5.6.2 Additional PI Compensation Payment

Where a person who has already received a PI compensation lump sum or is receiving periodic PI compensation payments claims additional compensation under section 71 of the MRCA, the additional amount payable is calculated as follows:

• assess WPI which results from the person's accepted conditions using GARP M;
• ascertain the lifestyle effects of all conditions using Chapter 22 of GARP M;
• use Chapter 23 of GARP M to find the appropriate compensation factor for the combined impairment points and lifestyle rating;
• multiply the compensation factor by the current maximum MRCA periodic payment to calculate the gross weekly MRCA payment; and
• subtract from the gross weekly amount the weekly PI that the client is receiving or would be receiving if they had not converted their payment to a lump sum.

The remaining amount is the weekly amount of PI payable for the additional compensation.

Note that for “additional” compensation to be payable under section 71, the increase in the person's overall impairment rating from another service injury or disease (or the deterioration of an original condition) only needs to constitute 5 impairment points.  The same also applies to additional compensation for “aggravations” under section 72 of the MRCA.

Note also that where a person's existing MRCA compensation for a cause of action has been subject to recovery based on receipt of compensation from another source for that same cause of action, the impairment - and therefore the impairment points - attributable to that condition still exist and must be taken into account for any future payment of additional compensation.

Gold Card eligibility - 60 impairment points

Section 281 of the MRCA has the effect that a person determined to have suffered a degree of impairment of 60 or more points, is entitled to be provided with medical treatment for any injury or disease.  A person in this situation is provided a Gold Card for this purpose.  

Gold Card eligibility - 30 impairment points

Section 85(7A) of the VEA has the effect that a person receiving a service pension under Part III of the VEA and who is determined as suffering a permanent impairment under the MRCA of at least 30 points, is entitled to be provided with medical treatment for any injury or disease.  A person in this situation is provided a Gold Card for this purpose.

Gold Card eligibility - 50 impairment points and eligible for Special Rate Disability Pension

Section 282 of the MRCA has the effect that a person determined eligible for the Special Rate Disability Pension (SRDP), whether they elect to receive it or not, is entitled to be provided with medical treatment for any injury or disease, indefinitely. A person in this situation is provided a Gold Card for this purpose. Section 282 of the MRCA operates slightly differently to section 281 of the MRCA and section 85(7A) of the VEA, in that a person who later ceases to be eligible for the SRDP, whether on the basis of rehabilitation or increased working hours or other changes linked to eligibility, retains access to the Gold Card indefinitely. 

For further information, please visit Chapter 13.8 of the MRCA Policy Manual.

Maintaining Gold Card eligibility when additional PI is assessed

When a person is determined as suffering an impairment, the delegate is also required to determine whether the impairment is permanent and stable. 

For a person in one of the above circumstances who has previously been determined as being permanent and stable at or above the 30, 50 and 60 impairment point thresholds, it is appropriate to assume that the degree of impairment will remain at least at that level, irrespective of subsequent claims under section 71 of the MRCA. 

This applies so that a person who has become eligible for a Gold Card in one of the above circumstances, is not negatively impacted by the outcome of subsequent claims under section 71 of the MRCA and can continue to be provided medical treatment for any health condition indefinitely.

If in considering evidence to address a section 71 claim, the delegate discovers the degree of impairment is less than the 30, 50 or 60 impairment point thresholds for Gold Card eligibility, it is appropriate to leave the previous rating in place (i.e. carry through) as being the current degree of impairment for compensation and entitlement purposes.

In this situation, the delegate may determine that no further permanent impairment compensation is payable (as a result of not meeting the 5 point threshold increase under section 71), however eligibility for the Gold Card will remain.