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Case Studies

10 June | WIRO encourages insurer to step in after employer repeatedly fails to issue payments to injured worker

A worker, who suffered an injury to his foot while working as a storeman, has received outstanding compensation payments after contacting WIRO to complain that his employer hadn’t paid him. The Western Sydney man, who had since left the company, explained that he had not been paid his entitlements since January of this year. WIRO staff immediately contacted the man’s insurer, who reported similar difficulties receiving a response from the man’s employer. It told WIRO that it would make payments by the end of the month if it did not hear from the employer. After WIRO reminded the insurer that it missed its self-imposed deadline, the insurer agreed to compensate the worker directly for the amount of $2,000. The man received his outstanding compensation payment two weeks after he contacted WIRO for assistance. If you have an enquiry about your claim, contact WIRO on 13 9476.

16 May | Single mum with two kids receives help from WIRO​

A 34-year-old hospitality worker from the country NSW, who suffered a chest injury contacted WIRO because her osteopath had refused her treatment, without an upfront payment from the insurer. Despite receiving a verbal authorisation from the insurer for the treatment to go ahead, the Osteopath did not want to treat the worker on the basis that there was no written approval. WIRO contacted the insurer and requested that the insurer liaise with the Osteopath and provide written approval for treatment, as well as the relevant details for the provider to invoice the insurer directly. Additionally, as the single mother was struggling financially, WIRO suggested that the insurer set up a pharmacy account for the worker. The insurer agreed to both requests. If you have an enquiry about your claim, contact WIRO on 13 9476. 

7 May | Disability Service Worker receives approval for knee surgery following WIRO intervention

A 59-year old disability services worker from the Illawarra has had his claim for knee approved following WIRO’s intervention. The insurer had issued a dispute notice where it cited a ‘small risk’ with the procedure suggesting an underlying arthritic condition could potentially be aggravated by surgery. WIRO contacted the insurer and suggested the treatment was nevertheless ‘reasonably necessary’ and that many treatments have side effects. The insurer was informed that the worker had accepted the risks and wanted to proceed. The insurer reviewed the matter with the iCare Medical Support Panel and subsequently approved the claim. If you have an enquiry about your claim, contact WIRO on 13 9476. 

30 April | Cleaner receives $60,000 in outstanding workers compensation benefits 

A 54-year-old cleaner from Southern Sydney contacted WIRO to advise that he had not been paid workers compensation benefits since August 2017. The insurer admitted that even though it had received a completed tax file number declaration form in January, no payments had been processed. A back payment was processed within days resulting in a gross payment of $60,000. If you have an enquiry about your claim, contact WIRO on 13 9476. 

24 April | Northern Rivers residential care worker receives increase in weekly compensation payments

A 49-year-old woman who suffered an injury to her arm contacted WIRO to express uncertainty about the compensation payments she had received. The woman queried the period and hours that had been used to calculate her Pre-Injury Average Weekly Earnings.  Before the injury, she had been employed on a casual basis and since resuming her duties her work hours had continued to vary. The insurer advised WIRO that PIAWE had been calculated based on the national award rate, as the woman’s employer had not supplied wage information. The insurer agreed to review the PIAWE using the worker’s pre-injury earnings as supplied by the worker, and the weekly payment was increased from $550 to $770. The woman was back paid.  If you have an enquiry about your claim, contact WIRO on 13 9476. 

8 April | Injured boilermaker receives $20,000 in insurance payments after contacting WIRO for help

A 65-year-old boilermaker who complained to WIRO that his employer had not been paying him correctly since he was injured, has received $20,000 in back pay. The Southern Sydney man felt he had not been appropriately compensated for his back injury and had been unable to resolve the issue with his case manager. WIRO reviewed the man's pay receipts and noticed that the worker's pay had been unchanged at 80% of pre-injury average earnings, even though he had been performing 15 hours of work per week. WIRO forwarded the payslips to the insurer and suggested that the injured worker was entitled to be compensated up to 95% of pre-injury average weekly earnings. The insurer reviewed the matter and agreed to process a back payment of nearly $20,000. If you have an enquiry about your claim, contact WIRO on 13 9476.

