3.2.3 Valid Certificate of Capacity

WorkSafe’s approved Certificate of Capacity Ongoing certificate is issued for up to 28 days and can be issued by a: medical practitioner, osteopath, physiotherapist, chiropractor. can be found here: Certificate of Capacity

The initial Certificate of Capacity (also called a medical certificate The first medical certificate is for a maximum of 14 days and can only be issued by a registered medical practitioner.) must be completed by a medical practitioner (general practitioner, surgeon, or psychiatrist). Note that a psychologist Registered psychologist means a person registered under the Health Practitioner Regulation National Law to practise in the psychology profession (other than as a student). is not a medical practitioner.

All subsequent Certificates of Capacity (also known as ongoing Certificates of Capacity) can be completed by a medical practitioner or physiotherapist Registered physiotherapist means a person registered under the Health Practitioner Regulation National Law to practise in the physiotherapy profession (other than as a student)., chiropractor or osteopath.

A Certificate of Capacity can also be used as an attendance certificate if the worker requires time off work to attend a medical appointment for their injury.

3.2.3.1 Valid Initial medical certificate

For the first Certificate of Capacity (called the medical certificate) to be considered valid, it must:

• either accompany a claim for weekly payments or be given to or served on the employer or lodged with the Agent at a later date
• be issued by a medical practitioner
• be signed*
• be in a form approved by WorkSafe

• For mental injuries sustained on or after 31 March 2024:

  • the diagnosis must be in accordance with the latest version of the DSM; and

  • the certificate should specify whether the worker has significant behavioural, cognitive, or psychological dysfunction (if not otherwise detailed in supporting medical information).

• specify the diagnosis (the nature of injury or disease) that is related to the claimed injury and bodily location
• certify the worker’s capacity for work during the period of the certificate
• specify the expected duration of the worker’s incapacity
• not exceed 14 days unless special reasons exist. See: Extended certificates
• not contain a material defect Material defects, omissions or irregularities can affect the decision to accept or reject a claim., omission or irregularity

*For the purposes of a certificate of capacity, electronic signatures (including a typed name) can be accepted by Agents.

When does an initial medical certificate contain a material defect, omission or irregularity?

No material defect	Material defect
Where the defect in the initial medical certificate is not relevant to the decision to accept or reject the claim for compensation in the form of weekly payments, the certificate is valid.	Where the defect in the certificate is relevant to the decision to accept or reject the claim, the certificate is invalid.
For example If the medical practitioner has signed the certificate and noted their provider number but have failed to provide their name and address, this would not be relevant to the liability decision and the initial medical certificate should be considered valid.	For example Any of the following are considered material defects, resulting in the certificate being invalid: no diagnosis* unacceptable diagnosis, for example, ‘medical condition’ medical practitioner or worker has not signed the certificate unable to identify worker certificate completed by a treater who is not a medical practitioner e.g. psychologist.

*Claims for mental injuries sustained on or after 31 March 2024

Where:

• a diagnosis has been provided however it is not in accordance with the latest version of the DSM, and/or

• the certificate or accompanying medical information does not confirm that the worker has a significant behavioural, cognitive or psychological dysfunction,

The Agent must clarify the diagnosis and dysfunction with the certifying practitioner e.g. via phone or in writing and record this on file.

The Agent should request that the certifier of the certificate includes a valid DSM diagnosis on all subsequent certificates.

Awaiting diagnosis clarification should not delay the scheduling of an IME Independent Medical Examiner / Independent Medical Examination where required.

3.2.3.2 Valid Ongoing Certificate of Capacity

To be valid, an ongoing Certificate of Capacity (subsequent certificate) must:

• be a signed certificate
• be in a form approved by WorkSafe
• be issued by a medical practitioner, registered physiotherapist, registered chiropractor or registered osteopath
• specify the diagnosis (the nature of injury or disease) and bodily location (note exception to this requirement below)
  • For mental injuries sustained on or after 31 March 2024:

    • the diagnosis must be in accordance with the latest version of the DSM; and

    • where the diagnosis on an ongoing certificate has changed, the certificate should specify whether the new diagnosis has caused the worker to have significant behavioural, cognitive, or psychological dysfunction (if not otherwise detailed in supporting medical information).

