There will be times when new information advising of a change in capacity comes to the attention of the insurer.
It is important for work capacity assessments to be undertaken promptly following receipt of a certificate indicating a change in a worker’s capacity, to ensure workers continue to receive appropriate compensation and support.
If a worker submits a certificate of capacity reflecting a change in capacity, an insurer must promptly conduct a work capacity assessment to investigate the reason for the change. The change in capacity may change the amount of the weekly payment of compensation payable to the worker.
The insurer is required to consider this new information and review the worker’s capacity for work (perform a work capacity assessment) and determine the worker’s current work capacity. This work capacity assessment should involve talking to the nominated treating doctor about the change in capacity.
A work capacity decision can be simple and based on available information (eg the certificate of capacity), or it can be more complex (eg to determine what is suitable employment where the worker has some capacity but cannot return to their pre-injury employment). A more complex work capacity assessment may require the sourcing of additional information through assessments such as a functional or vocational assessment.
The outcome of the work capacity assessment may or may not change the amount of weekly payments the worker receives, however, when an insurer makes a decision about a worker’s current work capacity they are making a work capacity decision.
The insurer is required to inform the worker of the outcome of the work capacity assessment and decision, and clearly communicate changes (if any) to the amount of weekly payments. The information must also advise the worker of the review options available if they do not agree with the decision.
An insurer can advise the worker of the work capacity decision in different ways. Where the decision doesn’t change the amount of weekly payments the worker receives, the worker should be contacted to inform them of the decision, and their right to request an internal review if they do not agree with the decision. This conversation should be noted in the worker’s file.
Where the decision reduces or discontinues payment of weekly payments to a worker, then communication to the worker must be in person or by post and should be communicated by telephone as well.
