3.3.5.2 Additional services after 130 weeks
The following additional services may be provided to help workers who continue to have an entitlement to weekly payments after the second entitlement period.
Occupational rehabilitation
OR Occupational Rehabilitation services can be vital to achieve a safe and sustainable return to work. Agents are expected to assess and actively manage those workers identified as suitable candidates.
See: Approve occupational rehabilitation services | A guide for employers - What to do if a worker is injured
Intensive case review program (ICRP)
ICRP Intensive Case Review Program claims concern workers who were injured between 12 November 1997 and 19 October 1999 and do not have access to common law.
Aim of the ICRP
A file review of those workers within the ICRP period who have an ongoing entitlement to weekly payments is undertaken to ensure:
- seriously injured workers are supported
- the services provided meet their individual needs
- return to work options are explored where there was a capacity to work and
- that where an entitlement exists, that the worker receives their statutory entitlements (including lump-sum benefits).
ICRP settlements
Workers seriously injured during this period can voluntarily apply for a lump sum payment instead of ongoing weekly payments if they meet the criteria.
See: ICRP settlements
3.3.5.3 Determine entitlement after second entitlement period
The Agent determines a worker’s entitlement to weekly payment after second entitlement period.
Workers with a current work capacity Under the legislation, unless inconsistent with the context or subject-matter — current work capacity, in relation to a worker, means a present inability arising from an injury such that the worker is not able to return to his or her pre-injury employment but is able to return to work in suitable employment, declared training program (CWC Current Work Capacity) who meet the criteria may apply to the Agent at any time for weekly payments to continue after the expiry of the second entitlement period.
All workers with a CWC are treated in the same manner and subject to the same return to work criteria in these circumstances. A pre-12 November 1997 claimant A person who applies for WorkCover benefits. who is not seriously injured and has a CWC may remain entitled to weekly payments after the second entitlement period.
The process is described in Process for application after second entitlement period.
Timeframes to respond to application
Workers with a date of injury on or after 5 April 2010
The Agent has 28 days from receiving the worker’s application to write to the worker to advise whether the application has been approved or rejected. The Agent must give the worker a statement of the reasons for its decision if the application is rejected.
Workers with a date of injury before 5 April 2010
The Agent has 90 days from receiving the worker’s application to write to the worker to advise whether the application has been approved or rejected. The Agent must give the worker a statement of the reasons for its decision if the application is rejected.
3.3.5.4 Worker can make application
A worker with a current work capacity (CWC) may apply to receive weekly payments after the second entitlement period provided they satisfy all four of the following criteria:
- work at least 15 hours per week
- have current weekly earnings of at least $222 (indexed annually)
- are incapable of undertaking further additional employment or work which would increase their current weekly earnings.
- the likelihood that the worker’s current level of capacity is likely to continue indefinitely, that is, the current level of capacity will not improve in the foreseeable future.
Agent’s responsibility
It is essential that Agents review the above points as part of the second entitlement review process, even though the decision is made at a later date.
A termination notice at the end of the second entitlement period must advise the worker of the right to apply for a determination that weekly payments should not cease. Where appropriate, Agents should give the worker an Application for Weekly Payments after the Second Entitlement Period form.
Compulsory Medical Panel referral by WIC
Where a medical question arises in a dispute about entitlement to weekly payments after the second entitlement period that has been referred to conciliation the Conciliation Officer must, within seven days after becoming aware of the medical question, refer the medical question to the Medical Panel Under the legislation, unless inconsistent with the context or subject-matter — Medical Panel means a Medical Panel constituted under Division 2 of Part 12.
The Agent must bear the costs reasonably incurred by a worker for the referral to the Medical Panel.
The relevant medical question to assess an application for weekly payments after the second entitlement period is defined in the legislation. This question has two main components:
- is the worker incapable of undertaking further or additional employment or work because of the injury?
- if the worker is capable, what further or additional work is the worker capable of undertaking?