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5.4 When is an Impairment Stable?
Stable - simply means it is unlikely to improve to any major degree. This should not be judged on the basis of possible improvement in impairment ratings
Permanent - means that the condition is not likely to resolve.
Essentially, it is a matter of medical evidence when an impairment becomes stable for the purposes of PI compensation. A delegate should rely, in particular, on medical opinion to establish a date when the impairment stabilised. However, the last date of any active (as opposed to palliative) treatment of the impairment may also be indicative of stabilisation, if that treatment is no longer required. In cases where the stability of an impairment is unclear, it may be appropriate to seek the advice of a Contracted Medical Advisor (CMA) in providing an opinion based on existing medical evidence or by liaising with the clients treating/assessing medical practitioner.
It is important to note that there is a difference between the date an impairment becomes stable and the date an impairment becomes permanent. An impairment may well be permanent (i.e. likely to continue indefinitely, or not likely to resolve) but not yet stable (i.e. further treatment is likely to provide an improvement in the impairment, such as a back injury where active treatment is being undertaken or surgery is scheduled).
In some cases impairment may be intermittent, that is, remain at a low or negligible level of impairment between discrete episodes of increased impairment. A sufferer of epilepsy who remains well between “fits” is a useful example. This does not necessarily mean that the impairment should not be considered stable. Many conditions will have periods where symptoms may be more or less severe, including fluctuations of symptoms or 'spikes' as part of their normal manifestation.
It will be medical opinion provided by the assessing medical practitioner or the CMA that will guide a decision around the permanence and stability of a condition.
In cases where the stability of a condition, the timeframe for follow-up, or an estimate of points post stabilisation is unclear, it may be appropriate to seek the assistance of a CMA in providing a medical opinion based on the available evidence, or to liaise with the clients treating medical practitioner for clarification via a supplementary report.
Client has an accepted condition of Major Depressive Disorder and has been receiving treatment for the past 6 months. The assessing medical practitioner states that the condition is permanent, and whilst treatment to date has been beneficial, further improvement is expected with ongoing treatment over the next 6 months. On the basis of this information the conditions is considered permanent but not yet stable, therefore interim compensation is appropriate with a review recommended for 6 months’ time. On review 6 months later the assessing medical practitioner states that despite a requirement for ongoing regular treatment and fluctuations in the condition as a result of ongoing life events such as stress at work and moving house, the condition is now considered to be stable as it is not expected to improve to any further major degree.