Work capacity decision reviews

If you disagree with your insurer's decision about your ability to work or your entitlement to weekly payments after a work related injury or illness, you can apply for a review by us.

First, you need to make sure you have asked the insurer to carry out an internal review of their decision. If you still disagree with the insurer after the internal review, you can apply to our workers compensation merit review service (MRS) for a merit review of the decision.

We have created an easy-to-use online portal where you can submit an application (and supporting documents) to have the decision reviewed by us, and follow its progress to completion.

This is called lodging an application for 'merit review'. All you have to do is click the button below to log in to the merit review portal. You can still submit a paper application form if you prefer.

Before using the portal there are some things you need to know:

1. What is 'work capacity'?

‘Work capacity’ is a legal term.

In general terms a work capacity decision is a decision by an insurer about whether you can work, for how long and at what type of work, which has an impact on the types of entitlement you can receive.

Can you return to work right now? If yes then for how many hours a week can you work and what sort of tasks can you do?

Click here for some examples of disputes

  • you disagree with the insurer on your current ability to return to work
  • you disagree with the ‘suitable work’ (work you can do while you're recovering) the insurer has recommended for you
  • disagreement on how much you can earn in suitable employment
  • disagreement on your pre-injury average weekly earnings (PIAWE) or current weekly earnings, or
  • any other decision that impacts your entitlement to weekly payments of compensation

2. Before you can request a merit review, you must first request an internal review by the insurer

An internal review is a review of the work capacity decision by the insurer. It is conducted by someone other than the person who made the initial decision.

The review will consider the information used in the initial decision, as well as any further information you provide in support of your internal review application.

Fill out the application for internal review by insurer form to begin the process.

The insurer will contact you within seven days of receiving the application and explain their internal review procedure.

The insurer is required to complete the internal review within 30 days from the date of your application and notify you of the outcome in writing.

If you are unhappy with the outcome of the insurer's internal review, SIRA can then review the work capacity decision.

Further information

What about legal costs?

You may seek advice from a legal practitioner about an application (or proposed application) for merit review of an original work capacity decision made by the insurer on or after 16 December 2016.

The insurer is liable to pay costs for this advice. However, legal costs will not be payable if you seek legal advice more than 30 days after you were notified of the insurer's internal review decision.

For guidance regarding work capacity assessments and decisions refer to the Guidelines for claiming workers compensation (effective from 1 August 2016).

For guidance regarding work capacity assessments and decisions prior to 1 August 2016 see the Guidelines for work capacity decision internal reviews by insurers and merit reviews by the Authority, Guidelines for claiming compensation benefits, and the work capacity guidelines 2013. These guidelines were effective from 11 October 2013 to 31 July 2016.

Conducting merit reviews

An independent decision maker from the SIRA Merit Review Service will conduct a merit review of the insurer’s work capacity decision and will outline findings and recommendations. These are binding on the insurer.

They will send the details of the findings and recommendations (with their reasons) to you and the insurer as soon as possible, and preferably within 30 days of the application for merit review being lodged.

The guidelines for claiming workers compensation and the dispute resolution services guide to workers compensation merit reviews has detailed information about the processes for merit reviews.

A list of merit reviewers is available on our website.

Contact WIRO

If, after you are informed of the findings of the SIRA merit review, you remain dissatisfied with the work capacity decision, you can seek a procedural review of the insurer's work capacity decision by applying to the Workers Compensation Independent Review Office (WIRO).

You can do this by phoning WIRO on 13 94 76 or visiting their website for more information.

The Workers Compensation Commission

The Workers Compensation Commission (WCC) can make decisions about claim liability and weekly payments of compensation but it does not have decision-making powers in relation to work capacity decisions.

Stay of a work capacity decision

A review of a work capacity decision may operate to stay (temporarily suspend) the work capacity decision that is under review. The insurer will explain how a stay may apply to your circumstances.