accepted work-related injury or illness. What is a weekly payment? A weekly payment compensates you for your loss of income as a result of a work-related injury or illness. This is not a pension. It is aimed at compensating you for your loss of income until you RTW or until you recover from your work-related injury or illness. The method used to calculate your rate of payment is set out in the SRC Act 1988, and depends on a number of factors, including: your normal weekly earnings (NWE); any amount you are able to earn (AE); the length of time you are unfit to work; and whether your loss of income is before or after the first 45 weeks of incapacity. How are my periods of incapacity added up? Any period of approved compensation leave is added to an overall total. This total can either be consecutive weeks, or any number of short periods of compensation leave. For example: If you are absent from work on compensation leave for 2 weeks, you will have two weeks counted towards your compensation leave balance, or If you are working 30 hours per week and you normally work 40 hours per week, you will have 10 hours per week counted towards your compensation leave balance. What happens if I require short-term compensation leave? If you sustain a work-related injury, you may require a short period of compensation leave. If this is the case, compensation would be payable at a rate equal to 100% of your normal weekly earnings, less any amount you are actually earning, for periods of compensation leave up to a total of 45 weeks. What happens if I require long-term compensation leave? As a result of your work-related injury you may require a longer period of compensation leave. After a total of 45 weeks, your compensation is calculated based on the percentage of normal weekly hours you worked during the week, and subject to statutory limits. These percentages are: Page 17 of 23

18 % Normal Weekly Hours Worked % NWE Limit Compensation Payable Not working 75% 75% NWE 25% or less 80% 80% NWE - AE More than 25% but not more than 50% 85% 85% NWE - AE More than 50% but not more than 75% 90% 90% NWE - AE More than 75% but less than 100% 95% 95% NWE - AE 100% 100% 100% NWE - AE What about when I reach age 65? The SRC Act 1988 states that weekly payments stop when you reach 65 unless: You are aged 63 or over - you are able to access a maximum of 104 weeks incapacity, or Turning 65 years of age will NOT affect your other entitlements under the SRC Act 1988, such as medical treatment and attendant care. Other factors: When assessing your weekly payments, WCID must take into account: any government-financed portion of your superannuation, if you receive it, that resulted from your injury; and your ability to earn income from other employment, including self-employment. In some cases employees who were earning high incomes before their work-related injury or illness will be subject to a maximum limit to their weekly payments. The upper limit is reviewed four times a year. Other employees who were on very low incomes before their work-related injury may have increased payments in line with minimum earnings entitlements. The minimum earnings rates are updated annually in line with other Fleetmaster rates. How do I claim weekly payments? For long-term payments Fleetmaster will need regular medical certificates from your doctor confirming your inability to work as a result of your work-related injury or illness. From time to time Fleetmaster may also ask you to state whether you have been working or have undertaken other activities that should be taken into account when deciding your benefit rate. When are my weekly payments updated? Page 18 of 23

19 Your weekly payments are based on your normal weekly earnings. While you are an employee of Fleetmaster, your weekly earnings change in line with changes at your workplace. If Fleetmaster no longer employs you, your normal weekly earnings are updated by using the Australian Bureau of Statistic s Labour Price Index on 1 July each year. Other times that your weekly payments will change are when: your superannuation, if you are receiving it, changes; your earnings change; or statutory rates, if they apply, change. You will receive a written Determination when WCID has decided your weekly benefit. The Determination will include the amount payable, a start date and an end date. The end date up to which the benefit is to be paid does not mean that the benefit will automatically stop at that time. Fleetmaster will let you know in advance and in writing if an ongoing payment is to stop. How does the payment of compensation leave affect the accrual of other leave? If an injured employee is receiving compensation for incapacity, the accrual of their sick leave and recreation leave may be affected. Checklist for claiming weekly payments 1. Get a regular medical certificate from your medical provider. 2. Get details, including wages and hours for any employment (including self or voluntary employment) you are undertaking. 3. Send medical certificate and wage details to your RTWC. Redemption payment If you are in receipt of a weekly payment from Fleetmaster and if that payment is less than a certain threshold amount you must convert your weekly payments to a lump sum payment. This is called a redemption payment. It means instead of being paid weekly payments, you receive your future weekly payments in a one-off lump sum payment. The redemption threshold amount is updated each year in line with other Fleetmaster rates. The current rate is available by phoning WCID. Fleetmaster will only award a redemption payment if the level of your inability to work is unlikely to change. A redemption payment does not affect the payment of other forms of help and entitlements such as medical treatment. According to the Australian Tax Office, any part of the lump sum redemption that includes weekly payments that would have been made to you before you reach age 65 is subject to taxation. The Page 19 of 23

