Note: This article was written for Victorian audiences, and some of the information may not apply to other regions around Australia.
A Certificate of Capacity is an approved medical certificate issued by a legally qualified medical practitioner (also known as a ‘certifier’) for WorkSafe Victoria (WorkCover) and TAC (Transport Accident Commission).
If you have been injured in a workplace or on the road in Victoria and you’re unable to perform your regular pre-injury work tasks, then you may want to claim for loss of earning benefits from TAC or weekly payments from WorkCover as compensation for time you’ve taken off work.
If you are claiming for just treatment expenses only, then you will not need a Certificate of Capacity.
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Is a Certificate of Capacity the same for WorkCover and TAC Claims?
Yes!
In Victoria, there is only one Certificate of Capacity form that is used by both WorkCover and TAC, and serves the same purpose.
A copy of the Certificate of Capacity form can be found on the WorkSafe website at the link below:
What are the different types of Certificate of Capacity?
The Certificate of Capacity form can be categorised under two types:
The First Certificate of Capacity
Must be completed by a medical practitioner and is valid for a period of up to 14 days. A medical practitioner is a doctor, surgeon or psychiatrist.
Note: A Psychologist cannot complete a Certificate of Capacity for you.
Subsequent Certificates of Capacity
If you are unable to return to work within the first 14 days after your injury and require further certificates, any ongoing Certificate of Capacity can be for a period of up to 28 days. Any Certificate of Capacity issued for a period of more than 28 days will be considered invalid by an insurer or the TAC. Subsequent certificates can be completed by a general practitioner, physiotherapist, chiropractor, or an osteopath.
NOTE
On the Certificate of Capacity form, there is a checkbox right at the beginning to confirm ‘Attendance Only’, also known as an ‘Attendance Certificate’. If that section is checked, then the Certificate of Capacity for the purposes of claiming loss of earning benefits or weekly payments is not valid.
What information does a Certificate of Capacity contain?
The form is fairly easy to complete and only contains two pages, divided into 7 sections. It must be completed with a medical practitioner and contain the following:
- Workers Details: The injured worker’s personal details, claims number and date of injury (if applicable)
- Diagnosis: The diagnosis as a result of the workplace or road accident injury, the body part affected and the severity
- Capacity Assessment: Physical and Mental function limitations as well as work environment recommendations with suitable or modified work duties recommendations
- Certification: Dates and durations for how long the certificate is valid for
- Treatment Plan: Recommendations or any treatment plans and rehabilitation strategies
- Certified Declaration: Contact details of the medical practitioner conducting the medical examination
- Worker Declaration: Worker’s employment declaration and signature (failure to provide this may result in the form being returned).
The purpose of a Certificate of Capacity form in the WorkCover Claims Process is to keep all parties informed of the current status of the worker’s injury, including their employer and their WorkCover insurer.
It should clearly outline any physical and mental function limitations that have an impact on the worker’s ability to work and undertake daily activities at their place of employment.
How To Complete The Certificate of Capacity Form
It should also outline any necessary accommodations needed to help the worker return to work safely, including limits on the duration of work, weight-handling capacity, repetitive or sustained postures, movement types or cognitive function limitations if experiencing mental health symptoms. The form should also provide recommended strategies that address any barriers to prevent the recurrence and aggravation of their injury again.
On the second page, the ‘certifier’ (medical practitioner completing the form) should also outline any treatment and rehabilitation plans for helping the Worker slowly increase their capacity to work again.
When should I get a Certificate of Capacity?
You should obtain a Certificate of Capacity as soon as you get injured and seek medical treatment. It must be completed by a medical practitioner, which falls under the category of:
- A General Practitioner
- A Surgeon
- A Psychiatrist
Following your first Certificate of Capacity, any subsequent Certificates of Capacity can be issued out by either any of the medical practitioners listed above or:
- A Physiotherapist
- A Chiropractor
- An Osteopath
Note: You can not complete the Certificate of Capacity yourself.
How long is a Certificate of Capacity valid for?
The First Certificate of Capacity is valid for up to 14 days only.
Subsequent Certificates of Capacity are valid for up to 28 days. However, in special circumstances, if your injury is seen as severe, extended certificates can be issued for longer periods with no limit on the maximum length of time; however, each of these cases are assessed on their own merits.
When you receive loss of earnings or weekly payments, it is important to ensure that you have a valid Certificate of Capacity for the entire period for which you wish to receive payments. Failure to ensure the insurer is provided with a fresh Certificate of Capacity before the expiration date of your last one may result in delays in your payments.
Tip: Seek a fresh Certificate of Capacity about a week before your previous one expires so that the insurer has sufficient time to approve your claim.
Common mistakes when completing the Certificate of Capacity form
It is important to avoid common pitfalls and mistakes when completing the Certificate of Capacity form to prevent the insurer from rejecting it and, therefore, your weekly payments or loss of earning benefits. In some worst-case scenarios, it could even be denied.
