Insurer Stopped Your Weekly Payments? How to Dispute a Work Capacity Decision Before the Time Runs Out

The letter arrives eighteen months into your claim. The insurer has decided you have “current work capacity” for suitable employment as a customer service officer, 20 hours a week, at $28 an hour, so your weekly payments will reduce to a fraction, or stop, in three months. Your GP’s certificate says you can’t sit for more than 20 minutes. Nobody has offered you a job.

Work capacity decisions are the most disputed decisions in workers compensation because they’re made on paper, often on the basis of a single independent medical examination and a vocational assessment that lists jobs that exist in theory. They’re also the decision with the tightest practical deadline, because the money stops on a date already written in the letter.

Your rights

In every scheme the insurer must give you written notice before reducing or stopping weekly payments, with reasons and the evidence relied on, and a notice period (commonly 13 weeks in New South Wales, and set periods elsewhere) before the change takes effect. You have the right to dispute the decision, to have your treating doctor’s evidence considered against the insurer’s examiner, and to have an independent body decide. “Suitable employment” must be work you are actually fit for, taking into account your injury, skills, experience, age and, in most states, the labour market in your area. A vocational report listing jobs no employer has offered doesn’t end the enquiry.

By state

• New South Wales. Workers Compensation Act 1987, s 43 (work capacity decisions). The insurer must give reasons and the notice period before payments change. You may ask the insurer for an internal review (optional, by a different decision-maker) or apply directly to the Personal Injury Commission to determine the dispute. The IRO funds your lawyer through ILARS at no cost to you. Lodge before the payments change if at all possible.
• Victoria. Workplace Injury Rehabilitation and Compensation Act 2013. A decision to terminate or reduce weekly payments (including a 130-week capacity decision) is disputed by applying for conciliation at the Workplace Injury Commission within 60 days. The conciliator can direct payments continue pending the outcome; unresolved medical questions go to a Medical Panel, whose opinion is binding.
• Queensland. Workers’ Compensation and Rehabilitation Act 2003. A decision to cease or reduce compensation is reviewable by the Workers’ Compensation Regulator within 3 months, then by appeal to the QIRC.
• Western Australia. Workers Compensation and Injury Management Act 2023. The insurer must give notice before discontinuing or reducing weekly payments; dispute by applying for conciliation at WorkCover WA Conciliation and Arbitration Services, then arbitration. The conciliator can order interim payments.
• South Australia. Return to Work Act 2014. A work capacity or discontinuance decision is reviewed by the South Australian Employment Tribunal on application within one month; SAET can order payments continue while the dispute runs.
• Tasmania. Workers Rehabilitation and Compensation Act 1988. Disputes about stopping or reducing weekly payments go to the Workers Rehabilitation and Compensation Tribunal (TASCAT), which conciliates and can make interim orders.
• Australian Capital Territory. Workers Compensation Act 1951. Conciliation first, then arbitration in the Australian Capital Territory Magistrates Court; WorkSafe ACT for conduct complaints.
• Northern Territory. Return to Work Act 1986. Mediation through NT WorkSafe, then the Work Health Court, which can order payments continue pending hearing.

Comcare claimants: reconsideration within 30 days, then the Administrative Review Tribunal. The Claim Done document asks your state first and drafts the dispute to that state’s Act, body and deadline.

What to do right now

1. Find two dates on the letter. The date of the decision (the review clock) and the date payments change (the money clock). Work back from both.
2. Get the insurer’s evidence. The IME report, the vocational assessment, any labour-market research, surveillance. Ask in writing; the decision must be based on documents you’re entitled to see.
3. Take the insurer’s job list to your doctor. Ask for a written opinion on each listed role against your restrictions: sitting tolerance, lifting, driving, medication effects. This is the evidence that wins.
4. Document your job search and the employer’s response. If your pre-injury employer has no suitable duties, get that in writing. If you’ve applied for the “suitable” roles and been knocked back, keep every rejection.
5. Lodge the dispute and ask for payments to continue pending the outcome. Most bodies can order interim continuation; you have to ask.

Why “suitable employment” on paper often fails

A work capacity decision usually rests on a vocational assessor identifying roles that fit the IME’s restrictions. Tribunals look past the label to the substance: is the role available in your region, do you have the skills and qualifications it actually requires, can you physically perform every core task, and has anyone offered it to you? A 55-year-old labourer with a shoulder injury is routinely assessed as fit for “call-centre work” with no experience, no typing speed and no vacancies within 100 km. Line up each listed role against your restrictions and the real labour market, with your treating doctor’s comments, and the decision starts to look like what it often is: a desktop exercise.

Who to complain to

The review body for your state (above) for the decision. For insurer conduct, delay or failure to give proper notice: the IRO (New South Wales), WorkSafe Victoria, the Workers’ Compensation Regulator (Queensland), WorkCover WA, ReturnToWorkSA, WorkSafe Tasmania, WorkSafe ACT, NT WorkSafe. Your union, if you have one.

Dispute the work capacity decision now — $49

Claim Done drafts a Workers Compensation Claim Dispute for your state that challenges the work capacity or discontinuance decision role by role against your medical restrictions, requests the insurer’s evidence, asks for payments to continue pending review, and cites the Act, the review body and the deadline.

Dispute the Decision — $49 →

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