Most of the form is to be completed by your medical practitioner. However, this guide will help you to understand what information you will need to provide to your medical practitioner and what each section of the Certificate of Capacity means.
Certificate of Capacity details:
- Download a copy of the Certificate of Capacity (PDF ~633KB)
- Certificate of Capacity form can be used for both a TAC Claims or WorkCover Claims
- It is likely that your medical practitioner will obtain the Certificate of Capacity themselves
- If you need to provide it yourself you can either print and use block letters, or type in Acrobat PDF Reader, fill and sign
The Certificate of Capacity is separated into 7 sections, most of which are completed by your medical practitioner.
There is a Worker Declaration in section 7 which must be completed by you before the certificate is provided to the relevant insurer.
Things to note:
- Aside from the Workers Declaration in section 7, the Certificate of Capacity cannot be completed by yourself
- The ‘First Certificate of Capacity’ must be completed by a medical practitioner, who is either a general practitioner, a surgeon, or a psychiatrist
- A psychologist cannot complete a Certificate of Capacity for you
- In this example, we’ll be using a fictitious ‘John Doe’
- This form is for injured persons in Victoria, Australia
- This article does not constitute any formal legal advice. Please contact Arnold Dallas McPherson Injury Lawyers for legal advice on 1800 242 588
On this page
Section 1. Worker Details
Purpose:
In section 1, Worker Details, the purpose is to identify the injured worker and to link the certificate to an existing WorkCover claim (if available). Note these details must be accurate, and if filled out incorrectly, your certificate could be rejected by the relevant insurer.
Fields to Complete by the medical practitioner:
- Full name of the worker.
- Address.
- Date of birth.
- Contact number.
- Employer’s name (optional, depending on the type of insurance).
- Claim number (if available).
Image Reference:
- Must tick if the Certificate of Capacity is related to a transport accident (TAC) or a work-related injury (WorkCover).
- Checkmark this section of this is simply an ‘attendance only’ form (not an actual Certificate of Capacity).
- Claim Number and Date of Injury are optional and only need to be put into the certificate if known at the time of completing the certificate.
Note for Medical Practitioner: If ‘Attendance only’ is ticked, then complete Sections 1, 2, 5 and 6. Skip sections 3 and 4.
Section 2. Diagnosis
Purpose:
In section 2, Diagnosis, the medical practitioner certifying you will need to indicate the date they assessed you and confirm what their clinical diagnosis is of your injury. For example, it might be ‘right shoulder rotator cuff injury’ or ‘shoulder bursitis.’
Fields to Complete by the medical practitioner:
- Description of the diagnosed injury or illness.
- Relevant clinical findings.
Section 3. Capacity Assessment
Purpose:
In Section 3, Capacity Assessment, the medical practitioner certifying you will indicate any physical and or mental health limitations that prevent you from performing your normal work duties. If checked, further details MUST be provided to the right section of the checkboxes. Failure to provide further details regarding work capacity may result in the Certificate of Capacity being rejected by the insurer.
This section is essential for you, your employer and the relevant insurer, when planning a return-to-work program and managing your claim.
Note for Medical Practitioner: If capacity to work isn’t affected, physically and or mentally, then you can skip this step and continue on to Section 4, Certification.
Fields to Complete by the medical practitioner:
- Is the injured individual’s work capacity affected by their injury or condition?
- If not, skip this section.
- If yes, complete the check boxes, and complete the additional comments section, ensuring you indicate specific tasks or limitations (e.g., restricted hours, no lifting over 10 kg)
Section 4. Certification
Purpose:
In section 4, Certification, your medical practitioner confirms what your capacity for employment is. You can either have a capacity for your pre-injury employment, alternative suitable employment, or no capacity for any employment.
It is important to get the dates and durations accurate. This is one of the common mistakes medical practitioners make and the insurer may reject your Certificate of Capacity if the dates entered are wrong.
Fields to Complete by the medical practitioner:
- The injured individual’s capacity for employment and the dates of any capacity/incapacity.
- Anticipated return to work date (if applicable)
Section 5. Treatment Plan
Purpose:
Section 5 lists the treatments that are recommended to assist you with your recovery. This section assists the insurer and your medical practitioner to ensure you are getting the treatment that you need.
Fields to Complete by the medical practitioner:
- Details of treatment (e.g., physiotherapy, surgery, medication).
- Frequency and duration of treatment.
- Referrals to specialists or allied health professionals.
Section 6. Certifier Declaration
Purpose:
Section 6 requires your medical practitioner to certify that the information they have provided is true and correct.
Fields to Complete by the medical practitioner:
- The doctor’s name, address, provider number, and contact details.
- The doctor signs and dates this section.
Section 7. Worker Declaration
Purpose:
Section 7 must be completed by you. The purpose of section 7 is to confirm that you have not engaged in any form of work and confirm that the details contained within the certificate are correct.
Fields to Complete by the worker:
- Check box: Check the relevant box confirming whether you have engaged in any work, paid or otherwise.
- Signature: Sign to confirm that the details on the certificate are accurate and that you agree with the information provided by your doctor.
- Date: Write the date you signed the form.
Important Tips:
- Ensure all personal details are accurate.
- If you have questions about the diagnosis or capacity details, discuss them with your doctor before signing.
- Submit the completed form promptly to your employer or insurer to avoid delays in processing your claim.
If you need further help filling out the form, reach out to your employer, HR department, or workers’ compensation insurer. Alternatively, we’re always here to provide any advice on legal matters relating to your WorkCover or TAC Claim.
Certificate of Capacity: Explained in Layman’s Terms
Experiencing any work-related or road injury claim issues? 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.
