Work Capacity Assessments play a vital role in the workers compensation process and in determining an injured worker’s entitlements. By the end of this article you should have a better understanding about:
- Overview of Work Capacity Assessments
- Different types of information insurers consider when performing a work capacity assessment
- How often Work Capacity Assessments can take place
- Who are exempt from Work Capacity Assessments
What is a Work Capacity Assessment?
A Work Capacity Assessment is an assessment that is conducted to determine an injured worker’s ability to work and earn income. It takes into consideration factors such as the worker’s current symptoms, functional restrictions, and their ability to work certain hours per day or week. Medical evidence, including certificates of capacity and medical reports, is also taken into account during the assessment.
The goal is to assess the worker’s true capacity for work rather than the worker’s pre-injury employment or earnings. This assessment helps in determining suitable employment options and enables injured workers to receive the appropriate level of compensation for their injury.
According to Section 44(A)(2) of the Workers Compensation Act 1987, work capacity assessments must be conducted in accordance to the Workers Compensation Guidelines.
Do I need a work capacity assessment?
Unless you are an exempt worker, you will need a work capacity assessment as it helps ensure injured workers receive appropriate support and benefits. It is also required when there is a dispute over the worker’s capacity to work or when the insurer needs to make a capacity decision based on medical evidence.
During the assessment process, the insurer considers various factors, including medical reports, certificates of capacity, and vocational assessments. They may also request a medical examination to obtain a comprehensive understanding of the worker’s physical and psychological capacity.
Section 44(A)(6) of the Workers Compensation Act 1987 states that if a worker refuses to participate in a work capacity assessment, then the worker’s right to weekly payments is suspended until the necessary assessments have taken place.
How are Work Capacity Assessments performed?
In New South Wales, a work capacity assessment is a comprehensive process conducted by insurers to evaluate an injured worker’s ability to return to their previous role or undertake suitable alternative employment. This evaluation is multifaceted, encompassing several key factors:
- Understanding medical condition
- Reviewing Certificate of Capacity
- Functional Capacity Assessment
- Assessing Workplace Requirements
- Understanding rehabilitation and return to work plans
- Vocational assessment
- Age & Personal Factors
- Expert opinions from Independent Medical Examinations and Injury Management Consultants
Understanding Medical Condition
Insurers delve into the worker’s medical history, scrutinizing the diagnosis, treatment protocols, and future prognosis. This involves a thorough review of medical reports and potentially liaising with the healthcare professionals providing treatment. The goal is to gain a clear understanding of the injury or illness, its impact on the worker’s abilities, and the expected recovery timeline.
Medical reports provide valuable information regarding the nature and extent of the worker’s injury, the expected prognosis, and any functional restrictions that may impact their ability to work. These reports are compiled by a nominated treating doctor who assesses the worker’s current symptoms, medical history, and the results of any diagnostic tests or examinations.
Reviewing Certificate of Capacity
Certificates of capacity are another important tool in assessing physical capacity. These certificates provide a summary of the worker’s medical condition, detailing their current capacity for work, any restrictions on their tasks or hours, and an indication of their future capacity.
The certificates are typically issued by the nominated treating doctor, who has firsthand knowledge of the worker’s condition and can provide an accurate assessment of their physical abilities.
What is a Functional Capacity Assessment?
A functional capacity assessment for Workers Compensation is a systematic evaluation process to measure a worker’s ability to perform their job related tasks following a workplace injury or illness.
The assessment focuses on their physical and cognitive capabilities in relation to the demands of their specific job role. This typically involves a functional capacity assessment conducted by a health professional such as an occupational therapist or physiotherapist.
The assessment focuses on the worker’s capabilities, identifying any limitations or restrictions that need to be considered in a return-to-work plan and is a key item used when assessing work capacity.
Assessing Workplace Requirements
Insurers also assess the demands and requirements of the worker’s pre-injury job. This includes understanding the physical exertion, cognitive tasks, skills required, and the overall work environment. The possibility of modifying the job to accommodate the worker’s current capacity is also explored, ensuring a safe and sustainable return to work.
Rehabilitation and Return-to-Work Plans
Existing rehabilitation or return-to-work plans are reviewed to gauge the worker’s progress and the effectiveness of the strategies in place. This helps insurers understand the worker’s journey towards recovery and their readiness to reintegrate into the workforce.
The worker’s educational background, skills, and work experience are considered to identify any transferable skills. This is particularly important if the worker is unable to return to their pre-injury role and needs to transition into a different job.
Typically, insurers will require injured workers to participate in a vocational assessment. These assessments evaluate a worker’s ability to return to suitable employment following an injury.
Age and Personal Factors
The worker’s age, living circumstances, and other personal factors are taken into account as they can influence the worker’s capacity to work and their vocational options.
Using Independent Medical Examination (IME) or Injury Management Consultation (IMC)
Insurers may also require the injured worker to attend appointments to do an Independent Medical Examination (IME) or an Injury Management Consultation (IMC).
IMEs provide an unbiased medical opinion on a worker’s injury, recovery status, and work capacity. They are typically engaged when information from nominated treating doctors or practitioners is lacking.
While IMCs involve discussions between the injured worker, employer, and a health professional to develop an injury management plan. The information gathered in these consultations helps to form a comprehensive picture of the worker’s capacity to return to their pre-injury job or undertake suitable alternative employment.
How is work capacity determined?
Work Capacity is determined by reviewing the information provided about the injured worker such as medical history and records, functional and vocational assessments, certificate of capacity, and reports from independent medical examinations & injury management consultations.
After taking all relevant information into consideration, work capacity is then determined. Based on the injured worker’s work capacity, this will help inform suitable employment arrangements and compensation payments.
