A letter arrived and you are not sure what it means

Claim letters are written in scheme language. The words look like ordinary English, but most of them are defined terms with a narrow legal job, and a letter that decides one thing often reads as though it has decided everything. This is a dictionary for those words.

What the Letter Decoder is

59 phrases that actually appear in Australian claim letters, grouped by which system sent the letter. For each one you get three things:

• What it means in plain English. The phrase without the scheme grammar.
• Where it is defined. The instrument and section, or the regulator page, so you can read the source yourself rather than taking our word for it.
• What it does not decide. The whole reason this page exists.

That third line is the one to read first. A workers compensation decision does not decide a Centrelink question. A Centrelink decision does not decide an insurance question. A decision about weekly payments usually does not decide medical expenses. And nothing in any of them decides a total and permanent disability (TPD) or income protection claim held inside superannuation, which is judged by an insurer under a policy and, where the money is in super, by a trustee under a separate rule.

What this is not. It is not advice, and it does not assess anything. It describes published rules. Whether any rule applies to your situation is a question for a lawyer, and it is not one this site answers.

Which system sent your letter?

Look at the letterhead, not the content. The sender decides which rules the words come from, and the same phrase can mean different things depending on who wrote it.

Two senders are not here yet, the TAC (Transport Accident Commission) and WorkCover Queensland: we have not finished checking those letters against primary sources, and we would rather show nothing than guess.

Every phrase, by sender

If you know the phrase you are looking for, it is quicker to start here.

WorkSafe Victoria and its claims agents

• "second entitlement period" or "the 130 week review"
• "no current work capacity" and "current work capacity"
• "likely to continue indefinitely" or "not likely to continue indefinitely"
• "whole person impairment" (WPI) and "21% or more"
• "Impairment Specialist" and "estimated WPI"
• "administrative determination" and "interim determination"
• "Statement of Injuries" or "List of Compensable Injuries and/or Illnesses"
• "13 weeks' notice" and "the period of notice"
• "grounds relied on" and "reasons"
• "stabilised" and "material change"
• "vocational assessment"
• "an examination the agent arranged"
• "refer to a Medical Panel" and "request for conciliation"

NSW scheme insurers, under SIRA

• "work capacity decision"
• "no current work capacity" and "current work capacity"
• "suitable employment"
• "the amount you are able to earn in suitable employment"
• "second entitlement period"
• "a section 38 application"
• "section 39" or "cessation of weekly payments after 5 years"
• "worker with high needs" and "worker with highest needs"
• "notice of discontinuation or reduction" and "the required period of notice"
• "internal review"
• "stay"
• "medical assessment certificate"
• "certificate of capacity"
• "the IRO"

Comcare, and licensees under the Commonwealth scheme

• "determination"
• "notification of an intention to make a determination"
• "request for reconsideration"
• "reviewable decision"
• "reasonable administrative action taken in a reasonable manner"
• "the amount you are able to earn in suitable employment" (AE)
• "suitable employment" (Comcare)
• "maximum rate compensation week"

Centrelink, on the Disability Support Pension

• "impairment rating" and "20 points"
• "a single Impairment Table" and "severe impairment"
• "continuing inability to work" (CITW)
• "program of support"
• "manifest" grant and "manifest" rejection
• "diagnosed, reasonably treated and stabilised"
• "partial capacity to work"
• "job capacity assessment" (JCA) and "disability medical assessment" (DMA)
• "Authorised Review Officer" (ARO)

Life insurers, and cover held through superannuation

• "declined"
• "closing your claim"
• "Show Cause letter" and "Procedural Fairness letter"
• "own occupation"
• "any occupation"
• "activities of daily living"
• "waiting period"
• "benefit period", and the definition switch
• "offset"
• "surveillance"
• "an examination the insurer arranged"
• "interview"
• "Claim Received Date"
• "Circumstances Beyond Our Control"
• "final response" and the complaints clocks

Three traps that catch nearly everyone

• The same words are different tests in different systems. "Suitable employment" exists in NSW, in the Commonwealth scheme and, in a different form, in the Victorian scheme. Each is defined separately with different consequences. A national explanation of any of them would be wrong somewhere.
• The notice period is usually the deadline, and it rarely says so. In NSW the stay under s 289B of the 1998 Act only operates if the dispute is referred before the notice period expires. In Victoria the manual sets 13 weeks plus postage for a second entitlement period termination. In the Commonwealth scheme the reconsideration clock is 30 days from when the determination came to the person's notice.
• The warning letter is the one that matters. Comcare's notification of an intention to make a determination, and an insurer's Show Cause or Procedural Fairness letter, are both pre-decision letters. Neither is reviewable, because neither is a decision, and both are the point at which new information still changes the outcome.

Where to next

• Claim pathways: each scheme, its schedule, and what its end does not decide
• Claim pathways: how one system leads to another
• How to find out what insurance you hold, free, in one phone call
• My insurance claim was declined. What now?

Every phrase here was taken from a primary or regulator source, not from a summary, and checked on 14 August 2026. Where a figure could not be confirmed, the page says so instead of printing a number. If something has changed, tell us and we will fix it: contact.