NSW workers’ compensation claims: What is a certificate of capacity?

NSW workers’ compensation claims: What is a certificate of capacity?

Everyone has the right to go to work each day, knowing they’ll come home safely. If you’ve been injured or become ill at work you may be entitled to make a claim for workers’ compensation to cover lost wages, medical and rehabilitation costs, retraining expenses or a lump sum payment for permanent injuries.

There have been a lot of changes to arrangements in NSW for seeking workers’ compensation in recent years. You could be forgiven for being a little confused about where to start. After all, workers’ compensation laws and entitlements are already a little hard to keep up with because they vary between states and territories and may be known as WorkCover, CTP or WorkSafe. Compensation and benefits can vary greatly depending on your injury and on the law you’re covered by.

Have you heard of a ‘certificate of capacity’? If you’ve been injured in the workplace in NSW, then read on, as this blog provides essential reading on what you need to know.

What is a certificate of capacity?

The certificate of capacity is used by the workers’ compensation insurer to make decisions about your capacity for work and their entitlement to compensation.

It will help you, your employer, and their insurer develop an injury management plan concerning the treatment, rehabilitation and retraining required (where appropriate) for a successful recovery at/return to work outcome.

The certificate of capacity tells the insurer:

  • your name and details
  • the type of injury/illness and date it occurred
  • what management is planned
  • how the injuries impact your ability to do their usual activities including work
  • the details of the medical practitioner who completed the certificate including their provider number.

It also helps the employer find suitable work for you so that you can recover at/return to work with appropriate support.

Who completes the first certificate of capacity?

The first certificate of capacity is completed by your nominated treating doctor or specialist in consultation with you. This is important so that your full health needs can be assessed.

If you have interstate and need to obtain a certificate of capacity, a doctor in your new local area can become your nominated treating doctor and complete the certificate of capacity. Your new doctor is required to be registered with the AHPRA and agree to participate and take responsibility for coordinating all aspects of the your treatment and return to work management.

What do you need to do?

If you are the worker, there are two sections you need to review and complete. These are the ‘worker consent’ (section 1) and ’employment declaration’ (section 3).

By signing the consent section of the certificate, you approve of the following people collecting information from each other about your injury/illness (including personal information and health information about you):

  • the insurer
  • your employer
  • health practitioners (whether treating, consulting or examining)
  • other relevant parties (such as a workplace rehabilitation provider) and 
  • SIRA.

As the worker, you are required to complete the declaration to report if you have been engaged in any form of employment, self-employment or voluntary work for which you received or are entitled to receive payment in money or otherwise since the last certificate of capacity was completed.

You must complete this declaration before the certificate of capacity is provided to your employer or the insurer (after your consultation with the medical practitioner). 

NOTE: The worker declaration does not need to be completed by exempt workers

Read more hereNSW workers’ compensation claims: What’s an independent medical examination (IME)? – Littles

What is your doctor’s role?

Your nominated treating doctor or treating specialist medical practitioner is responsible for completing the ‘doctor’s’ part of the certificate of capacity. It should identify

  • a clear medical diagnosis using acceptable medical terminology, and
  • any reasonably necessary treatment.

When completing the ‘capacity’ section, your doctor is certifying whether you have:

  • capacity for pre-injury duties
  • capacity for some type of work, or
  • no current work capacity.

If you have capacity for some type of work, your doctor must identify the hours and days that you have capacity to perform suitable work.

If your doctor certifies that you have no current work capacity, they must estimate the time needed for you to regain some capacity.

Your doctor may also recommend referral to a workplace rehabilitation provider.

NOTE: Your doctor generally cannot issue a certificate of capacity that exceeds a 28-day period without providing special reasons for doing so.

Second and subsequent certificates of capacity

Your treating medical practitioner must issue you with the initial certificate of capacity. After that, the SIRA-approved treating physiotherapist or SIRA-approved treating psychologist can assess injuries within their area of expertise, and issue second and subsequent certificates of capacity using the Certificate of capacity – treating physiotherapist or psychologist.

If you have more than one type of injury and are being treated concurrently by more than one type of practitioner, your treating physiotherapist/psychologist is strongly encouraged to refer you back to your medical practitioner to certify your overall capacity.

NOTE: If a subsequent certificate covers a period that overlaps with a period covered by an earlier certificate, then the later certificate prevails for the whole of the period covered by the later certificate.

Read more hereHelp! My NSW workers’ compensation claim has been rejected. What do I do? – Littles

IMPORTANT: There are strict time limits for making and disputing a claim, so take advantage of our FREE initial consultation and get in touch. You have nothing to lose by speaking to one of our compensation law experts. The sooner we determine your eligibility to make or appeal a claim, the sooner we can help you to obtain or continue getting funding from the insurer so your rehabilitation can proceed smoothly.

Free advice and no upfront fees 

Not only do we offer a FREE initial consultation we handle most insurance claims on a no win, no fee basis.

The Head of our NSW team, Jessica Cheung, is an expert in NSW workers’ compensation claims. If you think you might have a claim, reach out to Jessica and her team for high quality legal advice.

Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles.

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