5 April | Blue Mountains Administrator receives compensation after reaching out to WIRO

A 44-year-old woman injured at work has reached out to WIRO to help resolve confusion over her weekly payments. The woman had not been paid workers compensation payments for 3-weeks. At the time the Administrator suffered the leg injury she had been working for two employers. Her attempts to rectify the non-payment issue with the insurer had been unsuccessful until WIRO contacted them on her behalf. ​WIRO sought a response from the insurer who found that payments had been incorrectly issued to the wrong employer. The woman was immediately back paid $900, and the insurer stated that it would recover funds already paid directly from the company. If you have an enquiry about your claim, contact WIRO on 13 9476.

29 March | Newcastle woman receives $6,000 after being made redundant

An injured worker who suffered a head injury, before she was made redundant, has received a back payment of $6,000, after expressing concerns to WIRO. The woman contacted WIRO because her former employer had stopped paying her compensation and she felt her redundancy payout was inadequate. The Newcastle woman was also concerned that the insurer had failed to incorporate her salary sacrifice contributions when it calculated her Pre-Injury Average Weekly Earnings. She also complained that she had not received any correspondence from the insurer about changes to her weekly payments. WIRO contacted the insurer requested a review of the woman’s PIAWE to ensure salary sacrifice contributions were included in the calculation. After providing a statutory declaration, detailing her earnings since her redundancy, the woman received close to $6,000 in back pay. If you have an enquiry about your claim, contact WIRO on 13 9476.

27 March | Sydney baker receives outstanding compensation after employer's business goes into liquidation

A 45-year-old baker from Sydney's North has finally received his weekly worker's compensation payments after contacting WIRO for help. The worker, who suffered an injury to the hand, claimed he hadn't received any weekly payments, or a claim number, from in the weeks following his injury. WIRO contacted the insurer and found the man's employer had gone into liquidation; and, that wages paid to the business had not been passed on. The insurer admitted that it had overlooked some of the case details and immediately processed back payments amounting to around $1500, representing two weeks of lost payments. If you have an enquiry about your claim, contact WIRO on 13 9476.

21 March | 46 year old logistics worker from the Northern Rivers learns she's entitled to two years of back payments

A 46-year old woman worker was told her medical treatment would cease in April 2019 as she had not received any weekly payments for almost 2 years. She was unsure why her weekly payments ceased in April 2017. WIRO contacted the insurer who produced a Certificate of Determination issued by the Workers Compensation Commission. The Certificate made awards by consent, and it was noted that upon receipt of the payments ordered, the worker would have received her entitlement to compensation for the first and second entitlement periods, under section 36 and section 37 of the Workers Compensation Act 1987. WIRO suggested to the insurer that since the Certificate did not make an award in favour of the employer, the worker was entitled to claim weekly payments under Section 38 of the 1987 Act and the insurer was obliged to determine it.

WIRO also ascertained that the worker had provided multiple Certificates to claim weekly payments but that the insurer had failed to respond, as required by Section 274 of the WIM Act. The insurer confirmed Certificates of Capacity had been received but not determined. It confirmed weekly payments would be made to the injured worker, dating back to 2017 and subject to Centrelink clearances. The woman was advised she would be receiving weekly compensation payments and that her entitlement to medical expenses would not be ceasing in April. If you have an enquiry about your claim, contact WIRO on 13 9476.

18 March | WIRO helps sales assistant solve problems with the insurer

A 39-year-old sales assistant who complained to WIRO after receiving notice that her weekly payments would cease in April of this year has received confirmation her insurer’s calculation was incorrect. The woman received a notice that her weekly insurer payments would cease in April of this year, as per Section 39 of the Workers Compensation Act of 1987.  The injured woman felt the calculation was incorrect as the cessation date was less than 260 weeks after she sustained the injury to her wrist. The woman also complained that her insurer had not determined a request for a specialist consultation to discuss surgery. WIRO contacted the insurer who admitted its 260-week assessment was incorrect. It then told the worker she was entitled to an additional 4 weeks of weekly payments before Section 39 would apply. The insurer also stated that it had sent an approval letter to the specialist who was never received. The approval for a surgery consultation was re-issued. If you have an enquiry about your claim, contact WIRO on 13 9476.

