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5.3.1 Psychiatric Conditions - Table 5

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The WPI ratings of 50, 60 and 70 under Table 5.1 require consideration of whether a client has 'need for supervision and direction in a confined environment'. In Dwight and Comcare (2006) AATA 730 the Tribunal stated that 'confined environment' 'refers to an enclosed situation in which a person is not free to come and go as he or she pleases; for example, where the person is confined in a hospital or psychiatric institution'. Mr Dwight did not meet the definition as when he was 'on optimum medication and when his condition is reasonably stable, he does not require that kind of care'. The confinement would therefore need to be a constant and permanent arrangement.

Fellowes and Table 5.1

Since Fellowes and Robson, it is possible to compensate a person for two ratings under Table 5.1. In these cases, delegates would need to be satisfied that:

  • both accepted conditions met the SRCA definitions of injury, permanent and impairment; and
  • the effects of the conditions can be isolated from one another i.e. the person is not being compensated twice for the effects of one condition.

 

In order to determine this second point, delegates will need to look in detail at the medical evidence provided. If the information cannot be properly assessed from the reports alone, then further information should be sought from the specialist(s) involved in the assessment(s) to clarify how they came to more than one rating under Table 5.1 e.g. which impairments are attributed to which condition and how this was determined.

 

The concept of a “bodily system” when considering the definition of an impairment and how psychiatric conditions are to be assessed is clearer since Robson. The fundamental SRCA principle, that injuries must be assessed separately, extends even to psychiatric conditions and impairments that relate to the same bodily system (the brain) and produce markedly similar functional impairment.

 

For example, a person has liability accepted for PTSD due to a traumatic incident which occurred whilst they were on SRCA service.  The client lodges a PI claim and is subsequently assessed with a PI rating of 40% WPI under Table 5.1. (psychiatric conditions). Sometime later, the person suffers another injury – Paranoid Personality Disorder (PPD) – which is accepted as related to SRCA service.

 

The medical evidence specifies that the person's PPD is a separate injury to their PTSD, rather than an alternate diagnosis of/or impairment from the PTSD. The PI assessment reveals that the PPD would produce approximately 50% WPI on its own under Table 5.1. This WPI rating represents the effect the PPD would have had on a hypothetical normal healthy person, with no pre-existing psychiatric condition/s.

 

In this case, the delegate must assess each condition in isolation, which would result in a total WPI percentage of 90% (40% + 50%). This is because each injury is considered a separate claim for PI.  In addition, the PI already paid in respect of the client's PTSD (40%) cannot be deducted from the amount determined for their second injury (50%). However, when assessing entitlement to NEL for each psychiatric condition, the delegate must ensure based on the medical evidence, that the person is not being compensated twice for the same effects on their lifestyle (part B of the NEL formula).

 

It is not possible to provide definitive advice on assessment of psychiatric conditions.  As with any PI claim, assessments depend on the individual circumstances of each case, particularly with reference to the medical evidence.  Delegates should be mindful to provide clear instructions to medical assessors and to seek clarification from the report writer if required.