5.7.2 Additional Permanent Impairment Compensation Payment for a new condition

Under subsection 77(2) of the MRCA, if additional PI compensation is payable under subsection 71(1) of the MRCA for a single accepted condition, that compensation is payable from the later of:

• the date the claim for liability was lodged for the new condition; and
• the date that the delegate determines to be the date on which all of the following applied:
  • as a result of the new condition, the person suffers additional impairment; and
  • the additional impairment is likely to continue indefinitely; and
  • the increase in the person's overall impairment constitutes at least 5 impairment points (which includes aggravations under section 72); and
  • the new condition has stabilised.

5.7.2.1 Date additional compensation payable for more than one condition where person became entitled prior to 1 July 2013

If additional PI compensation is payable under section 71 of the MRCA for more than one accepted condition from a date prior to 1 July 2013, that compensation is payable from the later of:

• the date the most recent claim for liability was lodged for one of the new conditions; and
• the date that the delegate determines to be the date on which all of the following applied: 
  • as a result of the new conditions, the person suffers additional impairment; and
  • the additional impairment is likely to continue indefinitely; and
  •  the increase in the person’s overall impairment constitutes at least 5 impairment points (which includes aggravations under section 72); and
  • all of the new conditions have stabilised.

5.7.2.2 Date additional compensation payable for more than one condition where person became entitled on or after 1 July 2013

If additional PI compensation is payable under section 71 of the MRCA for more than one accepted condition and 5.7.2.1 does not apply because the date of effect is not earlier than 1 July 2013, the date that additional compensation is payable in respect of each of the conditions may vary.

In such cases the date of effect of the additional PI for each condition to which section 71(1) applies is the later of:

•  the date each condition was claimed; and
•  the date that the delegate determines to be the date on which all of the following applied: 
  • as a result of the new conditions, the person suffers additional impairment; and
  • the additional impairment is likely to continue indefinitely; and
  • the increase in the person’s overall impairment constitutes at least 5 impairment points (which includes aggravations under section 72); and
  • each of the additional conditions has stabilised.

Note that the requirement for the increase in the overall impairment to constitute at least 5 impairment points can be met by the combination of several conditions. However, that criterion is not met by an individual condition that of itself is under the additional 5 point threshold, until the date it meets the threshold when combined with another condition (which is also likely to continue indefinitely and has stabilised).

Example 1 Client is in payment under section 68 for a number of accepted conditions. The client then claims liability and PI for a new condition on 12 June 2013. On the date of the claim all of the criteria for payment of additional PI are met. Subsequently, on 5 July 2013, the client claims another condition. As for the first condition, all criteria for payment of compensation under section 71 are met on the date of the claim for liability. The two claims are determined together in August 2013.

5.7.2.1 does not apply as the date of effect for payment of additional PI for these two conditions would, under the former rules, be in July 2013. Therefore in this example there are two dates of effect. They are:

• the first condition is payable from 1 July 2013 (the earliest date possible because the separate date of effect rules only apply from 1 July 2013); and
• the second condition is payable from 5 July 2013.

Example 2 Client is in payment under section 68 for a number of accepted conditions. The client then claims liability and PI for a new condition on 13 August 2013. On the date of that claim all of the criteria for payment of additional PI under section 71 are met, except that the condition does not increase the whole person impairment by 5 impairment points. On 5 September 2013, the client claims liability and PI for another condition which is likely to continue indefinitely and is stable. All criteria are met on the date of the claim for liability and PI for the subsequent condition because the two conditions in combination increase the whole person impairment by more than 5 points. The two claims are determined together in October 2013.

The date of effect for the two conditions is 5 September 2013 because until combined with the subsequent condition, the condition claimed on 13 August 2013 did not meet the threshold required for payment of additional PI.

Example 3 Client is in payment under section 68 for a number of accepted conditions. Client claims liability and PI for an additional condition on 24 August 2013. On the date of the claim all of the criteria for payment of additional PI under section 71 are met. On 2 September 2013 the client claims a second additional condition which is not yet stable. However by the time the two conditions are determined in December the second condition has stabilised. The delegate determines that the second condition stabilised on 25 November 2013. The dates of effect for the two conditions are:

•  the first condition is payable from 24 August 2013; and
•  the second condition is payable from 25 November 2013