Work Capacity Medical Certificate - New Zealand Doctor

Purpose of this guideWork and Income relies on health practitioners to indicate a person’s clinical conditions and theimpact those conditions have on their capacity for work. Work and Income uses this informationto help determine eligibility for financial assistance and the associated obligations.This booklet provides a guide to completing the Work Capacity Medical Certificate. It explainsthe questions we ask on the certificate and how your responses will help Work and Incomedetermine eligibility and plan with the person to move towards work.

About the Work CapacityMedical CertificateMost people tell us that they want to work, and they can with the right support. Researchalso shows that suitable work improves wellbeing and is generally good for physical andmental health. Additionally, recovery is generally faster and more successful if people canwork while rehabilitating. 1The Work Capacity Medical Certificate has been designed to help you to provide informationabout the impacts of a person’s condition on their capacity for work and the types of workthey can undertake.You do not need specialist occupational health expertise or a detailed understanding of theperson’s job to complete the form. The advice you give is on the effects of the condition withinthe limits of your knowledge and expertise.Purpose of the certificateThe Work Capacity Medical Certificate provides Work and Income with information to helpdetermine a person’s eligibility for a benefit, capacity for work, and ability to undertakework-related activities.The certificate is also used to estimate the length of time the person is likely to be restrictedin their capacity for work.The certificate is not benefit specific which means that all information provided will be consideredby Work and Income in the decision making and planning processes.Who can complete the certificate?The certificate can only be completed by registered medical practitioners, dentists, or midwives.Midwives can complete a medical certificate where the person is more than 27 weeks pregnantor has complications due to their pregnancy.To complete the certificate, you must be registered to practice in New Zealand and have a currentAnnual Practicing Certificate.Medical students, unregistered practitioners and allied health practitioners cannot completethe certificate.1 See the Australasian Faculty of Occupational & Environmental Medicine Position Statement: Realising the Health Benefitsof Work (2010) for further information.PAGE 2

When should the certificate be completed?You should complete the certificate as soon as you become aware that the person’s conditionimpacts on their capacity for work or when they indicate they wish to apply for the SicknessBenefit, Invalid’s Benefit or Independent Youth Benefit (Sickness). If the person does not meetthe medical eligibility for one of these benefits, Work and Income will assess their eligibility foran alternative benefit.You may also be asked to complete the certificate for people on other benefits who are temporarilyunable to meet their work-related obligations due to sickness, injury, disability or pregnancy.Completing the certificateThe certificate can be completed electronically using a number of practice management systems.Alternatively, pads of printed certificates are available from Work and Income.Once you have completed the form, please give it to the person so they can take it to their localWork and Income office. If you have completed an electronic version of the certificate, this will needto be printed and given to the person.PAGE 3

The benefits of workPeople often have preconceived ideas about the need to refrain from work in orderto recover. This is not always the case and recovery is often faster and more successfulif people can do some work while recovering.The longer a person is unemployed, the harder it is for them to find employment.Those who are unemployed long-term are at greater risk of mental and physical illness.When completing a medical certificate, it may be useful to discuss the following points withyour patient.• The health and social benefits of work, including that it:– can help promote recovery and rehabilitation– improves quality of life and wellbeing– is central to a sense of personal identity.• The adverse effects on health from being out of employment, include:– higher mortality and poorer physical and mental health– greater chances of the person and their family being in poverty– increased risk of social exclusion.• Obstacles to the person returning to work and what could be done to overcome them, such as:– a phased return to work– altered or reduced hours– amended or light duties– workplace modifications.PAGE 4

Definition of ‘Work’Work and Income defines work as any suitable employment which the person is familiarwith, or other types of work that the person might reasonably be expected to be ableto undertake when relevant limitations are accounted for.Suitable employment will vary depending on the person’s individual circumstances. When decidingon whether a job is suitable for a client, Work and Income will consider the relevant factors, including(but not limited to):• hours of work• days of work (eg days of the week)• childcare commitments• family commitments• religious commitments• strongly held views• type of employment• skills required• the person’s experience• location of the job• wages.For the Invalid’s Benefit, work refers to open employment. Open employment is any mainstreamemployment in the open labour market which pays no less than the minimum wage and excludesany employment designed to cater for the needs of a severely disabled person.A person may be unable to work if:• they are medically unable to undertake their current job now but will return to it soon – and it wouldbe unreasonable to expect the person to undertake alternative work in the interim, or• returning to work would be detrimental to the person’s health in the interim, or• they are unable to do any reasonable full-time job, either for a short period of time or permanently.See page 13 for definitions of full-time and part-time work.Work obligationsPeople on other benefits may be subject to work-related obligations. They may be required toparticipate in a planning process and, in some circumstances, may be required to look for part-timeemployment (15 hours or more per week) or undertake other work-related activities such as training.A person may be exempt from some or all of their work obligations due to temporary sickness,injury, disability or pregnancy. They are required to provide a medical certificate outlining theircurrent incapacity and expected recovery.Work and Income may continue to work with people for whom work is not immediatelyappropriate, to prepare them to move into employment.PAGE 5