Some common mistakes we see are:
- Not including a clear diagnosis or stating the specific medical condition the injured worker has
- Leaving some sections of the Certificate of Capacity blank
- Forgetting to complete and assign the Worker Declaration in Section 7
- Certificates that do not follow the rules and dates. For example, the initial Certificate of Capacity is dated for more than 14 days.
- Failure to advise the insurer if you have have undertaken any type of work. You are obligated to do so and failure to do so can cause issues with the payment of your weekly payments or loss of earning benefits.
- A Certificate of Capacity has been extended or backdated without any special reasons supplied to the insurer
- Using handwriting that is too difficult to read (printed-out versions should include Block letters)
What happens during my medical examination?
The medical practitioner examining you will diagnose your injury and complete the Certificate of Capacity for you based on what they believe you can and can’t do at work. They may also call your employer to find out more about your employment and workplace OH&S to better formulate a plan to help you return to work sooner.
For subsequent visits to your medical practitioner for ongoing Certificates of Capacity, your medical practitioner may discuss the following with you:
- Revise the Certificate of Capacity based on the current status of your injury
- Assess your working capacity
- Include specific functional impairments and restrictions on your ability to perform certain daily tasks
- Discuss returning-to-work strategies
- Set realistic expectations on return-to-work timelines
- Review return-to-work arrangements with your employer to ensure that the proposed work duties outlined in the Certificate of Capacity fit within what’s outlined
What happens if I don’t get a Certificate of Capacity?
Failing to obtain a Certificate of Capacity can have financial consequences. In some cases, you may not be able to claim any benefits at all and have no support to cover medical expenses and loss of wages. It can also have consequences for your employer, which can include significant fines and penalties.
In some situations, a Certificate of Capacity may be backdated, where, for example, you may have initially seen a medical examiner at the time of your injury but didn’t realise that you needed a Certificate of Capacity.
Backdated Certificates of Capacity
Certificates of Capacity can be backdated for a maximum of 90 days; however, these are accepted at the Worksafe agent’s discretion under special circumstances (3.2.7 Backdated certificates).
When You Can Get a Certificate Reissued
You might need a new certificate if:
- The original one got lost, and a new one was given.
- It was due on a weekend or holiday and was given right after the holiday.
WorkCover agents will check each case to decide if they can accept or reject the certificate.
The 90-Day Rule:
- Backdated certificates are usually not accepted if they’re for more than 90 days before they were given.
- But since September 1, 2022, if the person giving the certificate (certifier) explains why it’s for an earlier period, and WorkSafe or the agent agrees with the reason, then they can get accepted and pay for it.
Special Reasons:
- The certifier must write special reasons on the certificate.
- If there are no special reasons, the agent will send it back and ask for the reasons to be added.
Factors considered for special reasons include:
- Proof of work injury and incapacity.
- A statement saying the worker didn’t work during the period.
- How far back the certificate go (a little or a lot beyond 90 days).
- If there’s any evidence against the special reasons given.
- If accepting the certificate would harm WorkSafe.
- If the worker knew or should have known they needed to provide certificates.
Examples of Acceptable Special Reasons:
- A doctor treated a worker and gave attendance notes instead of a certificate. Later, backdated certificates are given.
- The worker and doctor didn’t know ongoing certificates were needed. Once they knew, they provided backdated certificates showing the injury and incapacity.
- Administrative errors led to certificates not being given to the agent. Later, backdated certificates were issued to fix this.
- The worker tried to get a certificate but couldn’t (e.g., one doctor sent them to another).
- An invalid certificate was first given within 90 days, but fixing it took longer than 90 days. Other evidence shows the worker couldn’t work due to injury.
I’ve provided a Certificate of Capacity, but my weekly payments haven’t been made
There could be potentially many reasons why the WorkSafe insurer may refuse to pay your weekly payments, even after you’ve provided a Certificate of Capacity medical certificate.
Some of the common reasons can include:
- The Certificate of Capacity is invalid or incomplete (see common mistakes)
- The Certificate of Capacity refers to an injury or illness that has yet not been approved or accepted by the worker’s WorkCover Claim Form
- There’s no entitlement to weekly payments
- The Certificate of Capacity is older than 90 days from the issue date
- The Certificate of Capacity was completed by someone not authorised to complete the certificate
- The Certificate of Capacity does not accurately specify the period of incapacity
- The Certificate of Capacity is not clearly written out
Do you believe you’re not receiving entitlements even though you’ve been able to provide a valid Certificate of Capacity? Reach out to the team at Arnold Dallas McPherson Injury Lawyers. They’ll be able to guide you in the right direction and take your side to guide you through the process.
Get legal advice and support
At Arnold Dallas McPherson Injury Lawyer, we have a team of highly skilled and experienced TAC lawyers and WorkCover Lawyers who can help you with any questions you have concerning your WorkCover or TAC claims and Certificates of Capacity.
If you need help obtaining a Certificate of Capacity or are having trouble getting your insurer to accept it, please contact us.