• be for a diagnosis that relates to the workplace injury
• certify the worker’s capacity for work during the period of the certificate
• specify the expected duration of the worker’s incapacity
• not exceed 28 days duration unless special reasons exist and the Agent accepts those special reasons

include a completed and signed patient declaration which is not otherwise invalid (e.g. by being crossed out)

See: Who can sign certificates | Extended certificates | Diagnosis

Agent receives an invalid ongoing Certificate of Capacity

Where an Agent receives an invalid ongoing Certificate of Capacity, the Agent can seek to rectify the anomalies or omissions as detailed below.

Unsigned patient declaration on certificates

If the patient declaration in the Certificate of Capacity is incomplete, the Certificate of Capacity may be considered invalid.

Note that a worker may sign the Certificate of Capacity digitally/electronically.

Seeking worker declaration via email

Where the worker has not signed the patient declaration on a Certificate of Capacity, the Agent can seek the declaration from the worker via email in order to process weekly payments.

The email provided by the worker must include a declaration stating whether they have engaged in any form of employment (including self-employment and volunteer work) since the last Certificate of Capacity and if they have, provide employment details.

When requesting the patient declaration, the Agent should utilise the standard email template.

The Agent should ensure the worker has given consent for digital communication prior to emailing the worker.

See: Consent for digital communication

Unclear or incorrect dates

In circumstances where the Certificate of Capacity is invalid due to dates being unclear, the Agent can seek to clarify the dates directly with the certifying provider. This includes:

• when a human error has been made by the certifying practitioner (eg. putting the incorrect year)
• missing examination/issue dates (these can also be reviewed by checking the corresponding invoice for the consultation, if received).

If the Agent has obtained the information needed to register the Certificate of Capacity verbally, they should in the same conversation request an amended Certificate of Capacity be sent to the Agent with the anomaly rectified. The Agent must clearly document the information received which validates the Certificate of Capacity.

The Agent should also notify the worker of the issue in writing.

Unacceptable diagnosis

Generally, for an ongoing Certificate of Capacity to be considered valid, it should specify the diagnosis (the nature of injury or disease) and the bodily location (unless bodily location can be reasonably determined from the nature of the disease). For mental injuries sustained on or after 31 March 2024, the diagnosis must be in accordance with the latest version of the DSM.

Valid diagnoses	Diagnoses which Agent may accept subject to verification:	Invalid diagnoses:
Examples: ‘Disc bulge L4&L5 – lower back’, ‘PTSD’, ‘rotator cuff tear’, ‘left knee meniscus tear’ ‘biceps tendinosis’   A mental injury diagnosis in accordance with the latest version of the DSM.	Examples: description of procedure: ‘ACL repair’, ‘knee replacement’, ‘spinal fusion’, sore body part, pain, inflammation, or injury of a body part: ‘back pain’; ‘sore back’, ‘back injury’, ‘mental trauma’ Agent actions: If the Agent is satisfied that the worker has an entitlement to compensation and the description of the injury or procedure is consistent with the accepted claim and other medical information on file: Where medical information on file is up to 6 months old: the Agent can utilise other recent medical information on file to confirm the diagnosis, such as prior certificates, medical reports or surgeons correspondence like surgery requests and post-operative reports Where no relevant information exists on file or the information on file is older than 6 months, the Agent should clarify the diagnosis with the certifying practitioner In all scenarios a clear file note should be made by the Agents to support the Certificate of Capacity being processed and any changes to Agent Received Dates, etc., (in line with current Data Integrity rules).	Examples: ‘a medical condition’, ‘chronic pain’, 'stress', or other non-specific diagnosis, ‘post-surgical management’, ‘as previously documented’ anxiety a mental injury diagnosis made by a psychologist Agent actions: The Agent must clarify the diagnosis with the certifying practitioner e.g. via phone or in writing. Other medical information on file cannot be used when an unacceptable non-specific diagnosis is provided.

Returning an invalid certificate

If the Agent is unable to obtain the information required to validate the Certificate of Capacity, it must be returned to the worker within 14 days of the claim together with a notice specifying each material defect, omission or irregularity within the certificate.

Faxed certificates of capacity

Agents have discretion to accept and pay weekly payments on a faxed Certificate of Capacity, subject to the above and following requirements:

• the fax must be legible and able to be understood
• all sections of the certificate are faxed, including the patient declaration
• that an electronic version of the certificate is retained.

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