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.
Quick answer: if your insurer says you can work and cuts weekly payments, respond point-by-point to each insurer reason with functional medical evidence, work-demand evidence, and indexed wage records. If a deadline is under 7 days, lodge a rights-preserving review first and supplement quickly.
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
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.
Internal review and PIC pathway
Many disputes begin with internal review and may then proceed to the PIC.
Capacity disputes often overlap with stopped-weekly-payments issues, PAWE evidence problems, and disagreements about whether the insurer has used the correct PIC stream. That means the most useful response is usually a decision-specific bundle rather than a generic complaint letter.
Read: internal review, PIC overview, and PIC merit review vs medical assessment.
First 14 days after an adverse capacity decision
Days 1–3: pull the decision letter, IME report, recent certificates, and wage/work records. Build a one-page insurer-reasons list so each disputed point is visible.
Days 4–7: map each insurer reason to a specific evidence item (treating doctor, employer duties, wage records, failed return-to-work chronology). Where letters mix capacity with treatment or PAWE issues, split those streams now.
Days 8–14: lodge internal review in a reason-by-reason format and include an indexed bundle. If your deadline is under 7 days, file a rights-preserving core package first and provide a dated supplement plan.
Building a better evidence bundle
The strongest capacity-for-work challenges usually answer the insurer point-by-point. If the insurer says you can work full-time, the reply should address hours, duties, productivity, breaks, travel tolerance, medication side effects, and whether the proposed role actually exists for someone with your restrictions.
- match each insurer reason to a treating or wage document that answers it directly
- keep certificates and doctor opinions consistent on hours, restrictions, and review dates
- use PAWE records if the insurer is understating the financial impact of reduced work capacity
- separate medical questions from merit-review earnings questions so the PIC filing goes into the right stream
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.
- What if my internal review deadline is close and my full evidence is not ready?
- Lodge a rights-preserving internal review with the core decision documents and key medical/work-capacity material before the deadline, then file indexed supplementary evidence promptly.