How often can insurers require a work capacity assessment?
In New South Wales, under Section 44(A)(1) of the Workers Compensation Act 1987, insurers are to conduct a work capacity assessment at any time throughout the life of the claim.
According to SIRA, the insurer must also conduct a Work Capacity Assessment during the last 52 weeks of the second entitlement period (78 weeks to 130 weeks). After 130 weeks, work capacity assessments must take place at least once every 2 years.
Important note: As per Section 44(A)(3), a work capacity assessment is not necessary for the making of a work capacity decision by the insurer. For more information, visit our article on Work Capacity Decisions.
Who is exempt from Work Capacity Assessments?
Police officers, paramedics and firefighters are known as exempt workers under the Workers Compensation Scheme in NSW. According to SIRA’s Workers Compensation Guidelines, work capacity assessments do not apply to exempt workers.
Injured worker with Permanent Impairment has partial exemptions
Partial exemptions are in place in the case of workers with highest needs (those with a permanent impairment exceeding 30%). Section 44(A)(4) of the Workers Compensation Act 1987, states that insurers are not to request workers with highest needs to perform a work capacity assessment unless the insurer thinks it is appropriate to do so.
How Alliance Compensation & Litigation Lawyers can help
Navigating through the complexities of Work Capacity Assessments can be challenging. That’s why our skilled Workers Compensation Lawyers are always happy to provide our clients with comprehensive support throughout the entire process.
Insurers often don’t have your best interests at heart, and would find ways to minimise your Workers Compensation Entitlements. Work Capacity Assessments and Decisions are a crucial element in determining what your entitlements are i.e. weekly payments. To ensure you maximise your payout, our expert team is able to represent you whilst always keeping your best interests top of mind.
For more information on Workers Compensation, visit our Comprehensive Guide to Workers Compensation in NSW.
Frequently Asked Questions
What is a certificate of capacity in NSW Workers Compensation?
A certificate of capacity is a crucial document in the New South Wales (NSW) Workers Compensation system. It plays a significant role in determining a worker’s current work capacity and their eligibility for compensation.
Obtaining a certificate of capacity is the responsibility of the worker’s treating healthcare professional, such as a general practitioner or specialist. This medical practitioner assesses the worker’s injuries, conducts examinations, and determines their ability to perform work-related activities.
The certificate of capacity contains important information, including the worker’s diagnosis, functional restrictions, and their capacity for work. It also outlines the recommended treatment, suitable employment options, and any specific work arrangements that may be necessary.
This certificate is crucial in establishing the worker’s current work capacity and their eligibility for compensation. It provides evidence of the worker’s medical condition and restrictions, helping insurers and authorities assess the appropriate level of support and compensation required.
How do I get a Certificate of Capacity in NSW?
Getting a certificate of capacity is simple, here are some steps you can follow to obtain the certificate:
- Visit your Nominated Treating Doctor: Schedule an appointment with a medical practitioner. This is typically your nominated treating doctor, who could be a general practitioner or a specialist, depending on your injury or illness.
- Medical Examination: During the appointment, the doctor will conduct a medical examination to assess your injury or illness and your capacity for work. They may ask about your symptoms, your ability to perform certain tasks, and how your condition is affecting your daily life.
- Discussion about Work Capacity: Discuss your capacity for work with the doctor. This includes any limitations you have, tasks you can and can’t do, and any modifications that might be needed in your workplace.
- Issuance of Certificate: If the doctor determines that your injury or illness affects your capacity for work, they will issue a Certificate of Capacity.
Can my Physio issue a certificate of capacity?
The initial certificate of capacity must be issued by the nominated treating doctor/practitioner. Only after that, the second and subsequent certificate of capacity can be issued by your treating physiotherapist or treating psychologist. It’s important to note that your chosen physiotherapist or psychologist must be SIRA-approved. They must fill out the Certificate of Capacity – Treating physiotherapist or psychologist form.
How do I increase my work capacity?
To increase work capacity, individuals can employ various strategies and techniques that enhance their physical and mental capabilities for work. Rehabilitation plays a crucial role in this process, as it helps individuals recover from injuries or medical conditions and regain their functional abilities. This may involve physiotherapy, occupational therapy, or other forms of specialized treatment to improve strength, mobility, and overall physical function.
Incorporating regular exercise into daily routines can also contribute to increasing work capacity. Engaging in both cardiovascular and strength training exercises can improve stamina, muscle endurance, and overall physical fitness. It is important to gradually increase the intensity and duration of exercise to avoid overexertion and injury.
Proper rest and recovery are equally important in building work capacity. Getting enough sleep and taking regular breaks during work hours can prevent physical and mental fatigue, improving overall productivity and efficiency. Additionally, it is important to prioritize proper nutrition, as a well-balanced diet can provide the necessary nutrients to support physical and mental well-being.
What is suitable employment under Workers Compensation?
Suitable employment, under Workers Compensation in NSW, refers to a type of work that an injured worker is able to perform given their current incapacity as a result of a work-related injury or illness. It takes into consideration various factors, including the worker’s age, education, skills, and work experience.
When determining suitable employment, assessing the worker’s incapacity is crucial. This involves evaluating the worker’s physical and mental abilities and limitations due to their injury or illness. Additionally, their age, education, skills, and work experience are considered to identify job opportunities that align with their capabilities and background.
The return to work planning process plays a significant role in identifying suitable employment. This involves creating a plan that outlines the steps needed to help the injured worker return to work. It may include vocational assessments, job placement services, and training programs to enhance the worker’s skills or adapt them to different types of work.