Getting back to work after an injury isn’t as simple as flipping a switch. There’s recovery to think about, workplace safety to consider, and then there’s the ACC18 medical certificate—a crucial piece of the puzzle that determines when and how a worker can return. But is it always being used the right way?
Too often, workers are stamped as “fully unfit”, even when there’s room for a gradual return to work (GRTW) with the right support. That’s not just frustrating; it can actually slow down recovery, impact mental wellbeing, and leave workers earning less than they should.
So, let’s get real: how can ACC18 medical certificates be used better?
ACC18 medical certificates: what they do (and what they should do better)
The ACC18 medical certificate is a key part of injury management. It’s meant to outline:
- whether a worker is fit for full work duties and hours or not
- if they can return in a reduced capacity and what that looks like, and
- what kind of vocational rehabilitation and treatment they might need.
In theory, it’s a tool for safe and structured recovery. In practice, it’s often used too conservatively, shutting down opportunities for active rehab and workplace engagement.
A better approach? To focus on what a worker CAN do safely.
The “fully unfit” dilemma
A “fully unfit” medical certificate should only be issued in three cases:
- The worker is in hospital or medically required to stay in bed.
- The injury requires quarantine (e.g., risk of infection) and remote work isn’t possible.
- Returning to work would be a unmanageable health and safety risk to the worker, their colleagues, or the public.
The first two are straightforward. But health and safety risks? That’s a grey area.
Many medical practitioners don’t have the full picture of the workplace and what modified duties and support might be available. Workers, on the other hand, might assume time off is the only option, when actually a structured return could speed up their recovery.
This leads to overly cautious medical certificates that unintentionally delay recovery, limit earning potential (weekly compensation usually covers only 80% of wages), and keep workers sidelined unnecessarily.
What makes a good ACC18 medical certificate?
An effective ACC18 medical certificate should highlight abilities, not just restrictions. Here’s what it should include:
- What the worker CAN do: Be specific. Can they lift up to 10kg, can they work in an alternative setting such as the workshop or indoor controlled environment, can they work reduced hours?
- Work tolerance levels: How long can they stand, sit, or walk or use their arms before discomfort kicks in? consider if task rotation or increased breaks are possible
- Workplace modifications: What adjustments or equipment can help them ease back in safely such as stools, tools or breaking down the role to manageable parts?
Instead of vague restrictions like “No heavy lifting,” which overly limits options for a return to work. An accurate, detailed certificate might say: “Can perform all tasks that don’t involve lifting more than 15kg, recommend 10min breaks every 90 minutes for stretching.”
This clarity allows employers to make informed decisions, guide vocational rehabilitation programmes and help workers transition back safely AND smoothly.
Why vocational rehabilitation matters
Recovery isn’t just about healing – it’s about staying engaged, keeping a sense of purpose, and feeling supported. Vocational rehabilitation helps workers:
- Stay active and connected to their workplace
- Avoid the mental and emotional toll of long-term absence, and
- Recover faster with structured support.
Signing someone off as “fully unfit” means they miss out on these benefits. But when GRTW is built into their plan, it’s a win-win: workers recover faster, and businesses keep things running smoothly.
Regular check-ins, clear return-to-work plans, and open communication make all the difference. A mapped-out plan keeps everyone on the same page, from the worker and employer to the rehabilitation providers.
The power of collaboration: workers, employers and medical professionals
For ACC18 medical certificates to do their job properly, everyone needs to be on the same team. That means:
- Employers providing clear info on workplace tasks, environments and potential accommodations/ alternative duties
- Medical practitioners making informed decisions based on the injury and workplace’s ability to manage risk and support the injured worker
- Vocational rehabilitation and treating providers assessments and recommendations are communicated clearly
- Workers understanding the benefits of early return to work and actively engaging in their recovery
When these groups communicate openly, we can cut down on unnecessary “fully unfit” certificates and create better injury management outcomes.
Final thoughts: a smarter approach to ACC18 medical certificates
A one-size-fits-all approach doesn’t work. ACC18 medical certificates should be a tailored to support recovery and reintegration to the workplace
Employers, medical providers, rehabilitation providers and workers all play a role in making sure injury recovery is structured, supportive, and efficient. When everyone’s on the same page, recovery is quicker, and the experience is better for everyone.
Are the medical certificates you receive helping or hindering recovery?
Want expert guidance on injury management and return to work? Injury Doc NZ has your back. Let’s get Kiwi workers back on their feet—safely and efficiently. Get in touch today!
FAQs
- What is an ACC18 medical certificate?
It’s a document that determines an injured worker’s fitness for work and helps guide their return-to-work process.
- Can an ACC18 medical certificate be changed?
Yes! If workplace adjustments allow for a safe return, medical certificates can be updated to reflect this.
- Why do doctors sometimes default to “fully unfit”?
They often don’t have full visibility of what workplace adjustments can be made or the time to find out. That’s why better employer-doctor communication is crucial.
- How does being “fully unfit” affect weekly compensation?
Workers on weekly compensation receive only 80% of their pre-injury earnings. A structured return-to-work plan helps maintain income up to 100% while supporting recovery.
- How can employers improve the return-to-work process?
By engaging with medical practitioners, providing clear functional job descriptions or Job task analysis, and offering alternative duties, employers can help reduce unnecessary time off and create a smoother transition back to work after injury
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