5.8.1 Eligibility criteria for interim permanent impairment payments

For clients claiming PI for the first time with: 

• Posttraumatic Stress Disorder (PTSD), 

• Depressive disorder, 

• Anxiety disorder, 

• Substance use disorder, or 

• Alcohol use disorder 

And:

• who are engaged with, but have not yet completed, rehabilitative treatment, or 

• have completed rehabilitative treatment but the conditions are not yet stable

And:

• have a current level of impairment of 10 points or more under chapter 4 of GARP M, an interim permanent impairment payment must be offered based on a level of impairment at a minimum of 10 points.

In this situation, the delegate is considering the nature of the mental health condition as part of ‘any other relevant matters’ at subsection 73(d) of the MRCA, to determine that a permanent impairment will likely remain, even after rehabilitative treatment has been completed and the condition stabilises. 

Though the final degree of permanent impairment cannot be determined until all reasonable rehabilitative treatment is undertaken and the mental health condition(s) stabilises, inclusion of at least 10 points in the assessment for the mental health conditions ensures clients can receive interim financial recognition and compensation, while they engage in treatment to improve health and wellbeing outcomes and their conditions stabilise.

An interim permanent impairment payment can be offered at a higher degree of impairment if the medical evidence in the individual case supports it. The important matter for the delegate to consider, is what level of impairment is likely to continue indefinitely, following the client’s engagement with all reasonable rehabilitative treatment and allowing for the condition to stabilise.  

The interim 10 impairment point minimum assigned to the client’s PTSD, depressive disorder, anxiety disorder, substance use disorder or alcohol use disorder condition/s should be combined with points from any other conditions assessed.

If a client receives an interim payment, but the final degree of their impairment stabilises below the interim PI rating, the client’s final impairment point rating remains as previously determined. Any interim payment amount that is more than the client would have received as their final payment amount is not considered an overpayment and will not be recovered.

This policy should only be applied to clients who have not previously received MRCA PI compensation.

Example 1

In this case, because the PTSD condition is not yet stable and treatment is still being undertaken, a determination under section 68 is not possible. Interim compensation is instead determined under section 75 based on 20 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area). A review date is set for 6 months to assess the stability of the PTSD.

Example 2

In this case, because the PTSD condition is not yet stable and treatment is still being undertaken, a determination under section 68 is not possible. Interim compensation is instead determined under section 75 based on 10 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area). A review date is set for 6 months to assess the stability of the PTSD.

Example 3

In this case, because the PTSD condition is not yet stable and treatment is still being undertaken, an assessment under section 68 is not possible. Interim compensation is instead determined under section 75 based on 10 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area). A review date is set for 6 months to assess the stability of the PTSD.

If the PTSD condition does eventually improve to less than 10 points the interim PI payment amount is not considered an overpayment and is not recovered.

Example 4

In this case, because the PTSD is not yet stable, an assessment under section 68 is not possible. Interim compensation is instead determined under section 75 based on 10 impairment points. Although there is no evidence to suggest what the final level of impairment of the PTSD might be, because this condition is included in the policy applicable to clients with certain mental health conditions, the minimum impairment points assigned to the PTSD is 10. Interim compensation is determined based on 23 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area). A review date is set for 6 months to assess the stability of the depressive disorder.

Even though the client would have met the minimum points for interim payment required from the stable conditions, resulting in a permanent impairment, alone (hearing loss and thoracolumbar spine disc disruption), 10 points is still included in the calculation in recognition of the PTSD.