14 March 2019 | Hunter Valley nurse receives $38,000 in insurance payments after contacting WIRO

A 38-year-old nurse who was receiving weekly insurance payments under the former Section 37 statutory rate, before the 2012 amendments, contacted WIRO with concerns about her payments. The woman had only been paid as a single worker even though she had informed the insurer that she had dependent children. She also complained that her new transitional rate had not been indexed. WIRO put both issues to the insurer who conceded the errors and the worker was paid $4,000, to address the indexation error and a further $34,000 as an adjustment for the statutory rate. If you have an enquiry about your claim, contact WIRO on 13 9476.

12 March 2019 | WIRO intervenes to ensure injured electrician receives psychiatric care

A 37-electrician whose doctor recommended he receive inpatient treatment in a psychiatric facility has had his treatment approved after contacting WIRO for help.  The man’s insurer issued a ‘dispute notice’ in response to his doctor’s decision to refer him to a hospital for care. WIRO contacted the insurer and referenced the insurer’s own medical report which agreed that the worker "may need further admissions to a psychiatric hospital.” WIRO asked the insurer to review its position based on its assessment. Consequently, the treatment was approved. If you have an enquiry about your claim, contact WIRO on 13 9476.

8 March 2019 | Hunter Valley nurse receives $38,000 in insurance payments after contacting WIRO

A 37-electrician whose doctor recommended he receive inpatient treatment in a psychiatric facility has had his treatment approved after contacting WIRO for help.  The man’s insurer issued a ‘dispute notice’ in response to his doctor’s decision to refer him to a hospital for care. WIRO contacted the insurer and referenced the insurer’s own medical report which agreed that the worker "may need further admissions to a psychiatric hospital.” WIRO asked the insurer to review its position based on its assessment. Consequently, the treatment was approved. If you have an enquiry about your claim, contact WIRO on 13 9476.

7 March 2019 | Eastern Suburbs carpenter gets quick response

A 30-year-old carpenter from Sydney’s eastern suburbs has received a prompt correction from his insurer after he contacted WIRO to complain about his weekly payments. The man told WIRO that he injured his ankle and was off work for two weeks. During this time, his employer was only paying him $950 a week, instead of $1,600 per week to which the insurer said he was entitled. The insurer advised WIRO that the employer had not paid the worker in accordance with its instructions. Within days the insurer had organised for the man’s employer to process a $1,300 payment to cover the shortfall. If you have an enquiry about your claim, contact WIRO on 13 9476.

19 February 2019 | Plumber from Western NSW receives $45,000 and help to keep brown snakes at bay

A 59-year-old plumber who contacted WIRO, after his insurer refused to continue to provide yard maintenance, has received $45,000 in outstanding workers compensation payments and received an assurance his yard maintenance will continue. The injured man contacted WIRO after his insurer notified him it was discontinuing his ‘domestic assistance’ while he was undergoing a work capacity review. The man was concerned that without yard maintenance his children might be in greater danger from venomous brown snakes. WIRO reviewed the case and discovered that the man had two open claims and was incapacitated as a result of both injuries. WIRO requested a review of the worker’s pre-injury average weekly earnings as well as the provision of domestic assistance. In response, the insurer confirmed that they would provide weekly yard maintenance during the summer months and monthly maintenance during the winter months. Additionally, it confirmed the worker had not received his correct weekly payments entitlements. He was back paid nearly $45,000. If you have an enquiry about your claim, contact WIRO on 13 9476.

18 February 2019 | Injured Newcastle woman payments to continue during review

A 50-year-old administrative worker from Newcastle has received confirmation that her weekly workers’ compensation payments won’t be discontinued after WIRO successfully intervened with her employer’s insurer. The woman contacted WIRO to report that her payments were about to cease after an unfavourable work capacity decision. However, the injured worker had correctly lodged an application for a Internal Review of the WCD decision within the required 30 days. WIRO contacted the insurer three times and eventually verified that the worker had lodged her application. Consequently, the insurer agreed in writing, to continue the payments until the completion of the review period. If you have an enquiry about your claim, contact WIRO on 13 9476.