20 part of the lump sum redemption of weekly payments after you reach age 65 is not subject to taxation. This information is based on advice we have received from the Australian Taxation Office. You should seek up-to-date advice from them if you are to receive a redemption payment. How do I claim for a redemption payment? Your NWCCM will let you know if a redemption payment must be made. Permanent impairment payment If your work-related injury or illness results in a permanent impairment, you may be entitled to claim a lump sum payment. Impairment includes hearing loss. A permanent impairment is one that is likely to continue indefinitely. In most cases, to be eligible for a permanent impairment payment a doctor must assess you as having a permanent impairment that affects at least 10% of your whole person. Permanent impairment lump sums must be assessed according to Comcare s Guide to the degree of permanent impairment. The guide tells a doctor how to make an assessment and what the different impairments are for the full range of bodily systems and functions. You can view it on the website, A permanent impairment payment does not affect other help and benefits provided by Fleetmaster. How do I claim for permanent impairment? To claim a permanent impairment you should first get the Compensation claim for permanent injury form from Fleetmaster NWCCM. You should take this form to your treating medical provider to complete the relevant sections. Your doctor should indicate whether you suffer impairment as a result of your work-related injury and whether your impairment is permanent. Once your medical provider has completed the form, return it to WCID. WCID will then assess your application and let you know whether you qualify for an assessment of your level of impairment and what you should do next. Assessment for a permanent impairment will normally include an assessment by a medical specialist to determine the percentage of your impairment. WCID will ask you to complete a questionnaire about the effect of your work-related injury or illness on your life. WCID will let you know in writing whether you are entitled to a lump sum, the percentage impairment and the amount of compensation that will be paid. Assessment of a permanent impairment is not a quick process. It usually takes about six months to a year to complete the process. Checklist for claiming for permanent impairment: Page 20 of 23

21 1. Get a Compensation claim for permanent injury form from WCID. Take the form to your medical provider, discuss your needs and have your medical provider complete the form. 2. Send the form to WCID. 3. If requested by WCID, attend a medical examination by an independent medical specialist. 4. Complete the questionnaire when requested by WCID. 5. WCID will let you know of any compensation payable. What happens if I die while receiving compensation? When an injured employee in receipt of weekly payments dies, their weekly payments cease. WCID should be notified immediately to prevent any overpayment. In the event of an overpayment of compensation, WCID is obliged by law to recover the money from the estate of a deceased person. If the death is a direct result of a work-related injury or illness, compensation may be payable to the dependants of the deceased person. This may include: a lump sum payment to dependants. weekly payments for each dependant child who was a dependant of the employee at the date of death and is under the age of 16, or aged between 16 and 25 and receiving full-time education and not working. help with funeral expenses. How to claim for death benefits A claim for the death of an employee should be lodged on the form available from Fleetmaster WCID. The person claiming, usually a relative should attach the following documents to that claim: a copy of the death certificate; and if there are dependants, a copy of the marriage certificate for a spouse and birth certificates for children. Fleetmaster may need to get additional information about the deceased s employment and ask for medical reports about the deceased s work-related injury or illness. The NWCCM will write to the person who made the claim within 28 days of WCID receiving the claim. They will advise them what decision WCID has made, or explain what further investigation or information they need. Page 21 of 23

22 What Happens Once I Make Any Type Of Claim? How long will it take for Fleetmaster to make a decision? Fleetmaster will give you a written answer to your claim within 28 days of receipt. If the answer is a decision on your claim (called a Determination by WCID), it will include advice that explains what you need to do if you do not agree with the decision. What if I do not agree with Fleetmaster s decision? If you do not agree with the Determination, you may request a review of the Determination. The request for review must be in writing, detail the reasons for the request and sent to the WCID within 30 days of the original Determination. The request for review will then be referred to Fleetmaster s nominated independent review office. The independent review officer will consider all the information available and advise all parties of the outcome of the review. Should you disagree with the independent review officer s decision, you may then apply to the Administrative Appeals Tribunal. An application to the Administration Appeals Tribunal may not be made until you have received a copy of the review officer s decision in writing. How does Fleetmaster protect my privacy? WCID undertakes the collection, storage and release of information in accordance with the privacy principles set out in the Privacy Act 1988 and the Privacy Amendment, (Private Sector) Act of A copy of Fleetmaster s privacy policy is available by telephoning WCID (02) Access to your Fleetmaster records: If you want copies of documents held on your claim file, write to WCID asking for the documents you need. You may ask for other Fleetmaster information under the Freedom of Information Act You may have to pay for FOI requests. What if I want to travel overseas? If you are receiving weekly payments from Fleetmaster and decide to travel overseas, you should let your NWCCM. Penalties apply in certain circumstances if you do not tell Fleetmaster that you are leaving the country. Page 22 of 23

23 What if I take legal action against my employer or another third party? If you have a claim with Fleetmaster and you or a dependant takes legal action against a third party, your employer or another employee, you must advise WCID of this action. There are penalties that apply if you do not do this within seven days of starting the action. If you are paid damages as a result of your injury, you must let WCID know within 28 days of receiving the damages payment. Penalties apply if you do not notify WCID of the payment within that time. Fleetmaster is required to recover compensation that we paid in relation to your work-related injury or illness from any damages you receive. What changes should I let Fleetmaster know of? You should write to Fleetmaster about any of the following changes in your circumstances: change of address; change of name; change of bank details (if you receive weekly payments from Fleetmaster); engaged in any employment; or you receive a pension, allowance or benefit. Do you want any further information? If you would like any further information on any of the topics covered in this Booklet, please telephone Fleetmaster Services Pty Ltd Workers; Compensation Insurance Department on and ask to speak to your Fleetmaster National Workers Compensation Claims Manager. Page 23 of 23