How long are Loss of Earnings (LOE) benefits payable for?
This policy must be read in conjunction with the Loss of Earnings Benefits policy.
What factors can affect a client's entitlement to LOE benefits?
LOE benefits are payable for a maximum period of 18 months, from the date of accident or when the injury first manifested itself, where supported by certificates of capacity verifying incapacity as a result of transport accident injuries. A client who has sustained a loss of earning capacity as a result of the injuries 18 months after the transport accident may be entitled to receive LOEC benefits provided they meet the normal criteria.
Will a client continue to receive LOE benefits once he/she reaches retirement age?
The TAC will not pay LOE benefits after the client attains the normal retirement age for workers in that occupation. If there is no normal retirement age set for that occupation, LOE benefits cease when the client reaches the age that they can apply for the Commonwealth age pension.
In circumstances where an earner has not permanently retired from employment at the time of the transport accident and has previously attained or is within 12 months of attaining:
- the normal retirement age for workers in that occupation, or
- the age that they can apply for the Commonwealth age pension, if no normal retirement age is set for that occupation
then LOE is payable for a period not exceeding 12 months (or aggregate periods thereof) from the date of injury.
Will LOE payments cease once the client is deceased?
An earner's entitlement to LOE benefits ceases upon their death. Future LOE payments which, but for the death, would have been made do not form part of the deceased's estate.
However, if prior to their death the client was eligible for LOE benefits, the TAC will pay LOE benefits to the estate of a deceased client in the first 18 months after the accident provided:
- the medical evidence confirms the client had an entitlement to LOE benefits during that period/s before the death and
- only for periods up to the date of death.
How much notice will the TAC give when ceasing or reducing benefits?
The TAC will immediately cease paying LOE benefits, to a client who:
- commences or resumes employment
- is serving a prison sentence (effective for the duration of the prison term).
The TAC will give 28 days notice to discontinue or reduce a client's LOE benefits in circumstances where the client has:
- recovered from the effects of the injury caused by the transport accident or
- an incapacity which is not related to the injury caused by the transport accident
- not accepted a reasonable offer of suitable employment or a reasonable offer of employment which offers increased earnings
- not accepted a reasonable offer of rehabilitation.
The TAC will cease paying LOE benefits to a client, with notice, where the client is not, and never has been, entitled to benefits.
Payments will not be discontinued or reduced if the client makes an application to the Victorian Civil and Administrative Tribunal within 28 days after receiving the notice unless the TAC later confirms the decision to discontinue or reduce the payments within 28 days of receiving the VCAT application.
Will LOE payments cease if a client refuses treatment?
The TAC will suspend LOE payments for a client when:
- The client fails to attend and adequately participate in rehabilitation treatment (such as a physiotherapy rehabilitation program) without reasonable excuse, and
- The client's treating practitioner believes that the client will benefit from the treatment and provides the client with a medical clearance to participate in the treatment.
The TAC will provide the client with warning that he/she must attend treatment, and after 28 days will suspend LOE payments until the client adequately attends and participates in rehabilitation
LOE payments will not be back paid for the period of the suspension.
Transport Accident Act 1986 reference: s.74(2)(b).
What factors will the TAC take into account when making an offer of rehabilitation or suitable employment?
The TAC will take the following factors into account when making an offer of rehabilitation or suitable employment:
- the nature of the injury
- the client's potential and ability to undertake rehabilitation
- the client's training skills and experience
- the age of the client
- all relevant medical reports and vocational assessments provided by the vocational provider. Refer to the policy on Return to Work Programs.
The TAC will give notice of its offer of rehabilitation or vocational assistance in writing and allow 28 days for a response.