Work Capacity Decisions: Receiving the letter

Notification of a work capacity decision:

The insurer must notify you in writing of the work capacity decision if it will result in a reduction or discontinuation of your weekly income replacements. The insurer should:

  • Contact you by phone and speak to them at the time of the decision, informing them that a work capacity decision has been made
  • Explain the outcome and consequences of their decision and the information that has led them insurer to reach that decision.
  • Clearly explain the internal review process and that a review application will be sent with the notice.
  • Confirm their decision in writing. The insurer must provide you and other relevant parties with their decision in plain language.

Plain language communication requires:

  • Being considerate of the nature of the worker’s circumstances
  • Communicating respectfully
  • Communicating a clear message
  • Presenting concise information
  • Adapting communication style to meet the worker’s needs. E.g. utilising an interpreter if necessary.

The Written decision must contain the following:

  • The date in which the decision was made;
  • The outcome of the decision and impact on weekly benefits;
  • The information considered in making the decision, including author and date;
  • A description of the information considered;
  • All the documents must be attached or the insurer must provide a process whereby you can access those documents;
  • The impact the decision will have on medical expenses;
  • The date the decision will take effect;
  • Any support that will be provided in the notice period;
  • An explanation about how an injured worker can seek a review of the decision

IWSN work capacity decision series. no 3 -with thanks to Sherri Haywood & the CFMEU