Weekly payments for Workers Insurance

icare is committed to providing support and transition services for all those who may be impacted by limits to weekly income replacement support relating to a workplace injury under Section 39 of the NSW Workers Compensation legislation. The limits commenced on 1 January 2013 and cap income support at 260 weeks (five years). 

Medical support will continue for an additional two to five years based on each individual’s circumstances.

In 2012 there were legislative changes to the NSW workers compensation legislation.  

icare’s role is to implement these changes for the Nominal Insurer (NI) and Treasury Managed Fund (TMF) schemes. In discharging its responsibilities, icare has undertaken to offer a tailored assistance program to support people transitioning from income replacement benefits for their workplace injury.

As an injured worker, you may have questions or concerns, or have been contacted by your insurer, and would like to know what support is available for you.

We are providing assistance through trusted transition support specialists who are tasked with providing care, understanding and respect to workers as they transition. (Note: we do not provide legal advice). 

We understand how transitioning from income support may be a big change, and some people may require more tailored community support services and assistance.  

Our Workers Assistance Program, operating since April 2016, ensures people affected will be afforded every opportunity for personalised transition support.  

The program includes services that are tailored to the needs of the individual. Details of the Advisory & Assistance Service (AAS) and Community Support Service (CSS) are below.

The Community Support Services (CSS) is a community transition program to help workers link in with the community, and other social services available to them when they exit the scheme. The program delivers tailored support services, through partnerships with experienced social services providers Uniting, St Vincent de Paul Society NSW and Interact.

Under the program, impacted claimants will be referred to a dedicated resource who develops a tailored plan to link them to the services most relevant to their needs.

Support services provided under CSS include:

• Phone-based or face-to-face sessions where professional case managers help facilitate access to community-based support services, such as government housing solutions, healthcare services, financial counselling and childcare.
• Assistance with engagement with other financial support institutions to minimise disruption and ensure they transition smoothly into other forms of support where necessary. 

Workers can self-refer or be referred by their case manager to access this service by phoning: 13 47 15, (8:30am to 5pm, Monday to Friday).

Relevant union representatives:

• Unions NSW
• CFMEU NSW – Construction & General
• NSW Teachers Federation
• NSW Nurses & Midwives Association
• Public Service Association (PSA)

To find out more on these changes, what they mean for injured workers, and the State Insurance Regulatory Authority’s (SIRA) additional support options available to impacted workers, visit SIRA's website.

Workers are also within their rights to seek legal representation or have their case reviewed by contacting:

• IRO (Independent Review Office) 
• PIC (Personal Injury Commission)
• SIRA (State Insurance Regulatory Authority)

If you aren’t able to work, you’ll get whichever is the smaller amount out of:

• 95 per cent of your pre-injury average weekly earnings, minus the value of any deductible amount
• Maximum weekly compensation amount minus the value of any deductible amount.

If you are working in some capacity, or cannot find suitable work due to your injury, you’ll get the smaller amount out of:

• 95 per cent of your pre-injury average weekly earnings, minus the amount that you are earning in suitable employment or have been assessed as able to earn in suitable employment, and the value of any deductible amount
• Maximum weekly compensation amount, minus the amount that you are earning in suitable employment or have been assessed as able to earn in suitable employment, and the value of any deductible amount.

If you still can’t work due to your injury your weekly payment will be the smaller amount out of:

• 80 per cent of your pre-injury average weekly earnings, minus the value of any deductible amount, or
• The maximum weekly compensation amount minus the value of any deductible amount.

If you can work 15 hours or more a week and are working 15 hours or more a week, your weekly payment will be the smaller amount of:

• 95 per cent of your pre-injury average weekly earnings, minus the amount that you are earning in suitable employment or have been assessed as able to earn in suitable employment, and the value of any deductible amount
• Maximum weekly compensation amount, minus the amount that you are earning in suitable employment or have been assessed as able to earn in suitable employment, and the value of any deductible amount.

If you can only work less than 15 hours a week or are able to but are working for less than 15 hours a week, your payment will be the smaller amount of:

• 80 per cent of your pre-injury average weekly earnings, minus the amount that you are earning in suitable employment or have been assessed as able to earn in suitable employment, and the value of any deductible amount, or
• The maximum weekly compensation amount minus the amount that you are earning in suitable employment or have been assessed as able to earn in suitable employment, and the value of any deductible amount.

If you still can’t work, your payments will cease unless you are assessed as likely to be off work indefinitely. Then your weekly payments will be the smaller amount out of:

• 80 per cent of your pre-injury average weekly earnings, minus the value of any deductible amount, or
  The maximum weekly compensation amount minus the value of any deductible amount.

If you are working or have some capacity to work but nothing suitable is available due to your injury, then weekly payments will cease after 130 weeks unless:

• You’ve applied to your insurer for continued weekly payments

• You’re working at least 15 hours a week and earn a minimum of $202 per week (indexed annually on 1 July) and have been assessed as unable to do additional employment or work in any capacity to increase your weekly earnings.

Note that if you’re a worker with high needs (your degree of permanent impairment is greater than 20 per cent), the 15 hours and minimum weekly earnings are waivered.

If you are entitled to payments after 130 weeks they will be the lesser of:

• 80 per cent of your pre-injury average weekly earnings, minus the amount you are currently earning or have been assessed as able to earn if suitable employment were available, and the value of any deductible amount, or
• The maximum weekly compensation amount minus the amount you are currently earning or have been assessed as able to earn if suitable employment were available, and the value of any deductible amount.

Unless your level of impairment from your injury has been assessed as greater than 20 per cent, payments stop after five years.

If you’re still working in some capacity, or can’t find suitable work due to your injury, and have been assessed as having an impairment greater than 20 per cent, you’ll receive the lesser of:

• 80 per cent of your pre-injury average weekly earnings, minus the amount you are currently earning or have been assessed as able to earn if suitable employment were available, and the value of any deductible amount, or
• The maximum weekly compensation amount minus the amount you are currently earning or have been assessed as able to earn if suitable employment were available, and the value of any deductible amount

Exempt workers including police officers, paramedics, firefighters, volunteer bush firefighters and rescue volunteers have different rules.

If you have been injured in the course of employment but can return part time to work, you’ll be paid for those hours. If that means you are earning less than before your injury, you may receive ‘make up’ pay. 

This is calculated based on the difference between your average weekly earnings (including overtime, shifts, special expenses, penalty rates) minus what you can earn afterwards.

However, your make up pay can’t be more than the compensation you would receive if you were completely incapacitated.

If you are unable to work at all, the first 26 weeks will be calculated based on your current weekly wage. After 26 weeks, it is based on the statutory rate.

Current weekly wage rate is:

• 100 per cent of the rate of remuneration for one week of work (excluding overtime, shift work, payments for special expenses and penalty rates) if you are paid under an award, industrial or enterprise agreement, or if there is a relevant award that can be applied to your pre-injury position
• 80 per cent of your average weekly earnings (including regular overtime and allowances) if you are not employed under an award, industrial or enterprise agreement and there is no relevant award that can be applied to your pre-injury position.

If your current weekly wage rate is more than the maximum amount (see SIRA's Workers compensation benefits guide), your insurer will use that amount to calculate what you’re entitled to. This amount is indexed every 1 April and 1 October.

After 26 weeks of benefits, your payments may be capped at the statutory rate. The statutory rate for a single worker can also be found in SIRA's Workers compensation benefits guide (PDF, 2.3MB) and is indexed every 1 April and 1 October. There are additional weekly payments for dependents, please see the benefits guide for those additional payments (PDF, 2.3MB).

Calculating PIAWE for workers injured on or after 21 October 2019