A work capacity assessment by an insurer may lead to a work capacity decision.
A work capacity decision can be about capacity to work, suitable work, earnings in suitable work or other decisions that affect the worker's entitlement to weekly compensation payments. Work capacity decisions are different from decisions about accepting or declining liability to a claim or for medical or treatment expenses.
Where a work capacity decision is made which changes the amount of weekly compensation you receive, the insurer is required to give all information and reasons used to make the decision and establish the amount of weekly compensation payable.
Where the insurer makes a work capacity decision that changes weekly compensation payments, there are some things they need to tell you. These include:
- What their decision is;
- The effect of the decision on your weekly payments;
- The reasons for the decision;
- Information considered;
- The date the decision takes effect;
- The process for requesting an internal review;
- What you need to do if a review is sought;
If you receive a work capacity decision, it is important to read it carefully and ensure that you understand the effect of the decision. Also make sure that there are no mistakes either in the assessment relied upon, or the calculation of weekly payments. These can impact on the decision that has been made.
It is important to know you have rights to seek various types of reviews of a work capacity decision. If there are errors or you disagree with the decision, don’t delay in seeking an internal review of the decision.
Following the internal review of the decision by the insurer you may apply for a review of the decision by the State Insurance Regulatory Authority ("SIRA").
If you have been injured at work and need advice about your rights and entitlements, please call one of our experienced compensation team in Bathurst, Lithgow or Oberon on 1800 650 656. We're here to help!
Angus Edwards | Principal