Work Capacity Decisions

Work Capacity Decision:

Through a Work Capacity Assessment, the insurer will make decisions on your work capacity.

These decisions can made on things like:

  • Your current work capacity
  • Your pre-injury average weekly earnings
  • What constitutes suitable employment
  • The amount you may be able to earn in suitable employment
  • If you are unable to engage in employment of a certain kind without substantial risk of further injury.
  • Any other decision that may affect your entitlement to weekly income replacement (positive or negative).

If there is no change to your entitlements you may not always find out that a decision has been made. generally you will find out soon enough what the outcome is though.

A work capacity decision will likely have an impact on your entitlements. It is important that you do not ignore any information the insurer sends you (and insist on getting it in writing).

Your RIGHTSNEXT STEP
You have the right to ask the insurer to review a decision that it has madeYou should make this request by completing the Application for a Review by Insurer form and provide it to your insurer within 30 days.
If you still believe that the insurer has not applied the correct approach:
You have the right to ask SIRA for a review of the merits of the decision.Completing the Application for a Review by the Authority form) and provide it to the regulator within 30 days after receiving the insurer’s decision. For more information about SIRA’s merit review.
If your issue is not resolved following the SIRA review:
You have the right to ask WIRO to review the insurer’s procedures in making the work capacity decision. The WIRO decision is binding.You can seek assistance with the completion of your application from anyone, including: • Your insurer • A support person • A union representative • An interpreter • Your employer • Your legal representative. A lawyer is not entitled to be paid for helping you to complete your initial review application.
Reproduced from WIRO. Accessed www.wiro.gov.au

When a worker requests a review of a work capacity decision made by an insurer, the insurer is presented from reducing or stopping income replacements until the review has been completed.

IWSN Work Capacity Decision series. No 2.