Capacity for work dispute (NSW CTP)
Capacity for work disputes are a common reason weekly payments are reduced or stopped. Insurers may say you have earning capacity based on medical opinions, rehabilitation notes, or vocational material. These disputes often intensify around the 78-week point.
General information only. The correct pathway depends on the decision type.
1) Evidence that commonly matters
- treating doctor evidence addressing functional restrictions (not just diagnosis)
- consistent certificates and symptom timeline
- wage/income evidence and work history
- vocational evidence where relevant
2) If an IME is driving the decision
If the insurer relies on an IME opinion, you may need to respond with targeted treating evidence.
Read: IME explained.
3) Internal review and PIC pathway
Many disputes begin with internal review and may then proceed to the PIC.
Read: internal review and PIC overview.
Frequently asked questions
- What is a capacity for work dispute?
- It is a dispute about whether you have capacity or earning capacity that affects weekly payments entitlement. The insurer may rely on medical/vocational material to argue you can work.
- Why does the 78-week point matter?
- In many matters, earning capacity decisions around the 78-week point can change weekly payments entitlement rules. The correct impact depends on the decision type and your circumstances.
- What evidence helps in capacity disputes?
- Treating evidence addressing functional capacity, consistent certificates, vocational evidence where relevant, and wage records can matter. The right evidence depends on the insurer’s reasons.
- Does an IME affect capacity decisions?
- It can. Insurers may rely on IME opinions. If the IME is inaccurate, targeted treating evidence may be needed.
- What is the dispute pathway?
- Many disputes begin with internal review and may then proceed to PIC, depending on the decision category.