If you are injured, your capacity for employment is known as your work capacity.
Work capacity assessments
The insurer will assess your work capacity so you can recover at work with appropriate support. This is known as a work capacity assessment and cannot be reviewed.
Seriously injured workers are not subject to work capacity assessments unless they request it and the insurer considers such assessment to be appropriate. A seriously injured worker is usually a worker who has been assessed as having more than 30% permanent impairment.
Work capacity decisions
In addition, the insurer will make a work capacity decision throughout the life of your claim based on:
- your current work capacity
- what constitutes suitable employment for you
- the amount you are able to earn in suitable employment
- the amount of your pre injury average weekly earnings or current weekly earnings
- if you are unable to engage in employment of a certain kind without substantial risk of further injury
- any other decision that affects weekly payments of compensation, including a decision to suspend, discontinue or reduce weekly payments of compensation based on the points above
Review of work capacity decisions
Work capacity decisions can be reviewed by a number of different people.
Review by insurer
You may request an internal review by the insurer of a work capacity decision after receiving an advice of a work capacity decision.
You must submit a completed work capacity - application for internal review by insurer form, if your internet browser won't open this form print out this static version, to the insurer specifying the grounds on which the review is being sought and providing any new information.
Review by WorkCover
If you are not satisfied with the outcome of an insurer's internal review, or if the review is not completed within 30 days, you may lodge a work capacity - application for merit review by the authority form, if your internet browser won't open this form print out this static version. You must lodge an application for merit review by us within 30 days after receiving the insurer's internal review decision
The guidelines for work capacity decision internal reviews by insurers and merit reviews by the authority have further information.
Review by Workers Compensation Independent Review Office
If you are not satisfied with the outcome of a WorkCover merit review, you may lodge an application for procedural review by the Workers Compensation Independent Review Officer (WIRO) within 30 days of receiving the merit review findings.
The WIRO will review of the procedures undertaken by the insurer when making the work capacity decision, not review the decision itself. Contact WIRO on 13 94 76 for more information.
The Workers Compensation Independent Review Office fact sheet contains general information about workers compensation entitlements and procedures. This fact sheet is not a detailed explanation of the law as it applies to claims made by individual workers.
If a worker who has an existing claim (made before 1 October 2012) requests a review of a work capacity decision within 30 days after receiving notice of the decision by the insurer, the insurer cannot take action, such as reducing or ceasing weekly payments, until the decision is reviewed.
For further information, or if you have any concerns about the review process, contact:
- the insurer or
- WorkCover's Customer Service Centre on 13 10 50 or
- the WIRO on 13 94 76