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5.8.6 Recalculation of whole PI payment when interim condition stabilised

Once the impairment(s) for which interim compensation has been paid stabilises, PI compensation is recalculated at the final assessed rate (i.e. the weekly rate applicable at the date the final assessment is undertaken).  If the final weekly rate of payment has increased, the ongoing periodic payment to the claimant is increased by the difference between the two.

When an interim payment has been made as a lump sum, the amount of PI payable is calculated by converting the lump sump paid to a current weekly amount and subtracting this from the total weekly amount of PI payable at final assessment.  The difference is the new weekly amount payable (which can be converted to a lump sum or taken as an ongoing weekly entitlement).

In either case, the new rate is subject to the rules for conversion to a lump sum set out in section 78 of the MRCA as discussed below.

In cases where multiple impairments are being considered as part of the PI assessment (and interim compensation has previously been paid), a final amount of PI compensation becomes payable once all of the service injuries or diseases concerned have stabilised.  If the final weekly rate of PI payment is greater than the weekly interim rate, the increase in the rate is backdated to the date on which the delegate is satisfied that all of the person's service injuries or diseases stabilised.

5.8.6.1 Date of effect for interim payments – single conditions

Where a determination is made that interim PI is payable in respect of a single condition the PI is payable from the later of:

  • the date the claim for liability was lodged; and
  • the date the impairment suffered by the person:
    • where the claim for PI was made prior to 1 July 2013 – constituted 10 IPs;
    • where the claim for PI was made on or after 1 July 2013 and the claimant has no previous compensable conditions under the MRCA – constituted 10 IPs (or 5 for those conditions that require a lower threshold);
    • where the claim for PI was made on or after 1 July 2013 and the claimant has previous compensable conditions under the MRCA – contributed at least 5 additional impairment points to the person’s overall impairment rating.

5.8.6.2 Date of effect for interim payments – multiple conditions – one or more conditions claimed prior to 1 July 2013

Where more than one condition was claimed prior to 1 July and at the time of those conditions being determined at least one of them is permanent but not stable, the date of effect for interim PI for all conditions included in the determination is the later of:

  • the date of the latest claim; and
  • the date Commission determines that the conditions met the threshold of 10 impairment points.

5.8.6.3 Date of effect for interim payments – multiple conditions – where person became entitled on or after 1 July 2013

Where PI was claimed prior to 1 July 2013 (condition A) and is being determined on or after 1 July 2013 together with a condition that was claimed on or after 1 July (condition B), interim PI is payable as follows:

  • if condition A of itself met all the criteria for payment of interim PI prior to 1 July, the date of effect is 1 July 2013 (the earliest date possible because the date of effect under the pre July 2013 legislation would have been on or after 1 July and the separate date of effect rules only apply from 1 July 2013);
  • if condition A of itself did not meet all the criteria for payment of interim PI prior to 1 July, (e.g. it did not meet the threshold) the date of effect is the date that, combined with condition B it met the threshold.
  • the date of effect for condition B is the later of the date for the condition and the date it met the relevant threshold.

5.8.6.4 Date of effect for interim payments – multiple conditions – all conditions claimed on or after 1 July 2013

Where a determination is made that interim PI is payable in respect of multiple conditions the PI for each condition may be payable from different dates because the date of effect for each condition is the later of

  • the date the claim for liability for that condition was lodged; and
  • the date the impairment suffered by the person as a result of that condition (either separately or in conjunction with another condition):
    • where the claim for PI was made prior to 1 July 2013 – constituted 10 IPs;
    • where the claim for PI was made on or after 1 July 2013 and the claimant has no previous compensable conditions under the MRCA – constituted 10 IPs;
    • where the claim for PI was made on or after 1 July 2013 and the claimant has previous compensable conditions under the MRCA – contributed at least 5 additional impairment points to the person’s overall impairment rating.

5.8.6.5 Date of Effect Examples

Example 1

Client claims a stable condition (condition A) which of itself meets all the criteria for payment of PI on 20 June 2013. On 12 July 2013 the client claims another condition (condition B) which is permanent but not stable. The two conditions are determined in September 2013.

The date of effect for the payment of interim PI for the two conditions is:

  • condition A: 1 July 2013 (this is the earliest this condition can be paid from because the date of effect under the pre July 2013 legislation would have been on or after 1 July and the new date of effect provisions commence on this date);
  • condition B: 12 July 2013.

Example 2

Client claims a stable condition (condition A) which of itself does not meet all the criteria for payment of PI on 20 June 2013 (4 IP). On 12 July 2013 the client claims another condition (condition B) which is permanent but not stable. The two conditions together meet the relevant threshold and are determined in September.

The date of effect for the payment of interim PI for the two conditions is:

  • condition A: 12 July 2013 (this is the earliest this condition can be paid from because it is not until this date that it meets the threshold when combined with condition B);
  • condition B: 12 July 2013.

Example 3

Client is receiving PI for several stable conditions. On 12 September 2013 he claims PI for one new condition. Medical advice is that whilst the condition is permanent it is not yet stable and that at the time of the claim for PI it increased this person’s overall impairment rating by more than 5 impairment points. The delegate decides to pay him interim PI. The date of effect for payment of the interim PI is the date of claim on 12 September 2013.