The 2024 amendments to Victoria’s WorkCover scheme surrounding the end of a worker’s entitlement to weekly payments has created a significantly more complex pathway of decisions and disputes.
In practice, navigating this framework feels less like a straight line and more like a game of snakes and ladders. Workers should be encouraged to seek legal advice regarding these decisions as the outcome can have significant impact on other entitlements.
What’s changed?
Under the current law, workers must satisfy two key requirements to continue receiving weekly payments:
- No current work capacity (indefinitely) and
- Whole person impairment greater than 20%
Fail either and payments can be terminated.
WorkCover insurers are not required to address both limbs in their decision notice, creating strategic complexity for disputes, especially where one element is left unaddressed.
The process starts earlier than you think
The insurer review process begins at week 78, not week 130.
By the time a decision is issued at week 117, much of the outcome has already been shaped by:
- The medical evidence on file;
- The “statement of injuries”; and
- Early strategic engagement (or lack of it).
For practitioners, this is a critical intervention window—particularly for:
- Submitting medical evidence
- Clarifying the statement of injuries
- Ensuring all relevant conditions are captured and assessed early.
How Insurers Decide What Happens Next
WorkCover insurer decisions are heavily influenced by their estimated whole person impairment level (WPI) and the nature of the injury.
This determines whether they:
- Arrange an Independent Impairment Assessment (IIA)
- Obtain capacity assessments
- Make an administrative decision without examination
For example:
- Low estimated WPI → administrative determination likely
- Mid-range WPI → formal impairment assessment required
- Higher WPI → capacity assessment becomes central
It is important to note that this framework is policy-driven, not strictly legislative, meaning it can evolve—and may be open to challenge.
The Critical Role of the Statement of Injuries
Every decision is based on a statement of injuries. This is the list of injuries that the insurer took into account when reviewing the workers’ weekly payments entitlements.
This is often overlooked—but should not be.
Questions to consider:
- Are all relevant injuries included?
- Would additional injuries:
- Increase impairment?
- Strengthen incapacity arguments?
If additional injuries should have been included in the review, the decision should be disputed via the Workplace Injury Commission (WIC).
Possible Outcomes of the Review
After completing the review, the insurer may continue or terminate payments via one of the following avenues:
- Make a determination
- Make an administrative decision
- Make an interim decision
In Part 2, we examine the three different decision types available to WorkCover insurers, the dispute pathways available to workers, and the hidden risks that can affect future impairment and common law claims.
How can I learn more?
Lisa Paul.
Principal Lawyer.
Lisa is a principal lawyer in the personal injury team at Robinson Gill. An Accredited Specialist in Injury Law, Lisa is a veteran advocate with extensive experience across the full spectrum of personal injury matters. Driven by a particular interest in cases on behalf of those injured in the course of their work, she specialises in worker’s compensation matters, however she is equally as passionate about TAC and public liability claims.
Some other resources you
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Navigating the “Snakes and Ladders” of 130-Week Weekly Payment Part 2: Disputes, Medical Panels and Hidden Risks
Workers and their lawyers should exercise caution when disputing weekly payment termination decisions as the outcome can impact other entitlements. It is now more essential than ever that workers receive legal advice regarding the review of their weekly payment entitlements at 130 weeks.
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