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Work Capacity Decisions (recent changes)

Work Capacity Decisions are made by a worker’s compensation insurer to determine the work capacity of an injured worker.

It is a formal process involving information gathering, medical assessment and then a formal decision by the insurer as to whether a worker is unfit for work, fit for work or partially fit for work.

A Work Capacity Decision can affect a workers ongoing entitlement to weekly payments of compensation.

When can a Work Capacity Decision be made?

A Work Capacity Decision can be made at any time throughout the life of the claim but will usually be made at or prior to the worker being in receipt of weekly compensation for a period of 130 weeks (2.5 years).

This period is important as a worker is only entitled to receive weekly payments after 130 weeks if they are either:

  1. Totally unfit for work; or
  2. The worker is working at least 15 hours per week.

For more information, please see What is a Work Capacity decision?

Examples of Work Capacity Decisions

A Work Capacity Decision is usually made in the following circumstances. At or just prior to 130 weeks, a worker has a medical certificate from the doctor that certifies them fit to work 4 hours per day, 5 days per week, that is 20 hours per week. There are restrictions on such employment including limitations on lifting, carrying and sitting for extended periods. The worker is unfit to return to their pre-injury employment but is fit to undertake suitable work, let’s say office type work. The worker however has no experience in office type work and is finding it difficult to obtain such employment.

The insurer is paying 80% of the worker’s pre-injury wages (without allowance or overtime) which in this example is the equivalent of $800.00 gross per week.

The insurer can make a Work Capacity Decision and obtain evidence, for example, that the worker is fit to undertake sedentary office type duties such as administrative or computer data entry work, working at least 20 hours per week and earning $22.00 per hour. That is the equivalent of earning $440.00 gross per week.

The insurer therefore makes a Work Capacity Decision that the worker can earn $440.00 per week (that is despite the worker not yet being able to find such employer).

The worker’s benefits are therefore reduced from the prior payment of $800.00 per week down to $360.00 per week being the difference.

The insurer has therefore made a Work Capacity Decision reducing the weekly payments.

Challenging the Decision

If such a decision is now made on or after 1 January 2019, the worker can dispute or challenge this decision through the Workers Compensation Commission (WCC). Previously the worker must have requested an internal review from the insurer and then sought a merit review from the WorkCover Authority of NSW.

Recent changes to the workers compensation legislation have now allowed a worker to seek a determination by the Workers Compensation Commission.

The Workers Compensation Commission is an independent commission set up to deal with dispute between insurers and workers. You are allowed the assistance of a lawyer to assist you in challenging the insurer’s Work Capacity Decision. Legal costs are payable by WIRO.

If you do apply to challenge a Work Capacity Decision in the Workers Compensation Commission, then the decision is stayed until such time as such dispute is determined. That means that the insurer must pay you the old rate of $800.00 until the dispute is determined.

Any such dispute is now determined by an Arbitrator of the Workers Compensation Commission with the assistance of legal advice.

If you receive a Work Capacity Decision from the insurer, and you disagree with the decision, you should contact a lawyer immediately to see if the decision can be challenged in the Workers Compensation Commission. If the lawyer thinks you have an arguable case, then legal funding can be obtained through WIRO and the decision challenged in the Workers Compensation Commission.

