WorkCover and the first certificate of capacity
The first WorkCover certificate of capacity that a person obtains in relation to their WorkCover claim must not exceed 14 days (in most cases) and must be issued by a medical practitioner.
This page will look into first certificates of capacity further.
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You only need a certificate of capacity if you want to claim weekly payments
You do not need a certificate of capacity in order to lodge and have accepted a WorkCover claim.
You only need to obtain certificates of capacity of you intend to claim weekly payments of compensation under a WorkCover claim.
If you have suffered an injury at work and your ability to work has been impacted, meaning that you can’t work at all or that you can only work at a partial capacity, you may be entitled to the payment of weekly payments.
The first certificate of capacity must not cover more than 14 days (in most instances)
When you visit a medical practitioner or health provider to obtain a certificate of capacity, they will specify how long the certificate covers, just like a normal medical certificate that you would obtain if you wanted time off work for a non work related reason.
The first certificate of capacity that you obtain must not cover more than 14 days.
There are some exceptions to this, but in most cases the 14 day period will apply.
Certificates of capacity after the initial certificate can cover periods of up to 28 days.
In a limited number of instances, they may cover up to three months provided that you have obtained the permission of the insurer.
Normally certificates of capacity can cover a period of 28 days and in limited instances, up to 3 months.
So keep this in mind – if the person that is issuing your certificate indicates on the certificate that it covers more than 14 days – and it’s the first certificate of capacity you’ve obtained under the particular WorkCover claim – it’s highly likely that the insurer will not accept the certificate.
There are instances where you can obtain a certificate of capacity that covers more than 14 days, which will be explained below.
When can first certificates of capacity cover more than 14 days?
There are certain instances where initial certificates of capacity can exceed the prescribed 14 day limit.
Severity of injury is likely to be the main reason that a certificate of capacity can cover more than 14 days.
For example, say that you are in hospital following a severe injury – it’s likely the insurer will accept an initial certificate that covers more than 14 days.
If the initial certificate is requested to cover more than 14 days, the reasons for why this is the case should be written on the certificate.
Can first WorkCover certificates be backdated?
Yes, just like other certificates of capacity the initial certificate can be backdated. But in most instances the 14 day period will still apply.
Who can issue a first certificate of capacity?
The fist certificate of capacity must be issued by a medical practitioner.
Certificates after the first medical certificate can be issued by a medical practitioner or other health providers such as a physiotherapist or a psychologist.
However the first certificate must be issued by a medical practitioner such as a general practitioner, or a specialist doctor such as an orthopaedic surgeon or a psychiatrist.
Worker declaration of the first certificate doesn’t need to be completed
You’ll see section on the certificate is a worker declaration.
This section does not need to be completed if the certificate is your first certificate of capacity.
If it is not the first certificate, this section must be completed.
Please see below:
When should the first medical certificate be provided?
Generally speaking, when people lodge a WorkCover claim and they wish to claim medical expenses AND weekly payments, a first certificate of capacity should accompany the claim or be served on the employer or insurer shortly thereafter.
In what instances is an insurer likely to reject an initial certificate of capacity?
As mentioned above, if the certificate runs for more than 14 days and no approval has been sought to obtain a certificate that runs for a greater period, or if there is no valid reason for why the certificate should run for more than 14 days – then the insurer is likely to reject the certificate.
The certificate may also be rejected if there is an error of some kind such as there being no written diagnosis on the certificate or the diagnosis that’s written on the certificate is not descriptive enough.
For example, if you went to your doctor with the flu and the doctor provided you with a normal medical certificate as opposed to a WorkCover certificate of capacity, that doctor may note that you have a ‘medical condition’ that prevents you from attending your work for a certificate period of time.
If your doctor noted that you have a ‘medical condition’ on a certificate of capacity, the insurer would likely not accept this and would ask you to rectify this.
What happens if the initial certificate is rejected?
This depends on why the certificate was rejected.
Generally speaking, if it is something that the medical practitioner has done or failed to do, the insurer will likely ask that you go back to them and get them to either amend the certificate or provide a new one.
If it is something that you are able to rectify yourself, then the insurer should let you know what the issue is and what you need to do.
Conclusion
In order to claim WorkCover weekly payments you need to obtain certificates of capacity.
The first certificate of capacity that you obtain is a little bit different to other certificates of capacity that you will obtain during the life of your claim.
In most cases an initial certificate cannot run for more than 14 days, and it must be issued by a medical practitioner such as a GP or specialist doctor.
In most cases, an initial certificate of capacity will accompany a WorkCover claim that has just been lodged, or is provided to the employer and/or insurer shortly thereafter.
