Work capacity decision reviews

A work capacity decision is a decision by the insurer about current work capacity:

• current work capacity
• what is suitable employment for the worker
• what a worker can earn in suitable employment
• pre-injury average weekly earnings or current weekly earnings
• whether the worker can engage in certain employment without risk of further injury
• any other decision that may impact entitlement to 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 Personal Injury Commission to have the dispute resolved.

Contact the Independent Review Office

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

IRO 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 IRO can help workers:

• visit their website,
• call IRO on 13 94 76, or
• send an email to [email protected]

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 Personal Injury Commission.

The Independent Review Office (IRO) 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 IRO 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 Personal Injury Commission’s dispute resolution services for that work capacity decision.

Applications to the Personal Injury 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 Personal Injury Commission.

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

For more information please visit the Personal Injury Commission website or call 1300 368 040.

Stay of a work capacity decision

A review by the Personal Injury 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 IRO 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's decision regarding 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 
Review form - application for review by the insurer
Decision notice summary

Further information

Find out more about work capacity decisions on our SIRA website or visit the claims management guide for more information about work capacity decisions.