6 February 2019 | Injured truck driver permitted to keep overpayment

An injured truck driver who was overpaid weekly workers compensation payments by his employer has been allowed to keep the money after he reached out to WIRO for help. The 50-year -old Western Sydney man had received three weekly payments for $1200 before it was discovered he was entitled to $500 a week. The injured man contacted WIRO after his employer proposed cutting off his future payments to recoup the money. When a WIRO team member spoke to the worker’s insurer, they admitted that instructions to the worker’s employer were, 'not as clear' as they could have been. WIRO suggested that given the injured worker was not at fault, recovery of the overpayment would not succeed in the Workers Compensation Commission, and the insurer should absorb the loss. The insurer agreed to reimburse the employer and instructed the trucking company not to recoup the funds. If you have an enquiry about your claim, contact WIRO on 13 9476.

5 February 2019 | WIRO discovers injured Illawarra worker was underpaid.

A 36-year-old Illawarra woman who contacted WIRO after her insurer suggested she’d been overpaid, has discovered she'd been underpaid by $3,000. The woman approached WIRO after her insurer claimed that her Pre Injury Average Weekly Earnings had been determined to be $550 per week, even though she’d been receiving payments of $750 per week. PIAWE is usually calculated over 52 weeks, prior to an injury occurring, unless there are exceptional circumstances. The woman reached out to WIRO staff who found that a previous promotion hadn’t been factored into the payment calculation. WIRO forwarded confirmation of the promotion to the insurer and suggested an exception to the 52-week calculation period should apply. The insurer responded by paying the woman a shortfall of $3000, based on a new weekly payment amount of $1,000. ... If you have an enquiry about your claim, contact WIRO on 13 9476. 

31 January 2019 | Man receives travel expenses to collect severe pain medication

An injured worker living in Western NSW has been reimbursed travel expenses required to collect strong pain medication from a pharmacy 100km from his home. The worker attempted to claim $112 in travel expenses but the insurer denied the claim because travel expenses to purchase medication only are not generally compensable unless there are unusual circumstances. The worker contacted WIRO explaining that his doctor had closed his medical practice for 6 weeks over the Christmas holiday period, and the local pharmacist was restricted from providing all the pain medication at once. The injured worker had needed to make a second round-trip to fill his prescription during the holiday period. WIRO put the facts to the insurer, and the travel claim was paid immediately with the insurer agreeing to cover further travel claims under similar circumstances. If you have an enquiry about your claim, contact WIRO on 13 9476.

29 January 2019 | Insurer reconsiders carpark fall after WIRO intervenes

An insurer who denied an injured health worker’s claim after she fell in her employer’s carpark has reconsidered its position after the woman sought help from WIRO. The 55-year old Western Sydney woman was denied compensation because she had already begun her journey home. However, WIRO requested a case review and asked the insurer to consider the case of Smith v Woolworths Ltd (2017) NSWWCC 290, where it... was found that a worker injured in their employer’s car park, was not yet on a journey. WIRO suggested there were similarities between the matters and the insurer overturned the decision and accepted liability. If you have an enquiry about your claim, contact WIRO on 13 9476.

14 January 2019 | WIRO helps injured teacher with insurer payments

An injured teacher from Wollongong has had her weekly payments reinstated after a dispute with her insurance company over medical information. The 56-year-old woman did not receive payments for 9-weeks, following a request by the insurer for more information. Payments did not resume even after the injured worker provided an updated Work Capacity Certificate. WIRO contacted the insurer and payments were quickly reinstated. However, the insurer did not explain the delay. If you have an enquiry about your claim, contact WIRO on 13 9476.

