When do you need a certificate of capacity?

You need a certificate of capacity when you want to claim weekly payments from the WorkCover insurer.

Certificates only required when claiming weekly payments

Certificates of capacity are only required if you want to claim weekly payments from the WorkCover insurer.

If you don’t want to claim payments, you do not need to obtain a certificate of capacity.

You would be entitled to claim weekly payments if:

• You have an accepted WorkCover claim
• Your ability to work has been impacted by your work related injury, illness or condition
• You still have an entitlement to weekly payments (eg: you have not crossed the 130 week threshold and have returned to full time work).

Certificates of capacity are not required to claim medical and like expenses, or an impairment claim or a common law lump sum claim.

You don’t need a certificate when lodging a claim

In order to initiate a WorkCover claim you do not need to have a certificate of capacity.

You can initiate a claim by completing and submitting the WorkCover claim form by itself.

However, if you wish to claim weekly payments at some point under this WorkCover claim, you will need to provide a certificate of capacity.

You can obtain certificates but not lodge a claim

If you have an injury and you believe it is work related in some way – but if you’re not yet ready to lodge a WorkCover claim – you may wish to obtain WorkCover certificates.

This allows you to (potentially) claim weekly payments down the track once you have an accepted claim.

(You do not need to lodge a WorkCover should you later decide not to).

You don’t need to obtain certificates if you intend to pursue a common law claim

As part of a common law claim, you may be able to claim for economic loss (or loss of earnings).

Certificates of capacity are not needed to pursue a common law claim.

Yes, you need to show an impact on your work capacity, but this is done by way of other medical material (from both your treating doctor/s and IME’s) and not by way of your certificates.

When you have a capacity for full duties

When you have a capacity for full duties (ie; your injury is not impacting your ability to work) you do not need to obtain certificates of capacity.

If your initial claim is rejected

If your initial WorkCover claim is rejected and you wish to contest that decision and claim weekly payments, it’s a good idea to continue to obtain certificates of capacity as if your claim is accepted, you’ll likely be entitled to arrears of weekly payments.

You may also be able to negotiate a period of arrears of weekly payments.

When the insurer has terminated your entitlement to weekly payments

When the insurer has terminated your entitlement to weekly payments (which they might do for a variation of reasons) and you do not wish to contest the insurer’s decision.

In some instances, when the WorkCover insurer terminates your entitlement to weekly payments you may want to continue obtaining certificates because you may be successful in overturning the insurers decision and getting back on payments, or alternatively you may be able to claim a period of arrears of weekly payments.

Post 130 weeks

If you’ve crossed the 130 week mark, and if you have returned to full duties you do not need to obtain certificates of capacity.

The test to remain on payments beyond 130 weeks is that you have no work capacity and this is likely to continue indefinitely.

If the insurer terminates your entitlement to payments at 130 weeks and you disagree with their decision and intend to contest their decision, you should continue to obtain certificates of capacity.

You may be successful in contesting the insurers decision or you may be able to negotiate a period of arrears of weekly payments.

If you have a capacity for work and you have returned to work for a minimum of 15 hours per week but not working to the extent you were working pre injury, and because of your injury you may not be able to increase your work hours and earnings – you may have an entitlement to payments from the insurer.

And if you wish to claim payments you will need to continue to obtain certificate of capacity.

Also in order to make the application for payments beyond the 130 week mark you’ll need to have a valid certificate of capacity.

Reinstatement of weekly payments

If you were previously in receiept of weekly payments but stopped claiming them (eg: because you returned to full, unrestricted duties) but if you wish to have your payments reinstated, you will need a certificate of capacity.

Conclusion

You only need to obtain certificates of capacity when you want to claim weekly payments under your WorkCover claim.

You would be entitled to claim weekly payments if your ability to work has been impacted by your work related injury, illness or condition.

In some instances, it may be appropriate for a person to obtain certificates of capacity but not have a WorkCover claim on foot if they have the intention of lodging a WorkCover claim down the track.