Certificate of capacity NSW: what claims teams need to check
The SIRA certificate explained for Injury Management Advisors and Claims Advisors on NSW workers compensation and CTP claims.
In NSW, the certificate of capacity is the SIRA-prescribed certificate used across workers compensation and CTP. The treating practitioner certifies diagnosis, capacity for work, restrictions and treatment for a stated period. Claims teams action it: weekly payments, suitable duties and treatment decisions all key off what it says.
Key Takeaways
- Regulator: SIRA (State Insurance Regulatory Authority) — always use the current SIRA form
- Used in: NSW workers compensation and CTP claims
- First certificate: issued by a medical practitioner; SIRA rules govern who may issue subsequent certificates and for what period
- Certificate period: generally up to 28 days per certificate unless a longer period is clinically justified
- What to reconcile: the treatment/medication section against the full dispense history — the certificate shows one prescriber’s view
How the NSW certificate works
NSW uses one certificate of capacity design across workers compensation and CTP, prescribed by SIRA. The treating practitioner certifies diagnosis, capacity (fit for pre-injury duties / fit for suitable duties with restrictions / unfit), hours and specific restrictions, the certificate period, and treatment. Insurers must have a current certificate to keep weekly payments and treatment decisions properly grounded.
Use the live SIRA form only — it is a statutory document and the current version matters. SIRA publishes the certificate and completion guidance at sira.nsw.gov.au.
The five NSW checks
- Currency: is the certificate current, and is the period justified rather than a rolling default?
- Capacity vs suitable duties: if "fit for suitable duties", are the restrictions specific enough to actually build duties from?
- Diagnosis scope: does the certified condition still match the accepted injury, or has it drifted?
- Medication vs capacity: does the treatment section undercut the certified capacity — sedating medications against driving clearances being the classic conflict?
- Certificate vs dispense history: is the medication section complete? On multi-prescriber claims it usually is not.
For the medication checks in depth, see reading a certificate when the worker is on multiple medications.
See what a complete medication picture looks like on a claim
Allmeds reads the NSW certificate's medication section against the claim's full dispense history and flags the conflicts a single certificate can't show.
Related pages
Important: This page is general health information, not personal medical advice. If you have questions about your medication — including starting it, stopping it, changing the dose, or combining it with something else — speak with your doctor or pharmacist. For an emergency or suspected overdose, call your local emergency number or poison information service immediately. Information is drawn from regulator and clinical guideline sources (TGA, FDA, MHRA, NICE, PBS, CDC); see our methodology for details.