Garling & Co Lawyers

Matthew Garling

Matthew Garling is an Accredited Specialist in Personal Injury Law approved by New South Wales Law Society. He is admitted to practice in the Supreme Court of NSW and the High Court of Australia. Matthew is also a member of...
Angie & B.
00:58 18 Sep 24
We cannot recommend Garling and Co. Lawyers highly enough! Our principal solicitor, Matthew Garling, was absolutely outstanding throughout our entire legal journey. He, along with the fantastic team... in the office, especially Allison, provided outstanding support. They were always responsive, willing to listen, and took the time to thoroughly explain the entire process. Thanks to their dedication and expertise, we achieved a brilliant outcome.read more
Yanthi S.
11:22 12 Sep 24
I engaged with Garling and Co to assist me for my weekly payment dispute with the insurance. I was upset with Natasha, as she didn't prepare me to the worse outcome or told me about the kind of... negotiation in the hearing. I assumed that as a Lawyer she should have an experience with the process or the way to solve the case. Even though I asked her what should I do or what would be happened in the hearing a week before but she didn't mentioned anything, and told me not do anything. But in the hearing she and the Barrister only gave me less than 5 minutes to make decision and pushed me to accept the disappointed outcome and what she said in the hearing totally different with what she said earlier. I don't trust her at all, her words is not consistent.I would like to express my appreciation to Matthew Garling who had stepped in to handle my weekly payment issue with the insurance. He is very professional, knowledgeable, easy to talk to and very humble. My disappointment earlier has melted away by his kindness and caring to resolve my issue which has came out the great outcome. Now I am satisfied with his expertise therefore I would not hesitate to let him to handle the case I might have in the future.As I said before I would not hesitate to let my other claim to be handled by a professional as Matthew Garling. I would like to thank him for his time and effort to settle my case smoothly and I trusted him to give me the best outcome. Also I appreciated his support and his patience to answer my questions from the time I signed the agreement up to the day before the mediation. He did not promise the unrealistic outcome but what ever he promised that what the result was according to his experiences. And I would not forget to Alison, Nathan who also have assisted this matters, by gathering all documents and answering my questions.Also my appreciation to a Barrister Mr Dallas Morgan.So, in summary I am really grateful to have Garling and Co as my lawyer to handle my damaged claim.read more
Tina S
07:45 29 Aug 24
Thank you for the great outcome!
Lisa L.
05:18 13 Jul 24
Outstanding service and commitment to my case was delivered from the first point of contact right until the end of my successful case.Highest recommendations to the team at Garling and Co. Matthew... got me an excellent result and was available and informative throughout the entire foreign process of legal proceedings. He was wonderful and so was his team.If i could rate higher than 5 stars i would!read more
J B
07:12 02 Jul 24
Matthew Garling and all of the team were extremely professional and supportive throughout what was a very long and arduous CTP battle. I am happy with the result and feel that their fees were fair... and well deserved.read more
Nelson B.
02:11 30 Jun 24
Professional, prompt & honest service
Brad M.
02:19 28 Jun 24
I worked with Garling & Co for 3+ years, the team has been incredible and I could not have been happier with Kerry's support and the results produced!I highly recommend choosing them as your... representatives!!read more
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
READ ALL TESTIMONIALS

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Angie & B.
00:58 18 Sep 24
We cannot recommend Garling and Co. Lawyers highly enough! Our principal solicitor, Matthew Garling, was absolutely outstanding throughout our entire legal journey. He, along with the fantastic team... in the office, especially Allison, provided outstanding support. They were always responsive, willing to listen, and took the time to thoroughly explain the entire process. Thanks to their dedication and expertise, we achieved a brilliant outcome.read more
Yanthi S.
11:22 12 Sep 24
I engaged with Garling and Co to assist me for my weekly payment dispute with the insurance. I was upset with Natasha, as she didn't prepare me to the worse outcome or told me about the kind of... negotiation in the hearing. I assumed that as a Lawyer she should have an experience with the process or the way to solve the case. Even though I asked her what should I do or what would be happened in the hearing a week before but she didn't mentioned anything, and told me not do anything. But in the hearing she and the Barrister only gave me less than 5 minutes to make decision and pushed me to accept the disappointed outcome and what she said in the hearing totally different with what she said earlier. I don't trust her at all, her words is not consistent.I would like to express my appreciation to Matthew Garling who had stepped in to handle my weekly payment issue with the insurance. He is very professional, knowledgeable, easy to talk to and very humble. My disappointment earlier has melted away by his kindness and caring to resolve my issue which has came out the great outcome. Now I am satisfied with his expertise therefore I would not hesitate to let him to handle the case I might have in the future.As I said before I would not hesitate to let my other claim to be handled by a professional as Matthew Garling. I would like to thank him for his time and effort to settle my case smoothly and I trusted him to give me the best outcome. Also I appreciated his support and his patience to answer my questions from the time I signed the agreement up to the day before the mediation. He did not promise the unrealistic outcome but what ever he promised that what the result was according to his experiences. And I would not forget to Alison, Nathan who also have assisted this matters, by gathering all documents and answering my questions.Also my appreciation to a Barrister Mr Dallas Morgan.So, in summary I am really grateful to have Garling and Co as my lawyer to handle my damaged claim.read more
Tina S
07:45 29 Aug 24
Thank you for the great outcome!
Lisa L.
05:18 13 Jul 24
Outstanding service and commitment to my case was delivered from the first point of contact right until the end of my successful case.Highest recommendations to the team at Garling and Co. Matthew... got me an excellent result and was available and informative throughout the entire foreign process of legal proceedings. He was wonderful and so was his team.If i could rate higher than 5 stars i would!read more
J B
07:12 02 Jul 24
Matthew Garling and all of the team were extremely professional and supportive throughout what was a very long and arduous CTP battle. I am happy with the result and feel that their fees were fair... and well deserved.read more
Nelson B.
02:11 30 Jun 24
Professional, prompt & honest service
Brad M.
02:19 28 Jun 24
I worked with Garling & Co for 3+ years, the team has been incredible and I could not have been happier with Kerry's support and the results produced!I highly recommend choosing them as your... representatives!!read more
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
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4.9