austlii:nsw/NSWPIC/2025/442
General information, not legal advice.
NSWPIC
2025-08-28
Original judgment source is linked above.
20 May 2006. He has been in receipt of weekly benefits compensation during all periods in respect of which he has been totally or partially incapacitated for work. 3. On 26 June 2024, the applicant's solicitors wrote to the respondent's insurer, EML, advising that the applicant's wife had become his dependent [sic] from 12 May 2018. 4. The applicant sought an adjustment of his weekly benefits to reflect the addition of a dependent spouse, and back pay to date. 5. After further communication between the applicant's solicitors and EML regarding this issue, the applicant's solicitors wrote to EML on 11 September 2024. 6. The applicant's solicitors claimed it had been anticipated the applicant would receive approximately $40,000 in outstanding payment of benefits. 7. The applicant had instructed his solicitors that EML had informed him the figure owed to him was approximately $26,000. This was apparently because the applicant had not added to a statutory declaration his eldest's daughter's date of birth. This had resulted in an overpayment that had been recovered without the applicant's knowledge or agreement. 8. The applicant's solicitors stated that each of the applicant's statutory declarations, with the exception of that in 2020, included his children's dates of birth. In 2020, the month and year of birth, but not the day, were added. 9. The applicant's solicitors "consider[ed]" the information relating to the children's dates of birth was easily available to EML, and if his benefits were overpaid, it was through no fault of the applicant. 10. The applicant's solicitors "expect[ed]" that EML would process the full amount of the amount owed to the applicant and update his dependents [sic]. 11. On 16 October 2024, the respondent's solicitors advised that EML had accepted the applicant's claim for a dependant [sic] spouse and had calculated the applicant's additional entitlement as $26,886.02. 12. The respondent's solicitors attached EML's calculation of back payment, as well as the calculated overpayment, which EML would not pursue or deduct. 13. The respondent's solicitors advised that the applicant's total back payment, based on the applicable statutory rate, inclusive of his dependent spouse, had been calculated to be $20,316.94. 14. EML had identified an overpayment of $6,569.08. EML did not seek repayment, and nor was this amount being deducted from the applicant's entitlement. EML had therefore calculated that the applicant was entitled to the sum of both totals, being $28,886.02 [sic: $26,886.02]. 15. The respondent's solicitors advised that EML's calculations did not deduct any over payments. EML only sought recognition that there were a number of weeks during the period claimed where the applicant had already been paid more than he was entitled to and therefore suffered no financial loss. The applicant had, in fact, had a financial gain, which was not pursued or deducted by EML. 16. There then followed a series of emails between the parties' solicitors, to which I will refer below. 17. With a dispute over the amount of back pay to which the applicant was entitled unresolved, the applicant lodged a Miscellaneous Application (the Application) on 18 March 2025. 18. The Application claimed that an adjustment to the applicant's weekly payments was required due to a change in his wife's dependant [sic] status, resulting in a back payment of approximately $43,000 owed by the insurer. 19. The Application claimed that the applicant had been informed by the case manager that he would be paid only $26,000, due to an alleged overpayment of benefits relating to a dependant [sic] child. The applicant later received assurances this would not occur, "however, received only the $26,000 and not the full [sic] anticipated by him and calculated by us." 20. The Application set out the calculations which had previously been sent to the respondent's solicitors, and to which I will refer below. 21. The respondent lodged its Reply on 10 April 2025.
(a) whether the applicant has been paid all the back pay to which he is entitled, and, if not, the additional amount to which the applicant is entitled.
PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION
(a) Application and attached documents, and
(b) Reply and attached documents.
(a) the applicant was entitled to be paid for his dependent spouse, pursuant to ss 37(1)(b) and 37(1)(c) of the Workers Compensation Act 1987 (the 1987 Act)
(b) those payments were to commence from 15 May 2018;
(c) the rates of those payments were:
- 1 October 2023 to 31 March 2024: $150.30
- 1 April 2023 to 30 September 2023: $148.50
- 1 October 2022 to 31 March 2023: $145.20
- 1 April 2022 to 30 September 2022: $143.70
- 1 October 2021 to 31 March 2022: $141.50
- 1 April 2021 to 30 September 2021: $139.80
- 1 October 2020 to 31 March 2021: $139.00
- 1 April 2020 to 30 September 2020: $137.90
- 1 October 2019 to 31 March 2020: $136.10
- 1 April 2019 to 30 September 2019: $135.00
- 1 October 2018 to 31 March 2019: $133.00
- 1 April 2018 to 30 September 2018: $132.00
(d) EML "purport[ed]" to have identified an overpayment of $6,569.08, which was not agreed.
However, EML did not seek repayment, nor was this being deducted from the entitlement.
30 September 2022, EML had calculated the correct statutory rate (including a dependent spouse) to be $1,069.40 per week. However, the applicant was paid $1,080.40 per week and therefore was overpaid $11 per week for that period (except in the short weeks, which were highlighted). 10. "In other words," the respondent's solicitors stated, when the applicant's correct statutory rate was applied, he had suffered no financial loss during the above period, as he had already received more than that to which he was entitled. EML did not seek to have that paid back but contended that the applicant could not receive additional overpayment. 11. The respondent's solicitors explained that the "-11" shown only indicated an overpayment for the week and was not a deduction from the total. The weeks where there had been an overpayment were not included in EML's final calculation, as the applicant had already been overpaid. The total of the amount in weeks in which an overpayment [sic] was due was $26,886.02. The respondent maintained this was the correct approach and an accurate calculation of the applicant's entitled back payment. 12. The respondent's solicitors were instructed by EML that the applicant's payment had been processed that morning and could not now be undone. 13. By email to the respondent's solicitors at 5:02pm on 21 October 2024, the applicant's solicitors stated that the total overpayment amounted to $6,59.06 [sic: $6,569.06]. The total underpayment was $43, 072.10. EML had not paid for a dependent spouse for the relevant period, so that was the actual underpayment. 14. The applicant's solicitors stated that EML asserted it had overpaid the applicant for a period but was not taking that into account ": but they are". 15. The applicant's solicitors claimed the overpayment could only be in relation to (a) a child dependent [sic] or (b) the applicant earning money that would impact his "s 40s" (of the 1987 Act). "Which of those situations is applicable?" 16. The applicant's solicitors stated that it was very simple to calculate the alleged overpayment, which had not been particularised, and the applicant was told, was not being taken into account, "but it is." The explanation about the spreadsheet that had been provided was "trite. It is a spreadsheet. It says what it says. [I]t says that there is $11,000 difference between $43,072.10 (less the alleged overpayment)." [sic].
a) GW, daughter (DOB 29 August 2000). This dependency ceased on 30 August 2021. This resulted in the overpayment from 31 August 2021 as evident below. > > b) MW, daughter (DOB 8 March 2002). This dependency ceased on 9 March 2023 and resulted in the lower rate recorded from 1 April 2023. > > c) JW, son (DOB 6 February 2004) > > d) HN, son (DOB 21 May 2018) > > e) Kylie Newby, dependant spouse (claimed from 15 May 2018)
the addition of the dependant spouse. This extended until 20 November 2023 when the error was identified by EML.
2 Applicable statutory maximum as per the Benefits Guide.
Newby
State of New South Wales