How long can I be on workers’ compensation in NSW?

How long you can be on workers’ compensation benefits in NSW depends on your capacity for work and your whole person impairment (WPI) assessment (which is used to determine any lump sum compensation due to permanent impairment).

The answer varies as it depends on several factors, including:

• the nature of your injury;
• your recovery progress;
• your capacity to return to work; and
• the type of workers' compensation benefits you are receiving.

Maximum period of workers’ compensation weekly payments

Generally, the maximum you can claim weekly payments of workers’ compensation in NSW is up to 5 years.

However, if your permanent impairment is greater than 20% WPI and you are assessed as being incapacitated indefinitely, then your weekly payments can be extended beyond 5 years.

We will explore the general guidelines for workers’ compensation weekly payments, the duration of benefits, and the circumstances that might affect your entitlements below.

First entitlement period:  weeks 0-13

During the first entitlement period, if you have no capacity for work, you can receive weekly payments for up to 95% of your Pre-Injury Average Weekly Earnings (PIAWE).

If you have some capacity to work in the first entitlement period, you will receive 95% of your PIAWE less your current weekly earnings.

Consider this example when you have some capacity to work:

• Your PIAWE were $1,250;
• After 4 weeks off work, you return to work but on limited hours at only 8 hours per week (20% of your pre-injury hours);
• 20% of your PIAWE is $250 (which your employer will pay);
• The remaining $1,000 per week of your PIAWE will be paid at 95%
• So, you will be paid $250 for the hours you work and $950 for workers’ compensation benefits.

Second entitlement period: weeks 14-130

If you have no capacity for work during the second entitlement period, you are entitled to 80% of your PIAWE.

If you have capacity to work less than 15 hours a week, you are entitled to 80% of your PIAWE, less your current weekly earnings.

If you have capacity to work 15 hours or more a week, your workers’ compensation payments increase, and you would be entitled to 95% of your PIAWE, less your current weekly earnings.

After the second entitlement period: weeks 131-260

If you are still incapacitated after 130 weeks, you can apply for payments after the second entitlement period and be entitled to 80% of your PIAWE if:

1. you have no capacity to work; or
2. you are working 15 hours or more per week; and
3. you are earning at least $155 per week (this amount is indexed based on the Workers Compensation Benefit Guide); and
4. you are likely to continue indefinitely to be incapable of increasing your hours or your weekly earnings; and
5. you apply for continuation of weekly payments to the insurer in writing 52 weeks prior to the end of the second entitlement period.

Entitlement after 5 years (260 weeks)

As mentioned earlier, weekly payments cease after 5 years unless your assessment for permanent impairment is greater than 20% WPI.

Permanent impairment claim

Your level of whole-person impairment determines the length of time you are entitled to weekly benefits and medical treatment expenses. It is important to explore your entitlement for a permanent impairment claim if you are eligible.

To explore your entitlement for a permanent impairment claim, you must reach the threshold of 11% or more for physical injuries and 15% or more for psychological injuries, and your injury must have reached maximum medical improvement and your condition must have stabilised. You can read more about this in our earlier blog, "Workers compensation NSW – lump sum claims for permanent impairment".

Permanent impairment compensation is not available for secondary psychological injuries. For example, if you sustain a psychological injury due to your primary physical injury.

Weekly benefits for an injured worker with high needs

If it is accepted that a worker has a whole person impairment of 21-30%, they are considered a worker with high needs.

A worker with high needs is eligible to receive weekly payments until retirement age and lifetime coverage of reasonable medical expenses for treatment related to their workplace injury or illness.

A worker with high needs must undergo work capacity assessments as requested by the workers’ compensation insurer, which could be at least every two years.

Weekly benefits for highest needs workers

If it is accepted that a worker has a whole person impairment that is greater than 31%, they are considered a worker with highest needs.

A worker with highest needs is eligible to receive weekly payments until retirement age as well as lifetime coverage of reasonable medical treatment expenses.

A worker with highest needs is not required to undertake work capacity assessments, unless they elect to do so.

Get help from a workers’ compensation lawyer

In NSW, the duration of workers’ compensation benefits varies depending on your injury, recovery, and the type of compensation you’re receiving. While most workers receive weekly payments for up to 130 weeks, those with more serious or long-term injuries may continue to receive payments and treatment for much longer, particularly if there is a permanent impairment.

If you're unsure of your entitlements or if you're approaching the end of your compensation period, it’s a good idea to seek legal advice to ensure you’re fully aware of your rights and options.

Contacting Hall Payne Lawyers

You can contact us by phone or email to arrange your consultation; either face-to-face at one of our offices, by telephone or by videoconference consultation.

Phone: 1800 659 114
Email: general@hallpayne.com.au