How Long are LOEC benefits payable for?

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This policy should be read in conjunction with the Loss of Earnings Capacity (LOEC) Benefits policy.

How long are LOEC benefits payable under the Act?

Where a client is not a "minor" at the date of the accident, LOEC benefits are payable from 18 months after the accident until the first of these events:

  • the expiry of 3 years from the date of accident, which applies to a client who is less than 50% impaired; or
  • the "normal retirement age" is reached, however if no normal retirement age is set for that occupation, then the age that the client can apply for the Commonwealth aged pension is used for a client who is 50% or more impaired; or
  • the pecuniary loss component of a common law action settles; or
  • when a client no longer has a loss of earning capacity as a result of the transport accident injuries

Where a client is a "minor" at the date of the accident, LOEC benefits are payable from 18 months after the accident, once the client turns 18, until the first of these events:

  • the client reaches the age of 21, which applies to a client who is less than 50% impaired; or
  • the "normal retirement age" is reached, however if no normal retirement age is set for that occupation, then the age that the client can apply for the Commonwealth aged pension is used for a client who is 50% or more impaired; or
  • the pecuniary loss component of a common law action settles; or
  • the client no longer has a loss of earning capacity as a result of the transport accident injuries

Note:

  • the TAC considers a client's "normal retirement age" to be the retiring age applicable to the client's pre-accident occupation.
  • a "minor" is eligible for LOEC benefits once they have reached the age of 18 years and 18 months have passed since the accident.

The TAC will give a client 28 days notice before it ceases benefits in all of the above circumstances , except where a common law action settles. The client will be advised of the 28 days notice in writing.

Transport Accident Act 1986 reference: s.53

What happens if a client had reached pension age or the normal retirement age and was still working when the accident occurred?

If a client was still working when the accident occurred and:

  • had reached pension age or the normal retirement age for their occupation; or
  • was reaching pension age or reaching the normal retirement age for their occupation, within 12 months time; then

a client is entitled to LOE or LOEC benefits or a combination of both for a period not longer than 12 months. This is payable over one continuous period of 12 months or a number of aggregate periods which equal 12 months but do not exceed 12 months.

'Pension age' is the age that the client can apply for the Commonwealth aged pension based on their date of birth.

Transport Accident Act 1986 reference: s.53(1)

Do LOEC benefits cease if a client dies?

Yes, LOEC benefits cease upon the client's death.

Does a deceased estate become entitled to ongoing LOEC benefits?

A client's entitlement to LOEC benefits ceases upon death. Future LOEC benefits which, but for the death, would have been payable, do not form part of the deceased's estate. However, if an LOEC entitlement exists for any period or periods before the date of death which were not paid to the client, then this is paid to the deceased estate.

LOEC benefits are payable up to and including the date of the death provided medical evidence exists supporting a loss of earning capacity due to the transport accident injuries.

If the death results from the transport accident injuries, the TAC will pay dependency benefits to the deceased earner's surviving dependants, subject to the TAA (1986).

For further information, also refer to the section for dependency policies.

In what circumstances will the TAC immediately stop paying LOEC benefits?

The TAC will immediately stop paying LOEC benefits to a client:

  • who has no loss of earning capacity and fails to advise they have returned to work whilst in receipt of LOEC benefits (this is an offence under the TAA 1986); or
  • who has no loss of earning capacity and advises they have returned to work, (effective from the return to work date); or
  • who starts serving a prison sentence, (effective for the duration of the prison term); or
  • who settles the pecuniary loss component of a common law claim

The TAC will also immediately stop paying LOEC benefits and give notice to a client if they are not and never have been entitled to benefits in respect of the accident. For example, where a client's injuries are not the result of a transport accident but other causes.

In what circumstances will the TAC give a client 28 days notice before it stops or reduces LOEC benefits?

The TAC will stop paying or reduce a client's LOEC benefits with 28 days notice where the medical reports and other information support the view a client has some earning capacity, for example:

  • a medical report advises a client has recovered from the transport accident injuries to the extent they now have a partial or total work capacity
  • a client has not accepted a reasonable offer of suitable employment or offer of rehabilitation or vocational services and a medical report, vocational assessment or other document advises the client has some work capacity. Refer also to the policy for return to work programs.

The TAC will also stop paying LOEC benefits where a medical report advises a client's incapacity is not related to the transport accident injuries.

Will LOEC payments cease if a client refuses treatment?

The TAC will suspend LOEC 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 LOEC payments until the client adequately attends and participates in rehabilitation

LOEC payments will not be back paid for the period of the suspension.

Legislative reference: Transport Accident Act 1986, section 74(2)(b).

What if a client disagrees with the TAC's decision to reduce or cease LOEC benefits?

A client who disagrees with the TAC's decision to reduce or cease LOEC benefits is able to have the decision reviewed. Refer to the section having a decision reviewed.

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