Your guide to workers’ compensation claims.

How does workers’ compensation work?

Workers’ compensation laws in South Australia are governed by a complex piece of legislation called the Return to Work Act 2014.

If you've sustained an injury or illness during the course of your employment, you should be eligible to make a workers’ compensation claim – and the first thing you need to do is report any injuries to your employer and seek medical attention to have your injuries recorded.

If it is clear that you will need time off work, or you will incur medical expenses as a result of this injury, you need to complete a Return to Work SA claim form and lodge it with your employer.

Your employer is required to forward the claim form to their relevant workers’ compensation claims agent, who will investigate the injury and provide a ‘determination’ either accepting or rejecting your claim.

If your claim is rejected, we recommend seeking legal advice immediately as these decisions can be disputed, but within relatively short time frames (usually within 28 days of receiving the decision).

What does workers compensation cover?

Weekly workers’ compensation benefits for income maintenance

If your claim is accepted by the workers’ compensation claims agent, and your inquiry prevents you from working, you are entitled to up to two years of income maintenance payments.

The first year is paid at 100% of your average weekly earnings (AWEs) and the second year is paid at 80% of your AWEs.

The workers' compensation claims agent can cease the income benefits during the two-year period for multiple reasons under the Return to Work Act 2014. If the workers’ compensation claims agent discontinues your income maintenance payments, it’s important to seek immediate legal advice, as these decisions can be disputed within relevant time frames (usually 28 days from receipt of the decision).

If you satisfy the criteria for being a seriously injured worker (SIW), the 80% AWE payments can continue up until the Commonwealth pension age, with annual reviews and increases based on your employer’s enterprise bargaining agreement or the consumer price index (CPI).

Medical expenses

You have an entitlement to receive reasonable medical expenses for 12 months following your injury. This is extended if you are receiving income benefits; and for an additional 12 months after your support payments cease.

In addition, your workers’ compensation claim can cover reasonable travel and accommodation expenses related to your treatment.

If you require rehabilitation or services like domestic help, home adjustments, massage, physiotherapy, gym sessions, or hydrotherapy, you can request coverage for the associated costs. These therapeutic measures will be assessed on a claim-by-claim basis.

You can opt to pay for treatment upfront and then be reimbursed by your workers' compensation claims agent. Alternatively, you can arrange pre-approval to avoid upfront costs with an application that our team can help you with.

If the workers' compensation claims agent refuses to fund medical expenses either as reimbursement or upfront upon application, you can dispute these decisions in the SA Employment Tribunal within the relevant timeframes (usually within 28 days of receiving the decision).

If you’ve been injured at work, you may be entitled to two lump-sum compensation payments

If you have a physical work-related injury and an accepted workers’ compensation claim, you may be entitled to two lump-sum compensation payments under the Return to Work Act 2014 (SA). One is called the 'non-economic loss payment' and the other is called the 'economic loss payment'.

A non-economic loss payment is accessible when your injury is assessed by an accredited doctor as having a whole-person impairment of 5% or more. If your injury has led to whole-person impairment between 5% and 35%, you may also be entitled to an economic loss payment.

Your impairment percentage is calculated during a permanent impairment assessment (PIA). This is governed by Section 22 of the Return to Work Act 2014 and the RTWSA Impairment Assessment Guides.

This assessment can only be arranged once your injury has reached maximum medical improvement, and must be performed by an accredited assessor (one that you have never seen or consulted with before).

For the economic loss payment, your age and hours worked in relation to your full-time equivalent percentage will be relevant to calculate the overall lump sum. In a general sense, the younger you are and the more hours of work performed, the higher the lump sum for economic loss.

Economic loss payments are not applicable for work-related hearing loss due to noise, and both payments are not applicable for psychological injuries. Economic loss lump sum benefits are only applicable to injuries occurring after 1 July 2015, provided they meet the specified percentage thresholds.

Want to learn more about workers’ compensation claim payouts? Explore our case studies here.

What happens if you’ve been seriously injured at work?

If a work injury has resulted in a permanent impairment assessment of 35% or more for a physical injury or 35% or more for a psychiatric injury, you will be assessed as a seriously injured worker.

A seriously injured worker is entitled to receive weekly compensation until the Commonwealth pension age and reasonable medical expenses for life.

Due to the ‘once and for all’ assessment rule, it is critical to seek compensation for any consequential injuries which arise from the initially accepted injury or its treatment. For instance:

• if you have an accepted workers' compensation claim for the right shoulder and then begin to experience pain in your left shoulder due to overcompensation;

• if medication for an accepted workers' compensation claim for a lower back injury leads to side effects like dry mouth or gastrointestinal or sexual dysfunction problems.

These additional injuries can form part of your workers’ compensation claim and must be assessed at the same time as the initial accepted injury.

In 2021 the Supreme Court clarified the Return to Work Act 2014 in confirming the right to combine whole-person impairment percentages for multiple impairments. The Summerfield decision highlights the importance of seeking legal advice to maximise your entitlement to your lump sum benefit.

The Return to Work Act is designed to get employees back to work

Under section 18 of the Return to Work Act, employers must provide suitable alternative work upon request. If they don't, the injured worker can seek an order through the SA Employment Tribunal.

Your case manager will also develop a recovery or Return to Work plan from time to time, which our workers' compensation claim lawyers can advise you on.

We’re here to help

For over 75 years, we’ve been helping thousands of South Australians land on their feet after being injured at work. We offer a free initial consultation and a no win, no fee commitment to help you act swiftly on your workers’ compensation claim.

When experience matters, we’re here to help you, too.

The content of this article is intended to provide a general guide to workers’ compensation claims. You should seek specialist advice about your specific circumstances.