3 January 2019 | An administration worker complained to WIRO that case manager would not reimburse future medical expenses for specialist consultations

An administration worker from Sydney complained to WIRO that their case manager would not reimburse future medical expenses in relation to specialist consultations. The case manager told the worker they had asked the specialist to invoice the insurer directly. At the worker’s next specialist appointment, the specialist’s administrator advised they had not received any billing instructions from the insurer. They demanded the worker pay the $360 fee upfront in order the keep the appointment and seek reimbursement from the insurer. The worker paid the fee and sent a request to the insurer for reimbursement. The case manager refused to pay and referred the worker back to the specialist. WIRO made an inquiry with the insurer. In response, it apologised and confirmed that nobody from the insurer had advised that particular specialist’s rooms of the billing procedure. The insurer reimbursed the worker immediately and provided billing instructions to the specialist’s rooms for use at subsequent appointments. Injured workers with enquiries about their claim may call WIRO on 13 94 76.

3 January 2019 | An injured worker was receiving incorrect payments

WIRO has resolved a compensation dispute for a 42-year-old Sydney woman, who had been injured at work and required wrist surgery.  The woman felt that her weekly compensation payments were incorrect, based on her pre-injury average weekly earnings (PIAWE.) The WIRO Solutions Group reviewed the calculation and found that the insurer had mistakenly based its payments on the income of a Queensland employee with a similar name. The insurer has reimbursed the injured woman $4,000 and her ongoing weekly payments have been increased by $400. Injured workers with enquiries about their claim may call WIRO on 13 94 76.

12 December 2018 | A worker underwent surgery and was off work for two months

A worker underwent surgery and was off work for two months. She complained to WIRO about the amount she was paid during those two months, that it was substantially less than her pre-injury earnings.​WIRO queried the PIAWE with the insurer. In response, it reduced PIAWE from around $980 to $920. The insurer provided WIRO with the wage information it had used to make its calculations.​WIRO reviewed the information and identified that the insurer had used payroll data for a different employee, one who had a similar surname to the injured worker but resided and worked in another state, resulting in a significant shortfall.When WIRO relayed this to the insurer and provided payslips from the worker, the insurer re-calculated PIAWE to be $1,500, resulting in a back payment of over $5,000 to the worker.If you have an enquiry about your claim, contact WIRO on 13 9476.

6 December 2018 | A financial services worker from the Blue Mountains submitted a quote for home modifications

A  worker submitted a quote for home modifications. She was wheelchair bound following her injury and needed a ramp built so that she could access her home without assistance from others. Her former scheme agent gave verbal approval for the claim but no written approval was completed before the claim was transferred to a new scheme agent. Therefore, the work had not commenced. The worker had not heard from the new scheme agent for some time and was having difficulty accessing her home. WIRO submitted an urgent inquiry. The insurer approved the modification within a day of receiving our email. If you have an enquiry about your claim, contact WIRO on 13 9476.

23 October 2018 | A clerk from south-west Sydney made a claim for psychological injury which was disputed by the insurer

A clerk from south-west Sydney made a claim for psychological injury which was disputed by the insurer. He sought some documents relied upon by the insurer in relation to his disputed claim, but the insurer refused to pass these on to the worker. The insurer cited Clause 41 of the Workers Compensation Regulation 2016 believing that supplying the documents could cause harm. WIRO contacted the insurer also citing Clause 41 and it was agreed the outstanding documents would be sent to the worker’s GP. The insurer also agreed to fund one further consult for the GP to explain and provide the outstanding documents to the worker. If you have an enquiry about your claim, contact WIRO on 13 9476.

18 October 2018 | A nurse employed at a hospital on the south coast of NSW complained that the insurer had miscalculated her PIAWE

A nurse employed at a hospital on the south coast of NSW complained that the insurer had miscalculated her PIAWE. WIRO requested a copy of the insurer’s calculations. After receiving a spreadsheet from the insurer, we identified that the insurer had included seven weeks of leave without pay in the relevant period and that shift and overtime allowances had not been included. The insurer directed our concerns to the employer who was making weekly payments. After explaining the process for determining PIAWE, the worker’s weekly benefit was increased from around $800 to around $1,100 per week. The worker also received a payment for past under payments. If you have an enquiry about your claim, visit https://wiro.nsw.gov.au/injured-workers/complaints-and-enquiries or call 13 9476.

