Issuing medical certificates and return to work

General practitioners (GPs) and nurse practitioners can issue a medical certificate if a patient needs to reduce their hours or change the activities and type of work they do because of their injury.

When you assess your patient there’s a few things we need to know so we can provide the right support.

Work can be a valuable component of a patient’s rehabilitation by keeping them connected to support at work and maintaining their income and overall confidence.

On this page

    Issuing a medical certificate

    As a GP or nurse practitioner, you can issue a medical certificate as part of the initial ACC45 injury claim. This covers your patient for up to the first 14 days. If you think your patient can do some tasks or parts of their job, state on the ACC18 that they're fit for selected duties and outline the activities and type of work they can do with their injury. This also applies to clients who are fully unfit (FUF) for a few days but are then fit for selected work (FFSW), clinicians can submit an ACC45 and an eACC18 at the initial consultation to reflect this. This is an interim measure while ACC revises the ACC45. The ACC18 is also used to certify beyond the first 14 days.

    Provide as much detail about your patient’s injury as you can. This helps us work out what support they need.

    You can certify your patient as either ‘fit for selected work’ or ‘fully unfit’. Read below to find out more about the instances when fully unfit certification is appropriate. You’ll need to outline on the medical certificate the activities and type of work that your patient can do with their injury.

    Submit the medical certificate through your practice management system or our online system.

    When your patient’s 14-day medical certificate ends, you’ll need to issue a new certificate to make sure they continue to receive support if they’re still recovering. You can do this by submitting an ACC18 form. The ACC18 form is also used to indicate medical clearance, in other words that your patient is now fully fit to work. This may happen when they’re still undergoing treatment for their injury.

    If you’d like more information about managing work certification, you can complete ACC’s educational module available on the Goodfellow Unit. Completion of the online module gives you one Continuing Professional Development (CPD) point.

    Certifying work capacity after injury module on the Goodfellow Unit

    Assessing your patient

    There are three components that contribute to work capacity — ability, tolerance, and risk. Based on these factors and the assessment you make, the advice you give your patient and their employer can influence how they view their injury as well as their recovery.

    Use the ability, tolerance, and risk model to inform the medical certificate.

    Ability
    • Specify what your patient can safely do — cognitively, physically, and interpersonally.
    • Set out your diagnosis, treatment, or rehabilitation recommendations and prognosis (if appropriate).
    Tolerance
    • Set out any appropriate adjustments to your patient’s work such as hours, travel, and tasks.
    • Specify dates for staged return to activities at work.
    Risk
    • Specify what your patient must not do – to keep them or others safe.
    • Outline what may constitute a risk to your patient, eg certain activities or situations.
    • Detail any specific actions that should be taken to reduce risk, eg changes to the environment, seating, or breaks.

    If your patient expresses concerns or fears about recovering at work

    The longer your patient is off work, the less likely it is that they’ll ever return. New Zealand and Australian industry data demonstrate that the chances of a patient returning to work reduce significantly after just five to six weeks, and that some never return to the workforce.

    Factors affecting return to work after injury: A study for the Victorian WorkCover Authority

    We can help you access expert supports and resources to help your patient to recover safely at work. This includes:

    • Stay at Work (SAW) service providers
    • specialised equipment and technology to support transport to and from work
    • occupational workstation assessments
    • functional assessments
    • specialised health professionals.

    Recovery is optimised when the patient, GP, employer, and ACC work together in the best interests of the patient and support a safe and effective return to work as part of the rehabilitation process.

    If they say there are no light duties

    We’ve found that most employers are happy to discuss alternative duties for their employee. It’s beneficial for you, the employer, and ACC to work together to transition the patient back to work.

    If you need help making a decision

    There may be cases where it's difficult to decide if your patient is ready to return to work or can do selected work, or you may not have enough information. Let us know on the ACC18 if you’d like us to contact you. We’ll get in touch and talk to you about referring your patient for an occupational assessment.

    Let us know about your plan for your patient's recovery

    Let us know about your plan for your patient’s recovery. Well use this to support your patient's recovery. When you're putting a plan together, it's good to let us know about:

    • referrals or investigations they need
    • relevant patient notes
    • what support you think they might need from us.

    What support we can offer your patient

    There are lots of different ways we can help your patient return to and recover at work. This may be through alternative work tasks, modifications at the workplace, or transport costs. Tell us if your patient needs more help when you complete the ACC18.

    Returning to work after an injury

    Helping your patient stay at or return to work

    It’s likely that your patient will still be able to work in some way. This could be returning part-time or doing lighter or alternative jobs while they’re injured.

    If they stay at or return to work on reduced hours or alternative duties as part of their recovery plan, we’ll continue to provide the support they need. Their employer will pay your patient for the productive hours they work. ACC can top up these wages with weekly compensation, so instead of getting up to 80% of their pre-injury income through ACC (as they would if their employer has no suitable work for them), your patient may earn up to 100%.

    Talk about these options with your patient. If they’re unsure about what options are available at work, contact us. We can talk to their employer and look at alternatives with them.

    If your patient is fully unfit for work

    There are only a few instances when your patient will be fully unfit for work:

    • The risks of returning to work are excessive and the work environment poses a risk of serious harm to your patient or someone else.
    • The available work tasks will aggravate your patient’s injury.
    • Your patient can’t travel to and from work – even with assistance.
    • Your patient has total inability to work, eg they are admitted to hospital.

    If they're fit for some work

    If you think your patient can do some tasks or parts of their job, state on the ACC18 that they're fit for selected duties and outline the activities and type of work they can do with their injury. We’ll then work with you and your patient to look at different return to work options.

    The form below provides information and talking points to discuss with your patient. 

    'Fit for selected work' medical certification (ACC8212)

    Contact us

    It's best to use your patient's recovery team as your first point of contact. You can also contact our Provider Contact Centre.

    Phone 0800 222 070 (Monday to Friday 8:30am - 5pm)
    Email providerhelp@acc.co.nz

    Last published: 21 October 2020