Personal detailsPlease record the person’s legal name, residential address, date of birth and gender. Where theperson has a number of names including colloquial names, the name that should be recordedis their legal name as it appears on their passport or birth certificate. It is this name that is usedby Work and Income to verify the person’s identity.(Q4) Are you the person’s usual practitioner?Tell us if you are the person’s usual medical practitioner.It is not always necessary for the practitioner completing the medical certificate to be the person’susual medical practitioner.Some people may choose to ask a practitioner with whom they have little or no previous contactto complete the medical certificate. Where a person is not enrolled with your practice you maynot have a comprehensive understanding of the person and their circumstances. This may makeit difficult to adequately complete the medical certificate.If the person is not enrolled with your practice, you are welcome to complete the medicalcertificate if you feel you are able to provide the required information.You may also recommend in Question 5 that an alternate practitioner provide the information.(Q5) Who do you consider best placed to provide this information?Work and Income recognises that there are circumstances where you may feel you are not in thebest position to provide the information. This may be because you do not have enough informationto complete the form or specialist input is required. It may also be because you are placed in a conflictof interest or feel pressured by the person, or because of the person’s complex social, financialor environmental factors.Please indicate who you consider best placed to provide the required medical information –yourself, a second opinion (eg designated doctor) or another health practitioner.If you signal that you are not the best person to complete the medical certificate, you should stillcontinue to provide the information to the best of your knowledge. You may also choose not tocomplete the form.PAGE 7

Where you indicate that the information should be sought from ‘Other’, this could includea medical practitioner such as a medical specialist, the person’s regular GP or a hospital doctor(if they have been hospitalised). Please use the space provided to give information such as thetype of specialist recommended and/or the specific contact details of the most appropriateperson to complete the assessment, including name and phone number.While waiting for the required information, Work and Income may be able to provide the personwith a range of assistance including:• a non-health related benefit• an emergency benefit or• other forms of financial assistance.The case manager may seek further advice, either internally or by referral to a designated doctor,before determining the most appropriate support for the person.Second opinion and designated doctorsIf you signal that a second opinion is appropriate or if we determine that benefit eligibilityis unclear from the medical certificate, we can arrange for a second opinion by a designateddoctor at our expense.Specialist opinions or assessmentsWhen you recommend an opinion from a specialist, the medical certificate will be referred to thelocal Work and Income Regional Health and Disability Team.Where the person has already been assessed by that specialist, we may ask the specialist for acopy of the report from their most recent appointment (with the person’s consent) or have themcomplete the Work Capacity Medical Certificate. If the person has not seen the specialist before,we will determine if the assessment is required to establish entitlement or for planning purposesand consider funding the appointment.HospitalisationWe need to know the date of admission and expected length of stay as benefit paymentsmay be reduced if the person is in hospital for more than 13 weeks.There are a range of different entitlements a person may be able to receive when they arein hospital for more than 13 weeks or are in residential care.PAGE 8

(Q12) Is the person blind?Indicate if the person is blind. The person must meet one or both of the following criteria:• the best visual acuity (sharpness), with correcting lenses, does not exceed 3/60 or 1/20 and/or• the visual field is contracted to a maximum of five degrees on either side of the fixation point.If the person is blind as defined above, they may have an entitlement to Invalid’s Benefitirrespective of the number of hours they are able to work or the income they receive fromtheir employment.If a person is not blind as defined above, but is both permanently and severely restricted in theircapacity for work because of visual impairment, they may have entitlement to Invalid’s Benefit.(Q13) If covered by ACC, what is the ACC number?Where a condition is the result of an accident covered by ACC, please indicate this and providethe person’s ACC number.Some payments made by ACC may affect eligibility to assistance or the rate at which the benefitis paid.Work and Income may be able to help with financial assistance while the person is waiting forACC cover to be determined. While receiving ACC payments, the person may also be entitled toother support from Work and Income.(Q14) How do the conditions listed in Question 11 impact on the person’s capacityfor work and the type of work they can undertake?To be eligible for Sickness Benefit, Invalid’s Benefit or Independent Youth Benefit (Sickness)the person must have an illness, injury or disability that reduces their capacity for work. While theperson may have a certain condition, not all people with the same condition have the same degreeof incapacity. This question asks you to link the condition with the person’s capacity for work.If a person could return to employment but there are restrictions on the type of work they canundertake or they need workplace accommodations including modifications, please advise us.PAGE 10