11 October 2018 | A retail worker from Sydney made a claim in June 2018 for an injury sustained in November 2017

A retail worker from Sydney made a claim in June 2018 for an injury sustained in November 2017. Initially, the claim was reasonably excused, before liability was accepted in August. The worker complained he had not received weekly payments. In response WIRO’s inquiries, the insurer advised there had been a further hold up as the employer had challenged their decision to accept liability. The insurer conducted a review and confirmed their decision to accept the claim in September. WIRO requested the insurer to process payments without further delay. In response, the insurer stated they processed payment to the employer but that one week’s entitlement had been withheld, being the excess for late lodgment of claim.

WIRO referred the insurer to the SIRA document When a worker is injured: A workers compensation guide for employers which states, “If you do not report the injury within five calendar days, you may pay a ‘claims excess payment.” In other words, the employer is penalised the excess, not the worker. WIRO asked whether the employer had paid all entitlements to the worker. The insurer replied that the employer had processed payment of nearly $9000, which covered the entire period of incapacity.  If you have an enquiry about your claim, contact WIRO on 13 9476.

5 October 2018 | A worker’s lawyer complained that their client had made a claim for hearing aids but had not received a response

A worker’s lawyer complained that their client – a 48 year old plumber from northern NSW – had made a claim for hearing aids on 15 August 2018 but had not received a response. Prompted by WIRO’s enquiry, the insurer contacted the worker directly to ask him if he would really wear the hearing aids. The worker reported this to his lawyer who complained it was not appropriate to contact the worker directly to ask a question of this nature. WIRO suggested the fact a claim was made should satisfy the insurer. The insurer apologised and then approved the claim for hearing aids. If you have an enquiry about your claim, contact WIRO on 13 9476

28 September 2018 | A worker complained the insurer was not paying weekly benefits for a period the worker took extended leave despite an award from the Commission

A worker complained the insurer was not paying weekly benefits for a period the worker took extended leave despite an award from the Commission. The insurer cited the employer’s handbook which stated that workers can be paid extended leave if they exhaust sick leave. The insurer would not deviate from the employer’s view that the extended leave should be treated like sick leave. WIRO referred to s49 and s50 of the 1987 Act and suggested the type of leave taken was more important than the reason it was taken. This was escalated to more senior representatives at the insurer, who confirmed weekly payments would be paid in addition to extended leave. If you have an enquiry, call WIRO on 13 9476.

6 September 2018 | Lawyer complained that client’s claim for hip replacement surgery from June 2018 had not been determined by insurer

A lawyer complained that their client’s claim for hip replacement surgery made in June 2018 had not yet been determined by the insurer. WIRO asked the insurer to explain why the claim had been delayed for so long. The insurer replied that the treating surgeon indicated in their report that the worker should think of delaying the hip replacement surgery if he could. However, the insurer never issued a dispute notice setting out that position. Consequently. the insurer approved the claim for surgery within one day of WIRO’s inquiry. If you have an enquiry about a claim, contact WIRO on 13 9476.

30 August 2018 | An insurer wrote to an injured worker whose weekly payments had ceased due to Section 39

An insurer wrote to an injured worker – whose weekly payments had ceased due to Section 39 – advising she was overpaid $4000 in travel expenses “due to a number of different reasons…that is no one particular person’s fault”. The insurer proposed reimbursing 50% of future travel entitlements until the overpayment was recovered. The worker unsuccessfully objected to the proposed recovery noting the overpayment was caused by the insurer’s administrative oversight.  WIRO made its own inquiry with the insurer asking them to review the correspondence and reconsider the recovery. The insurer replied to WIRO that they agreed to waive the overpayment. If you have an enquiry, contact WIRO on 13 9476.

22 August 2018 | An insurer reasonably excused a claim for weekly payments

The worker had yet to make a claim but the insurer promised they would decide on liability within 10 days of their independent medical examination. It hadn’t, several weeks went by and so the worker contacted WIRO. We suggested he complete a claim form so the insurer would be compelled to determine the claim within 21 days. At the same time, we asked the insurer about the promise it had made to the worker about determining the claim after the examination. In response, the insurer confirmed the claim was accepted and the worker was back paid around $10,000. If you have an enquiry about your claim, contact WIRO on 13 9476.

