A huge mistake: Taking the WorkCover QLD lump sum payments without legal advice

Experiencing a work-related injury can be a life-altering event, especially when it leads to permanent impairment. In Queensland, WorkCover QLD plays a pivotal role in this journey, offering compensation in the form of a lump sum payment. However, the process and your options can be complex. It’s crucial to understand your rights and the decisions you make can have long-lasting impacts. This comprehensive guide aims to demystify the process, helping you to make informed decisions and secure the compensation you rightfully deserve.

1. When will WorkCover Weekly Payments End?

WorkCover weekly payments provide crucial financial support to workers injured on the job. But it’s important to know when these payments might cease. According to Queensland’s Workers Compensation and Rehabilitation Act, several factors influence this.

1.1 Criteria for Stopping WorkCover Weekly Payments

• End of Incapacity: Payments stop if the work-related injury no longer incapacitates the worker.
• Duration Limit: A maximum of 5 years of payment is allowed for incapacity.
• Maximum Compensation Limit: Payments cease upon reaching the pre-set maximum allowable amount.

1.2 When Do Medical Expense Payments Stop?

Further, your entitlement to medical expense payments ends when:

• Concurrent with Weekly Payments: The termination of your weekly compensation payments typically signifies the end of medical expense coverage.
• Medical Assessment: If a registered medical professional determines that your injury no longer requires further treatment or hospitalization, your entitlement to these payments ends.

1.3 In Simple Terms

In essence, WorkCover weekly payments may end when:

• Your injury heals.
• You’ve received payments for five years.
• The total compensation hits its maximum limit.

2. How to get your WorkCover Notice of Assessment?

Under Section 178 of the Workers Compensation and Rehabilitation Act 2003, any worker with an approved compensation claim has the right to an independent medical evaluation through WorkCover. This assessment determines the existence and extent of permanent impairment resulting from work-related injuries.

WorkCover may not always inform you of your right to be formally assessed for a Degree of Permanent Impairment (DPI) score, and you may need to request it. As long as you have made a valid workers’ compensation claim, you are entitled to ask WorkCover to conduct a formal assessment to determine if your injury has caused you a degree of permanent impairment and, if so, to what extent.

We strongly advise that this assessment request be made through your legal representative. This ensures that WorkCover acknowledges the necessity of the assessment and avoids common pitfalls, such as WorkCover prematurely declaring that ‘the claim is already closed’. This practice is in contradiction to Section 179 of the Workers Compensation and Rehabilitation Act 2003, which mandates the insurer to organise an assessment upon receiving a request.

Additionally, if a request for assessment is not made within three years of the event causing the injury, you might not be able to make a common law claim (this is when the claimed amount is much higher)!

In essence, after your injury, WorkCover will assess if you have a permanent impairment. It’s crucial to ask for this assessment through a lawyer to ensure it’s done correctly.

3. Degree of Permanent Impairment 

3.1 Why Does It Matter?

As highlighted earlier, WorkCover QLD considers offering a lump sum payment only if an individual has sustained a permanent impairment. To clarify, a permanent impairment refers to an injury that has reached its maximum level of recovery and is not expected to improve further with medical treatment or rehabilitation. Such injuries can result in:

• Reduced or lost functionality of a body part,
• Complete loss of a body part, or
• Psychological incapacitation.

3.2 Assessment Process

To assess the extent of your permanent impairment, WorkCover QLD will arrange for an evaluation by independent medical examiners. These professionals determine if your injury has stabilized (reached a state of being stable and stationary) and whether you have attained maximum medical improvement. If so, they will assign a Degree of Permanent Impairment (DPI). Following this evaluation, a Notice of Assessment is issued. It’s important to note that the assigned DPI can sometimes be as low as 0%, indicating ineligibility for a lump sum compensation offer.

3.3 Critical Next Steps

Regardless of the degree of permanent impairment (DPI) indicated in your Notice of Assessment, it’s imperative to consult with a legal expert before accepting any offer. This step is crucial as it ensures you fully understand your rights and the implications of the assessment. At Ascent Lawyers, we specialize in guiding clients through this pivotal phase. Our expertise can help you navigate the complexities of your claim and ensure that your interests are effectively represented.

4. Lump Sum Payment Calculation

The Degree of Permanent Impairment (DPI) indicated in your Notice of Assessment plays a pivotal role in determining the lump sum payment you might receive. This calculation varies depending on whether your DPI is above or below 30%. We will explain what this means for you in detail.

4.1 If your DPI is lower than 30%

For DPIs below 30%, excluding certain chronic conditions like pneumoconiosis, the lump sum is calculated by multiplying the DPI by a specific maximum amount. This amount is defined under Section 140 of the Workers Compensation and Rehabilitation Act 2003 as 216.15 times Queensland’s full-time adult Ordinary Time Earnings (QOTE), as determined by the Australian Statistician.

