In 2012, the NSW Government established the Workers Compensation Independent Review Office (WIRO). WIRO’s primary function is to assist injured workers in disputes with insurance companies.

Our team of Approved Legal Service Providers can obtain Independent Legal Assistance and Review Service (ILARS) grants of funding through WIRO, allowing you to obtain free and independent legal advice. This includes the costs of disbursements such as clinical notes and expert reports. This means that you won’t be out-of-pocket for any workers compensation claim or investigation. Our professional fees and disbursements incurred in assisting you will be borne by WIRO.

Exempt workers (Police Officers, Fire Fighters, Paramedics and Coal Miners) aren’t entitled to receive grants of funding through WIRO but if you’re an exempt worker, click here to see how we can assist you in your potential claim.

If you were injured in the course of your employment, the workers compensation insurer accepted liability for your claim and you have suffered a permanent impairment, you may be entitled to receive a lump sum payment as compensation.

This compensation is in addition to weekly benefits and medical expenses you may be receiving. If you obtain a lump sum amount for permanent impairment, this does not prevent you from continuing to receive payment for weekly benefits and medical expenses. Click here to read further about how we can investigate your degree of permanent impairment and see if you are entitled to lump sum compensation.

If you sustained a physical and/or psychological injury (or even multiple injuries) in the course of your employment, you must make a claim before the relevant insurer can consider accepting or declining the claim. If you have received a response from an insurer that declines your claim, please feel free to contact us to seek advice on whether you may be able to challenge the decision by the insurer.

The current Workers Compensation Legislation that deals with entitlements to weekly benefits of compensation and medical/treatment expenses can be a labyrinth to negotiate, especially without legal assistance. We have included some general guidance material here, but we would be delighted to discuss any specific enquiries with you directly.

If the claim is accepted by the insurer (and the work-related injury has resulted in a loss of earnings because you have reduced capacity for work), you may be entitled to commence receiving weekly benefits of compensation and the insurer will calculate what is known as your Pre-Injury Average Weekly Earnings (PIAWE). This calculation should be done in accordance with the relevant legislation and is based on the average of ordinary earnings, overtime, non-pecuniary benefits, as well as shift allowances.

To substantiate you have a reduced capacity or incapacity for work, you must provide a completed SIRA certificate of capacity to the insurer. Your General Practitioner (or nominated treating doctor) can assist you with completing this certificate.

The calculation of PIAWE will only include overtime and shift allowance payments during the first 52 weeks for which weekly benefits of compensation are payable.

There are various “entitlement periods” defined under the relevant legislation which attract different percentages of PIAWE the insurer is obligated to pay you for weekly benefits during each entitlement period. This is also subject to your capacity or incapacity for pre-injury employment or alternative suitable employment.

The insurer has the right to assess your capacity for work based on your functional, vocational and medical status. Based on that information, they can make a decision about your ability to return to your pre-injury employment, or to return to suitable employment with the pre-injury employer or at another place of employment. These are called “Work Capacity Decisions”.

If the insurer makes a work capacity decision that is adverse or you disagree with their decision, please contact us to see if we can assist you with challenging the work capacity decision. These decisions can be reviewed and/or disputed.

Once a workers compensation claim has been accepted, the insurer will only bear the cost of expenses for treatment or services which are reasonably necessary as a result of your injury. Accordingly, you should always get your treating practitioners to obtain the insurer’s approval for treatments before you proceed with the treatment.

Some treatments don’t require pre-approval, for example:

1. initial treatment required immediately following the occurrence of the injury;
2. consultations with your nominated treating doctor (NTD) in relation to your injury and to obtain updated Certificates of Capacity;
3. any services for the injury that are provided in the emergency department of a public hospital.

You may only claim for the cost of medical and related treatment, hospital treatment and rehabilitation services during a specific compensation “entitlement period”. The compensation period that applies to your circumstances depends on whether or not your injury has resulted in an assessed degree of permanent impairment known as a “Whole Person Impairment”.

If your work injury results in a permanent impairment assessed as 10% Whole Person Impairment or less, you may only be entitled to claim expenses for treatment provided for two years after weekly payments stop being payable OR for two years from the date of claim if no weekly payments have been made.

If your work injury results in a permanent impairment assessed as greater than 10% Whole Person Impairment, but not more than 20% Whole Person Impairment, you may only be entitled to claim expenses for treatment provided for five years after weekly payments stop being payable OR for five years from the date of claim if no weekly payments have been made.

If your work injury results in a permanent impairment assessed as greater than 20% Whole Person Impairment, you may be classified as a “worker with high needs” for the purpose of the legislation. Workers with high needs may be entitled to claim medical and related expenses for life.