16 August 2018 | An injured worker was overpaid and later made redundant.

An injured worker was – due to mistakes by her public-sector employer and the insurer – overpaid a total of around $1500 in weekly payments over several weeks. Later, she was made redundant and the employer’s payroll department deducted that amount from the worker’s final pay. The worker complained to WIRO who contacted the insurer. They said they were aware of an overpayment but unaware a deduction had been made from the worker’s termination payment. The insurer acknowledged they must wear the error and advised they would be in contact with the worker to have the deducted funds repaid. If you have an enquiry about your claim, contact WIRO on 13 9476.

10 August 2018 | A worker was certified fit to work 8 hours per week.

Before her injury, she was employed to work 35 hours per week. In June, she underwent surgery for a non-compensable injury. Her weekly payments stopped and she was paid sick leave for five weeks. WIRO inquired with the insurer who confirmed weekly payments had ceased in error. The insurer instructed the employer to pay sick leave for the 8 hours per week she could not work due to surgery and pay workers compensation for the remaining hours, for which she was unfit regardless of the surgery. The worker’s sick leave was recredited by her next pay period. If you have an enquiry about your claim, contact WIRO on 13 9476.

6 August 2018 | A worker complained PIAWE was incorrect

The insurer calculated PIAWE at around $410. After WIRO’s initial inquiry, the insurer reduced PIAWWE to $390. The insurer based their decision on a “payroll summary” the employer provided. WIRO told the worker to request a review. In the meantime, we suggested the insurer obtain payslips to calculate PIAWE as they show gross earnings broken down among various types. The insurer obtained additional income details from the employer and the PIAWE was increased to $460, obviating the need for a review. The worker was back paid around $1300.00. If you have an enquiry about your claim, contact WIRO on 13 9476.

26 July 2018 | A worker had two concurrent claims managed by one scheme agent

The agent reduced PIAWE, after which the employer pursued the worker for alleged overpayments she received whilst the higher PIAWE applied. The worker complained to WIRO about the alleged overpayment and the revised PIAWE calculation. WIRO reviewed the matter and it appeared the calculation was too low. WIRO referred the scheme agent to Icare’s PIAWE handbook as well as Schedule 3 of the 1987 Act. In response, the insurer agreed that there was no overpayment, but rather a $6000 underpayment. The worker was back paid and PIAWE increased by around $300. If you have an enquiry about your claim, contact WIRO on 13 9476.

19 July 2018 | A worker from Walgett broke his tibia and fibula

He relied on his daughter, who resides in Dubbo to drive him to his specialist, who was also in Dubbo. This required one round trip to Walgett to collect the worker and another to get him home.  The insurer refused to pay for two round trips and suggested the worker take the bus. WIRO made representations to the insurer noting the type of injury and dearth of travel options, suggesting it was not appropriate to catch a bus with such an injury and the locations involved. The insurer then confirmed they would pay all round trips required. If you have an enquiry about your claim, contact WIRO on 13 9476.

13 July 2018 | A worker complained to WIRO that his PIAWE of $464.35 was too low

The insurer’s original decision relied on 52 weeks of prior earnings, even though the worker had recently been promoted to full time work. WIRO suggested they review the relevant period. In response, the insurer increased PIAWE to $676.35. However, this new calculation also included weeks of work after the date of injury in the relevant period. WIRO suggested the insurer take a third look at PIAWE and exclude periods after the date of injury. PIAWE was increased again, this time to $732.62. The worker was back paid for past shortfalls in entitlements. If you have an enquiry about your claim, contact WIRO on 13 9476.

5 July 2018 | A worker received a letter from his insurer saying weekly payments would reduce to $1330 after 52 weeks

He was confused because his gross payments from his employer were $1000.  The insurer told WIRO the worker should contact his employer to discuss a shortfall.  WIRO replied it was the insurer’s duty to confirm the employer was passing on the correct weekly payments.  The insurer subsequently investigated and found the worker was underpaid nearly $40,000.  The insurer confirmed the employer would be contacting the worker to reimburse the worker for its underpayment. If you have an enquiry about our claim, call WIRO on 13 9476.

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