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 by any amount (i.e. there is no minimum threshold to be met in these circumstances), the ongoing periodic payment to the claimant is increased by the difference between the two.

Where the available medical evidence indicates that the final level of impairment is not more than the previously assessed interim rating (i.e. in circumstances where the client's impairment has improved beyond the estimated level), it would appropriate to consider the existing interim rating as the final rating to enable the case to be finalised. This would be the continuing level of impairment for compensation purposes (i.e. reassessment thresholds would need to be met above the higher rating in accordance with s71).

If the final rating is below the interim rating, it will not be appropriate to consider a higher lifestyle rating as it can be argued that the lifestyle effects have already been compensated at the level determined as part of the previous interim assessment. In these scenarios, stability can be confirmed and the determination can indicate (where applicable) that no further compensation is payable. The claim can be considered finalised for the purposes of s75(4). 

When an interim payment has been made as a lump sum, the amount of PI payable is calculated by converting the lump sum 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.

It is not uncommon for the finalisation of an interim claim under section 75(4) to coincide with the assessment of additional compensation for impairment under s71. Where this happens the outcome should be one of a total combined whole person impairment as this is the most beneficial outcome for the client. If the s71 condition/s meet the 5 point threshold then the date of effect will be the same as in other s71 circumstances. If the s71 conditions do not meet the 5 point threshold, they are instead included as part of the s75(4) finalisation. The date of effect for these cases will be the date all of the conditions contributing to the WPI have stabilised.

Example

An interim claim initially determined under section 75 with a total WPI rating of 25 points for a combination of hearing loss and lumbar spondylosis is being finalised. The overall final WPI rating for these two conditions is now 28 points. At the same time, impairment for a new service injury of right knee osteoarthritis has been assessed at 10 points. The date of effect for the increase from 25 to 28 points for the finalisation of the interim conditions is the date both the hearing loss and lumbar spondylosis are considered stable. The date of effect for the additional 10 points for the new condition is the latter of the date of the IL claim for the osteoarthritis or the date the osteoarthritis became permanent and stable.

However, if the WPI rating of the new condition of right knee osteoarthritis did not meet the increase of 5 impairment points on its own, the points would be added to the overall WPI total along with the finalisation of the interim conditions, with an effective date when all of the person’s service injuries or diseases have 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 constituted 10 IPs (or 5 for those conditions that require a lower threshold);
  • where 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

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.

Example

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.