When the injured worker visit their own doctor for the first time they and the doctor will need to fill in a Certificate of Capacity. That doctor becomes the Nominated Treating Doctor (you have the right to change nominated treating doctors at any time). If there is a possibility that the doctor could change due to unavailability (in a medical clinic or regional location for instance), this possibility should be noted on the certificate of capacity.
It is important that the injured worker sees their own doctor and choses their own nominated treating doctor. NOT one suggested by the employee or the insurer.
The certificate of capacity is used by the insurer to help them understand the injured worker’s capacity for work and the entitlements they can receive.
The certificate of capacity will also help the insurer to develop an injury management plan with the injured worker and their doctor, which facilitates appropriate medical treatment and a return to work.
The Certificate of Capacity is the most important document in the process. It is the responsibility of the doctor to ensure the certificate reflects the true nature of the injured workers capacity. NOT influenced by an insurer, employer or anyone else.
The Certificate of Capacity should have a clear medical diagnosis using acceptable medical terminology to prevent misunderstandings by the insurer:
- It should also include a clear outline of any restrictions on the injured worker
- If further tests/assessments are required before a proper diagnosis can occur this should be identified on the certificate
- The certificate should include a recovery focused injury management plan.
- The injured worker’s Certificate of Capacity is binding on everyone involved in the claim. Everyone has to follow the diagnosis and prognosis written on that certificate.
- For a physical injury it is recommended that the treating doctor refers to the American Medical Association Guides to the Evaluation of Permanent Impairment, fifth Edition (or Sixth).
- For a mental health injury it is recommended that the treating doctor refer to the American Psychiatric Association DSMV 5 (the Diagnostic and Statistical Manual of Mental Disorders version 5).
The doctor is the only person who can change the medical certificate. They should do this without the influence of the insurer, employer or the rehabilitation provider.