Work capacity disputes
Section 43 work capacity decision NSW: what insurers must consider
Section 43 decisions can quietly reshape your entire claim. If an insurer says you can work more hours, perform different duties, or earn more in suitable employment, that finding can reduce weekly payments long before your dispute reaches the Commission.
Quick answer: what to do in the first 48 hours
Get the insurer's full written reasons and relied-on documents, then lock your response around three issues: functional restrictions, realistic suitable-employment options, and earnings assumptions. If any of those are weakly evidenced, prepare your challenge before the next pay cycle and map your escalation via the section 44 internal review pathway.
Where section 43 fits in your claim strategy
Section 43 is usually the legal bridge from medical restrictions to insurer decisions about earnings, suitable duties, and whether payments stay at the same rate. If the insurer gets this step wrong and you do not challenge it quickly, that mistake can flow into section 44 review outcomes and later PIC disputes.
Start with the work capacity disputes guide and then sequence evidence for the section 44 internal review process.
Common section 43 decision errors
- Suitable employment assumptions that do not match your training, restrictions, or local job reality.
- Earnings estimates based on theoretical work rather than actual labour-market conditions.
- Overweighting one insurer medical opinion while downplaying treating specialist evidence.
- Insufficient explanation of why contrary evidence was rejected.
If payments are already reduced, cross-check rates under section 37 weekly payment rules and use the urgent response checklist in weekly payments stopped.
First 14 days after a section 43 decision
Day 1–2: request full reasons, vocational material, and any medico-legal reports relied upon.
Day 3–6: obtain updated GP/specialist evidence with clear functional restrictions and capacity limits.
Day 7–10: gather wage records and role history to challenge unrealistic earning-capacity assumptions.
Day 11–14: finalise internal review submissions and prepare escalation pathway to the PIC if needed.
For escalation planning, use the PIC disputes process guide and align timelines with the work capacity review timeline.
What usually goes wrong before a section 43 dispute lands
- The treating doctor certificate is too generic, so capacity assumptions go unchallenged.
- Workers focus on medical symptoms but do not rebut earnings and labour-market assumptions.
- Insurer reasons are accepted at face value without obtaining the vocational documents behind them.
- Internal review timing is missed, forcing a harder and slower escalation path.
Related guides
- Workers compensation services hub
- Suitable employment disputes: challenge unrealistic job options
- Section 44 internal review: challenge work capacity decisions with a structured record
- Section 39: what happens when weekly payments approach 260 weeks
- PIAWE recalculation request NSW: fix underpaid weekly benefits
- Section 78 notice response timeline: preserve evidence early
- NSW workers compensation insurers list: identify the decision-maker fast
Need help responding to a section 43 decision?
If your insurer has reduced or threatened to reduce weekly payments, get a practical evidence plan matched to your notice and your current medical restrictions.