As of January 1, 2023, the QOTE value is $1,671.40. (Please note that the QOTE is updated annually, usually on July 1st). Therefore, the maximum statutory compensation amount is $361,273.10 ($1,671.40 x 216.15). This translates to $3,612.73 for each 1% of DPI.

To help you understand the potential lump sum offers, we have prepared a table below:

4.2 If the DPI is higher than 30%

For DPIs of 30% or higher, the same rights apply as those listed above, with an added lump sum payment based on a specific scale outlined in Schedule 3 of the Workers’ Compensation and Rehabilitation Regulation 2014.

Below is a table to help you understand the potential lump sum payments:

5. Understanding Your Options After Receiving a DPI Assessment

5.1 Making an Informed Choice

Your options post-DPI assessment largely depend on the DPI rating itself. This decision — whether to accept a lump sum payment from WorkCover QLD or to pursue a common law claim — is crucial and requires a thorough understanding of each path.

5.2 Options Based on Your DPI

1. DPI Lower Than 20%:
   • Accept the Lump Sum Offer: You can choose to accept the WorkCover lump sum payment, which finalizes your claim.
   • Pursue a Common Law Claim: Alternatively, you can opt for a common law claim. This path is irreversible once chosen.
2. DPI Higher Than 20%:
   • Dual Option: In this scenario, you have the flexibility to both accept the lump sum offer and pursue a common law claim simultaneously.

5.3 Why Consider a Common Law Claim?

A common law claim often results in significantly higher compensation, especially when factors like pain, suffering, and loss of income are taken into account.

5.4 Timeline to Decide

After receiving your Notice of Assessment, which includes the lump sum offer, you have a 20-business-day window to make your decision. If you don’t respond within this period, the offer is automatically deferred.

6. The Significance of a Common Law Claim

6.1 Eligibility Criteria

It is important to note that not every individual is eligible to make a common law claim. Such a claim is viable only if there is evidence of your employer’s negligence leading to your workplace injury. Establishing this link between your employer’s actions (or lack thereof) and your injury is crucial for proceeding with a common law claim.

6.2 Why Consider a Common Law Claim?

Opting for a common law claim can potentially result in a higher compensation amount compared to a standard lump sum payment. This is because common law claims take into account a broader range of factors affecting your life and livelihood post-injury. These factors include:

• Pain and Suffering: Compensation for your injury is closely linked to the Degree of Permanent Impairment (DPI). This takes into account the physical and emotional impact of your injury.
• Past Loss of Income: This covers the income you’ve lost due to your injury and the time taken for recovery.
• Future Loss of Income: It estimates the income you might not be able to earn from the resolution of your claim until your expected retirement.
• Future Out-of-Pocket Expenses: This includes anticipated costs for medical care, hospital visits, rehabilitation, medication, and travel related to your injury.

6.3 In Essence

A common law claim offers a pathway to compensation if your employer’s fault in your injury can be demonstrated. It not only acknowledges the immediate impact of your injury but also considers its long-term effects on your financial and personal well-being.

Considering the complexities involved in common law claims, it is highly recommended to seek professional legal advice. At Ascent Lawyers, we specialize in navigating these claims and can help ensure that your rights are fully protected and advocated for.

7. Comparing Lump Sum and Common Law Claims: A Real-Life Case Study

7.1 Background

To emphasize the importance of making informed decisions in workers’ compensation cases, let’s consider the real-life example of Frank Mills. In October 2014, Frank sustained neck and right shoulder injuries while working for BHP. After his claim with WorkCover QLD, Frank was assigned a 12% Degree of Permanent Impairment (DPI).

7.2 Decision Point

Frank was offered a lump sum payment of $36,886.20 based on his DPI. Being below 20%, he faced a choice: accept the lump sum or pursue a common law claim. Frank chose the latter, seeking the assistance of a solicitor.

7.3 Outcome Comparison

• Lump Sum Offer: $36,886.20
• Common Law Claim Settlement: $1,013,131.89

The disparity is stark: by opting for a common law claim, Frank secured an additional $976,245.69, nearly a million dollars more than the initial lump sum offer.

7.4 Key Takeaway

Frank’s case underscores the potential financial impact of the decision between accepting a lump sum offer and pursuing a common law claim. It highlights why it’s crucial to consider all options and seek legal advice, as the right choice can significantly alter the compensation received.

8. Conclusion: Making an Informed Decision 

The decision you make regarding your WorkCover QLD claim can have profound implications on your life. Seeking expert legal advice is not just recommended; it’s essential. At Ascent Lawyers, we understand the intricacies of these claims and are committed to guiding you through every step, ensuring you don’t miss out on the compensation you deserve.

Don’t navigate this complex process alone. Contact Ascent Lawyers today for expert guidance and support. With our No Win No Fee cost agreement, we’re your worry-free legal solution. Let us help you secure the compensation you need and deserve.