Overview
How this affects your claim in practice
A work capacity decision is an insurer decision about specified capacity and suitable-employment matters that can affect weekly payments. Read the decision, calculation, effective date and review information together. Compare the insurer's medical, vocational, duties and earnings assumptions with current evidence. Do not confuse a work capacity assessment, which gathers information, with the later decision.
- Identify the exact section 43 decision before choosing evidence or a dispute route.
- Liability and medical-expense disputes are not work capacity decisions.
- A work capacity assessment is not always required before the insurer makes a decision.
- The former mandatory section 44 internal-review pathway was repealed in 2018.
- The notice period and effective date matter; a timely PIC application may stay the decision.
- Compare the current certificate of capacity and medical restrictions with the actual duties, hours, travel and earnings assumptions in the notice.
Practical review
What to check in this situation
- Identify the exact section 43 matter decided and any issue that is legally outside that definition.
- Test proposed suitable employment against real duties, sustainable hours, location, experience and restrictions.
- Separate insurer review, PIC dispute and post-1 July 2026 injury-class rules.
Records that may help
Keep the decision notice, calculations, Certificates of Capacity, vocational material, job options, payslips and treating reports.
Next procedural step
Act promptly because a request for discussion does not itself protect every formal review or dispute step.
What section 43 includes and excludes
Classifying the insurer decision
| Included as a work capacity decision | Excluded from the definition |
|---|---|
| Fitness for employment, including whether the worker has current work capacity. | A decision to dispute liability for weekly payments or another form of compensation. |
| Suitable employment and the amount the worker is able to earn in suitable employment. | A decision about treatment, service, assistance or other medical-related compensation. |
| Risk of further injury in employment. | A dispute that merely appears in the same notice but has a different statutory character. |
| Current weekly earnings and a weekly-payment consequence based on a listed section 43 decision. | A PIAWE decision made on or after 1 July 2026; it has a separate review and PIC pathway under section 44BA. |
Source: Workers Compensation Act 1987 (NSW), sections 43 and 44BA as amended from 1 July 2026. A single insurer letter can contain more than one type of decision, so classify each issue separately.
A work capacity assessment is not always a prerequisite
Section 44A permits the insurer to conduct a work capacity assessment at any time, but section 44A(3) states that an assessment is not necessary for making a work capacity decision. The absence of a formal assessment therefore does not by itself invalidate the decision.
The better questions are whether the notice identifies the decision, gives intelligible reasons, uses the correct statutory test and relies on accurate medical, vocational and earnings material.
Match the evidence to the decision actually made
| Decision issue | Evidence to examine |
|---|---|
| Fitness and current capacity | Certificates, treating reports, function across a working week, work attempts and medication effects. |
| Suitable employment | The section 32A factors: incapacity, medical information, age, education, skills, work experience, return-to-work plans and rehabilitation. |
| Ability to earn | Assumed hours, wage rate, vocational material, current earnings and the calculation used. |
| Current weekly earnings | Post-injury payslips, actual gross earnings, suitable-employment assumptions and the insurer worksheet. |
| Separate PIAWE decision | Pre-injury payroll, overtime, allowances, concurrent employment, earning period and the PIAWE worksheet. |
| Risk of further injury | A specific medical opinion addressing the proposed work and the alleged risk. |
Optional insurer review or direct PIC application
Current SIRA guidance does not require a worker to complete a section 44 internal review. A worker may ask the insurer for an optional review or proceed directly to PIC. If an optional review is requested, it is conducted by someone other than the original decision-maker and the insurer must respond in writing within 14 days after receiving the request.
The review choice should be made after checking the notice period, payment-change date, evidence available and whether the dispute is truly a work capacity decision. The 14-day response time for an optional insurer review is not a universal 14-day filing deadline for the worker.
Notice dates and the possible PIC stay
Preserve the complete notice and proof of receipt. Record the notice period, effective date, old and new weekly-payment amounts and every report listed by the insurer.
SIRA states that a PIC review may temporarily suspend, or stay, the insurer decision if the worker lodges the PIC application before the notice period in the decision expires. Do not assume that asking the insurer for a review, making a complaint or preparing an application automatically keeps payments unchanged.
Documents to organise
- The complete insurer notice, envelope or email and proof of receipt.
- The weekly-payment calculation before and after the decision.
- All medical, rehabilitation, vocational and wage material relied on by the insurer.
- Current treating evidence answering the exact capacity, duties, hours or risk findings.
- Qualifications, employment history, work trials, rosters and actual earnings records.
- A short schedule separating factual, medical, statutory and calculation errors.
Official sources
Sources are listed for transparency. This guide is general information only and is not legal advice.
- Workers Compensation Act 1987 (NSW) - sections 32A, 43, 44A and current review provisions
- Workers Compensation Legislation Amendment Act 2025 - sections 43 and 44BA amendments
- SIRA - work capacity decision reviews
- SIRA - PIAWE reference guide current from 1 July 2026
- Personal Injury Commission - workers compensation changes from 1 July 2026
- SIRA - weekly payments
- SIRA - workers compensation benefits guide
Frequently asked questions
Do I have to request insurer review before applying to PIC?
No. SIRA says a worker may request an optional insurer review or proceed directly to PIC.
Is a treatment refusal a work capacity decision?
No. Section 43 excludes decisions about medical treatment and related compensation. A treatment dispute may need a different PIC pathway.
Does the insurer need a formal work capacity assessment first?
Not necessarily. Section 44A(3) says an assessment is not necessary for making a work capacity decision.
Do I have only 14 days to act?
There is no universal 14-day worker deadline on SIRA's review page. The 14 days is the insurer's response time after receiving an optional review request. Check the actual notice period, effective date and PIC requirements.
Can a PIC application keep payments unchanged?
SIRA says the decision may be temporarily stayed if the PIC application is lodged before the notice period in the insurer decision expires. The actual notice and filing position should be checked.
Workers compensation help by location
We assist workers across NSW. Choose a location guide for contact options, appointment information and links to the claim issues discussed on this page.
- work capacity dispute help in the Blacktown area
- suitable duties guidance for Parramatta workers
- work capacity decisions affecting Newcastle workers
- work injury claim assistance for Wollongong workers
Browse NSW workers compensation location guidesRead how IRO and ILARS funding is assessed
Has a work capacity decision reduced or stopped payments?
The notice may combine medical, vocational and calculation issues. Consider obtaining advice about the exact decision, evidence, notice period and current review options.