If you’ve ever had employee was injured at work and had a reduced capacity for duties (either totally unfit or only fit for light duties), it’s likely you’ve come across a Certificate of Capacity or two in your time.
What is a Certificate of Capacity?
These certificates are essentially a medical certificate in a WorkSafe-approved format that provides important information to help employers plan for the worker’s duties and also to help WorkCover case managers administer the claim.
Because these certificates are central the ongoing management of the claim, WorkSafe is very particular about ensuring they are completed to certain standard and the information they contain is correct and legible.
A Certificate of Capacity that fails to comply with WorkSafe’s standards may be considered invalid. And invalid certificates can create an administrative headache for employers, injured workers and even the medical providers.
What is the problem with invalid Certificates of Capacity?
When an injured is off work due to their injury, the employer must pay them their compensation amounts and then seek reimbursement via their WorkCover agent (sometimes refered to as the “insurer”). WorkSafe will only process these reimbursements if a valid Certificate of Capacity covering the applicable dates is provided in a timely fashion.
An “invalid” Certificate of Capacity may be rejected by your WorkCover agent. This may result in a situation where the company has paid the employee but is not reimbursed, potentially leaving the company out of pocket. This is why it is so important to ensure every certificate your employee provides is in an acceptable format and completed with the necessary details for it to be considered valid.
What makes a Certificate of Capacity Valid?
A valid Certificate of Capacity must have the following:
- Injured worker’s name and correct address details
- Date of the medical examination and date of issue. Usually both dates should be the same. If not, double-check with your employee around the reasons the dates are different. In some cases, an injured worker may have been examined by their treating health practitioner on a particular date, but the certificate was written on a later date.
- The diagnosis should be in line with the accepted compensable injury. Any additional or different diagnoses mentioned in this section would need to be investigated by the WorkCover agent before the certificate can be accepted.
- An initial certificate of capacity should only cover a period of up to 14 days. Every subsequent certificate can cover up to 28 days. Watch out for certificates that cover a whole calendar month (ie. 31 days) as it may exceed the allowed period.
- Treting health practitioner details and signature must be clearly indicated in the relevant section of the certificate.
- Injured workers must complete the ‘Workers Declaration’ section, ensuring the appropriate box is ticked to indicate if they have attended work or not. The signature and date also need to be complete. N.B. The very first Certificate of Capacity is the only exception to this and does not require the declaration to be completed.
What makes a Certificate of Capacity invalid?
Invalid certificates cause a great deal of frustration for many employers. If even one of the above-mentioned points are not clearly indicated on the certificate, it may be deemed as invalid and the agent may send the certificate straight back to you and your worker advising of the reasons of invalidity. Some other common reasons we’ve seen that cause a certificate of capacity to be invalid include the following:
- The certificate is unclear or illegible. In some cases, the treating practitioner’s handwriting may be unclear, or some providers use a fax machine from the 80s and the clarity of the document is compromised.
- Only first page of the certificate was sent to agent. For a certificate of capacity to be valid, the Agent requires both pages of the certificate.
- The worker forgot to tick “THE BOX”. This is the bain of many case managers and many return to work coordinators. The box in the worker declaration may seem like a minor detail, but we can absolutely assure you, if this one little box is missed there is a very high chance the certificate won’t be accepted.
The details around valid vs invalid Certificates of Capacity highlight the importance that employers implement robust systems around the management of cases and files. Long term success in your WorkCover claims and premiums outcomes stems from effective systems and best practises.
About Mark Stipic Consulting
Mark Stipic Consulting are trusted advisors to decision-makers at employers, helping them achieve the goals of reduced injuries, claims and premiums. Mark Stipic is #TheWorkCoverGuy and author of WorkCover that Works, the only book of its kind written specifically to help employers reduce their injuries, claims and WorkCover premiums.
When you’re ready, here are two ways Mark Stipic Consulting can help you and your business take control of your WorkCover situation:
- Get a copy of Mark’s book WorkCover that Works. It will show you how to reduce your injuries, claims and WorkCover premiums.
- Request a free, no obligation 30-minute strategy call. We will help you address your most pressing challenges and connect you with potential solutions if appropriate.