Impact on capacity for work(Q15) Do the conditions listed in Question 11 limit the person’s capacityto work for 30 hours or more per week?This question helps Work and Income to assess eligibility for a medical-related benefitor an exemption from work obligations due to sickness, injury or disability.(Q16) Do the conditions listed in Question 11 limit the person’s capacityto work regularly in open employment for 15 hours or more per week?This question helps Work and Income to assess eligibility for a medical-related benefitor an exemption from work obligations due to sickness, injury or disability.Open employment is defined as any mainstream employment in the open labour marketwhich pays no less than minimum wage and excludes any employment designed to caterfor the needs of a severely disabled person.PAGE 11

(Q16) (part 2) If yes – Is the person’s incapacity for work expected to lastat least 2 years? Or: Is the person’s life expectancy less than 2 years?This question assists Work and Income to determine the permanence of the person’s incapacityfor work.A person is considered to be permanently restricted if their incapacity for work is expected tolast at least 2 years. Many conditions that last for more than 2 years do not consistently affectthe person’s ability to work for this duration. For example, a person with osteoarthritis of thehip may be very incapacitated until they have a hip replacement. Following the hip replacementosteoarthritis will remain an issue for the person, but their incapacity will have been significantlyreduced by the treatment.(Q17) Is the person receiving active treatment under the care of a specialistfor any of the conditions listed in question 11?It is important for Work and Income to know when a person is accessing treatment as it mayhave an impact on their ability to participate in work or planning, and on the types of work theycan do. However, many treatments can happen concurrently with work or work-related activities.For example, where a person is undergoing intensive treatment such as chemotherapy,adjusting to a new management routine or awaiting imminent surgery, their readiness for workmay be substantially reduced.(Q18) When is the person likely to be capable of:• Work planning• Limited training (less than 15 hours per week)• Training (at least 15 hours per week)• Limited part-time work (less than 15 hours per week)• Part-time work (at least 15 hours per week)• Full-time work (30 hours or more per week)Work and Income is asking your opinion on the person’s capacity for work. This will be used todetermine their entitlement for benefit and their ability to meet obligations. It is also used to informthe provision of supports to assist the person into work.It is expected that most people’s ability to work will improve, allowing them to progress towardsemployment. Although it is not possible to determine the exact date on which a person will be ableto start work, we are asking you to indicate what you think their likely progress will be.In completing this section, please tick the appropriate boxes to show at what stage Work and Incomeshould start to consider that the person may be able to undertake suitable work-related activities.When indicating capacity for planning, training or work, please focus on the person’s conditionand its impact on their ability to work; not their ability to gain employment or on other factorssuch as literacy or the availability of childcare. In determining a person’s ability to work, you shouldconsider the person’s abilities without reference to local labour market conditions. If a personrequires assistance to get a job, Work and Income have a range of services available to supportpeople into work.PAGE 12

Although the person may focus on their previous employment, we are interested in theirability to undertake any type of work that they could reasonably be expected to do,given their relevant restrictions.Where the person is able to work but is unable to find a job, they may be entitled to a rangeof other support and assistance.Work planningWork planning actively engages the person in the process of identifying the steps and servicesrequired for them to move into work. These may include health services such as PATHS, but couldalso include vocational, educational, social, cultural, environmental or legal services.For people on Sickness Benefit, Independent Youth Benefit (Sickness) and Invalid’s Benefit,work planning may include a vocational assessment to identify likely employment options.TrainingWhile a person may not be ready or able to start work, they may be able to undertake somelevel of training. Training may include:• secondary school (for 16 and 17 year old people)• vocational training or retraining• literacy skills.Indicate if the person is able to undertake limited training (less than 15 hours per week)and/or training for longer periods (at least 15 hours per week).Part-time workWhen a person is capable of some degree of part-time work, they may continue to be eligiblefor benefit.Please indicate if the person is able to undertake limited part-time work (less than 15 hoursper week) and/or part-time work for longer periods (at least 15 hours per week).Full-time workWork that is 30 hours or more per week is defined as full-time work.When a person is able to work 30 hours or more per week, they are expected to be in work.However, if they are able to work full-time they may be eligible for other assistance fromWork and Income. For example, where a person is able to work 30 hours or more per weekand are looking for work, they may receive Unemployment Benefit with the associated obligationsto actively seek employment.Work and Income will consider all the information provided on the medical certificate whendetermining if the person will qualify for assistance.PAGE 13

Further informationIf you have any further questions about the financial assistance available fromWork and Income, or any other types of assistance available to disabled people or peoplewith ill health, please contact your local Work and Income Health and Disability Team.If you do not have their contact details, please call our General Enquiries number 0800 559 009and one of our Customer Services Representatives will arrange for them to contact you.People who are deaf or find it hard to communicate by phone, you can send a messageto our Deaf Link free-fax on 0800 621 621 or email MSD_Deaf_Services@msd.govt.nzMore information about the types of assistance we offer can be found at:• www.workandincome.govt.nz or• call us on 0800 559 009 from 7am to 6pm Monday to Friday and Saturday 8am to 1pm.PAGE 19

WDB5 – OCTOBER 2010