Once injured on the job it can be difficult to assess when an employee is ready to return. This is often due to differences of opinion regarding the worker’s ongoing level of disability, available work, and the employers’/insurance carriers’ willingness to continue to make workers compensation payments to an injured employee. Based on all this, the insurance carrier has the right to make a decision with regards to the employees capacity to return to work.

What Is Involved in a Work Capacity Decision?

A work capacity decision is one in which the insurance company uses various forms of information to assess if the worker is ready and able to return to work at some capability. The return to work does not necessarily have to be at their former position or at their former salary. Instead, the insurance company will look at various factors when making a return to work determination, such as;

  • What is the employee’s current work capacity? i.e. part-time, full time, lesser physical requirements etc.
  • What salary would be available to the returning worker?
  • What types of employment could the worker currently engage in? i.e. the same job with modifications, a new job using transferable skills, etc.
  • What would be the comparison between the pre-injury weekly wage and the proposed weekly wage?
  • Is the worker unable to engage in particular types of work based upon their injury?

Oftentimes the insurer will also use medical evidence garnered by a physician of their choice and the injured worker’s designated physician.

When Can a Decision Be Made?

A decision regarding a workers capacity cannot be made too soon into the process of treating and allowing the injury to heal. However, after approximately 78 weeks of receiving benefits, it is likely that the insurer will begin the process of assessing the injured worker to determine their capacity to work. This assessment must take place before the worker has been out of work and receiving benefits for 130 weeks.

How Much Notice Must an Injured Worker Receive Prior to A Work Capacity Decision Being Made?

Once a worker has received 12 continuous weeks of benefits, the insurance carrier must give the worker three (3) months’ notice that a reduction in benefits is forthcoming.

What can Employers Do?

The most important thing employers can do at this stage is keep the lines of communication open. Employers should remain in contact with the insurer so they’re informed about when the employee is likely to return and available to the employee when needed to answer any questions.