Work capacity decision reviews

If you disagree with the insurer's decision about your ability to work or your entitlement to weekly payments after a work-related injury or illness, find information on work capacity decisions and review options for a worker 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 (the worker) disagree with the insurer's work capacity decision, your options to challenge the decision will depend on the date of the insurer's decision notice.

On or after 1 January 2019

You (the worker) have the choice to apply for a review of the decision by the insurer, or proceed directly to the Workers Compensation Commission (WCC) to have the dispute resolved.

For guidance, you can use or simply refer to the Review form - application for review by the insurer.

Requesting a review

If you are a worker requesting a review you should explain why you are requesting it and include any additional information that you think is relevant to help the insurer review the decision.

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.

Contact the Workers Compensation Independent Review Office

If you are a worker, please contact the Workers Compensation Independent Review Office (WIRO) for assistance.

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

For more information about how WIRO can help injured workers:

Legal advice

A worker 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 (WCC).

When an initial complaint becomes a dispute, 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). The lawyer will review your case and may make an application to WIRO to see if funding is available to have the dispute resolved by the WCC.

Applications to the Workers Compensation Commission

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

The WCC is an independent tribunal that helps resolve workers compensation disputes between injured workers, employers and/or insurers.

The kind of disputes they resolve include:

  • work capacity decision
  • weekly payments compensation
  • medical, hospital and related expenses
  • permanent impairment compensation
  • compensation for damage to personal property
  • compensation for domestic assistance.

For more information please visit the WCC website or call 1300 368 040.

Stay of a work capacity decision

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

Before 1 January 2019

Request a review by the insurer

If the decision notice is dated before 1 January 2019, the worker must request an ‘internal review’ by the insurer before a SIRA ‘merit review’ can be requested.

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 to support your internal review application.

A completed Application for internal review by insurer form is required to begin the process.

The insurer will contact the worker 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 the application and notify the worker of the outcome in writing.

If the worker is unhappy with the outcome of the insurer's internal review, the worker can then apply to SIRA to conduct a 'merit review' of the work capacity decision.

Request a merit review

If the worker still disagrees with the insurer after the internal review, an application can be made to SIRA’s workers compensation merit review service (MRS) for a merit review of the decision.

SIRA has created an easy-to-use online portal where an application (and supporting documents) to have the decision reviewed by SIRA can be submitted.

This is called lodging an application for 'merit review'. Click the button below to log in to the merit review portal. It is also possible to still submit a paper application form if preferred.

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 the worker and the insurer as soon as possible, and preferably within 30 days of the application for merit review being lodged.

The 2016 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.

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.

Legal advice

A worker 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, this advice must be sought and received promptly. Legal costs will not be payable if the worker receives legal advice more than 30 days after being notified of the insurer's internal review decision.

For guidance regarding work capacity assessments and decisions made prior to 1 January 2019, refer to the Guidelines for claiming workers compensation (effective from 1 August 2016 to 31 December 2018).

Contacting the Workers Compensation Independent Review Office (WIRO)

NOTE: This section applies to work capacity assessments and decisions made prior to 1 January 2019

If, after being informed of the findings of the SIRA merit review, the worker remains dissatisfied with the work capacity decision, a procedural review of the insurer's work capacity decision can be sought by applying to the WIRO (WIRO).

Please contact WIRO on 13 94 76 or visiting their website for more information.

What is current work capacity?

‘Current work capacity’ is a legal term.

In relation to a worker, it means a present inability arising from an injury whereby the worker is not able to return to their pre-injury employment but is able to return to work in other suitable employment.

Examples of disputes include:

  • 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,
  • 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.