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