Work Capacity Decisions

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Work Capacity Decisions are important. Here is a brief introduction on what a work capacity decision is.

Through a Work Capacity Assessment, the insurer will make decisions on the injured workers 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 they 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).

Work capacity decisions by insurers are decisions defined in section 43 of the 1987 Workers Compensation Act as:

(a) a decision about a worker’s current work capacity,

(b) a decision about what constitutes suitable employment for a worker,

(c) a decision about the amount an injured worker is able to earn in suitable employment,

(d) a decision about the amount of an injured worker’s pre-injury average weekly earnings or current weekly earnings,

(e) a decision about whether a worker is, as a result of injury, unable without substantial risk of further injury to engage in employment of a certain kind because of the nature of that employment,

(f) any other decision of an insurer that affects a worker’s entitlement to weekly payments of compensation, including a decision to suspend, discontinue or reduce the amount of the weekly payments of compensation payable to a worker on the basis of any decision referred to in paragraphs (a)–(e).

Notification of a work capacity decision

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

Contact the injured worker 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 the injured worker 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.

Remember you can appeal a work capacity decision.