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Work capacity decision reviews

If you disagree with the insurer's decision about the amount of weekly payments payable after a work-related injury or illness, find information on work capacity decisions and review options for workers here.

A work capacity decision is a decision by the insurer about the worker and:

  • current work capacity
  • current weekly earnings
  • pre-injury average weekly earnings
  • suitable employment
  • anything that may impact on weekly payments of compensation.

If you are a worker and you disagree with the insurer's work capacity decision, you have the choice to apply for a review of the decision by the insurer, or proceed directly to the Workers Compensation Commission to have the dispute resolved.

Contact the Workers Compensation Independent Review Office

Workers can contact the Workers Compensation Independent Review Office (WIRO) for assistance.

WIRO is an independent statutory office with a variety of roles, including helping find solutions to workers compensation complaints by contacting the insurer on behalf of the worker.

For more information about how WIRO can help workers:

Legal advice

Workers can choose to get advice from a legal professional about an application (or proposed application) to have a dispute resolved by the Workers Compensation Commission.

The Workers Compensation Independent Review Office (WIRO) can advise you (the worker) and your representative about how to get advice from a lawyer approved under the Independent Legal Assistance and Review Service (ILARS) at no cost to you. The lawyer will review your case and may make an application to WIRO to see if funding is available for independent legal advice to assist in resolving your dispute.

Requesting a review by the insurer

Workers, or their legal representatives, can ask for an optional review of a decision by the insurer, by someone other than the person who made the initial decision. If you are a worker and you are requesting a review by the insurer, you (or your legal representative) should explain why you are requesting it and include any additional information that you think is relevant to help the insurer review the decision. For guidance, you can use or simply refer to the Review form - application for review by the insurer.

The insurer must respond to you in writing within 14 days of receiving the request for a review. The review will be conducted by someone other than the person who made the initial decision.

Workers who requested an internal review by the insurer prior to 1 January 2019 are not able to use the Workers Compensation Commission’s dispute resolution services for that work capacity decision.

Workers who have a work capacity decision notice dated before 1 January 2019, who have requested an internal review by the insurer from 1 January 2019 to 30 June 2019, should visit the merit reviews of work capacity decisions page for more information.

Applications to the Workers Compensation Commission

If you are a worker and you do not wish to seek a review by the insurer or you are not satisfied with the insurer's decision after a review, you or your legal representative can lodge an application to have the dispute resolved by the Workers Compensation Commission.

The Workers Compensation Commission is an independent tribunal that helps resolve workers compensation disputes between workers, employers and/or insurers.

For more information please visit the Workers Compensation Commission website or call 1300 368 040.

Stay of a work capacity decision

A review by the Workers Compensation Commission may ‘stay’ (temporarily suspend) the effect of the work capacity decision made by the insurer on your weekly payments, providing the application to resolve the dispute is lodged with the Commission prior to the expiry of the period of notice as stated in the decision notice issued by the insurer. This means your weekly payments may continue. The insurer or WIRO can explain how a stay may apply to your claim.

Work capacity dispute examples

Examples of work capacity disputes may include:

  • you disagree with the insurer on your current work capacity
  • you disagree with the insurer’s decision regarding what is ‘suitable employment’ for you and how much you can earn in suitable employment
  • disagreement on your pre-injury average weekly earnings (PIAWE) or current weekly earnings
  • disagreement about whether you are unable to engage in employment of a certain kind, or
  • any other decision that impacts your entitlement to weekly payments of compensation.

Resources

Workers compensation guidelines 2018
Review form - application for review by the insurer
Decision notice summary

Further information

Find out more about work capacity decisions.