Assessment Of The Degree Of Permanent Impairment And Non-Economic Loss

This Desktop Ready Reference summarises the procedures for the assessment of the degree of permanent impairment resulting from an injury and non-economic loss resulting from an injury or impairment in terms of the Safety, Rehabilitation and Compensation Act 1988.  It is a summary only.  For further information refer to the Act, the relevant Legislation Information Paper and the 'Guide to the Assessment of the Degree of Permanent Impairment'.  Further assistance may be obtained from your supervisor or the Quality Assurance Group.

“impairment" means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function.

"non-economic loss” means loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware.

"permanent" means  likely to continue indefinitely.

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PROCEDURE

The claim:  A claim initiated by an employee should be made on the specific Comcare form.  Supporting medical evidence should be submitted with the claim.

If solicitors are acting on behalf of a claimant, ensure that Part C of the claim form is completed by the treating Doctor.

Where the claim is initiated by a decision maker or Rehabilitation Advisor, a claim form is not necessary because the screening criteria should have been met.  With the employee's concurrence, assessment may proceed.

Screening:  The screening ensures that only valid claims proceed to assessment.  Frivolous or premature claims are dealt with quickly without incurring the financial and resource costs involved in the final assessment process.

The decision maker should evaluate the claim, reports on file, rehabilitation assessments, etc. to determine whether assessment should proceed.  Issues for initial consideration include whether -

-rehabilitative treatment has been completed;

-the impairment is permanent and, if so, when - has the optimum level of recovery been reached;

-there is an impairment and, if so, whether the degree of that impairment will possibly satisfy the % threshold;

-the transitional provisions apply.

Date impairment became permanent: In determining whether an impairment is permanent regard shall be had to -

-the duration of the impairment:

-the likelihood of improvement in the condition;

-whether all responsible rehabilitative treatment for the impairment has been undertaken; and

-any other relevant matter.

An impairment will be regarded as permanent when the recovery process has been completed, that is, when the full and final effects of convalescence, the natural healing process and active (as opposed to palliative) medical treatment have been achieved.

If the impairment became permanent prior to 1 December 1988, entitlement is assessed under the 1972 Act.

If the injury was sustained before 1 December 1988, use the following table:

Establishing when the impairment became permanent will therefore be crucial in the determination of claims for permanent impairment resulting from injuries sustained prior to 1 December 1988.

If the injury was sustained on or after 1 December 1988, entitlement is assessed under 24 of the SRC Act.

Outcome of screening:  The following possible courses of action will emerge as a result of the screening process:

-defer assessment - no evidence of impairment at this stage;

-defer assessment - rehabilitation incomplete;

-defer assessment - impairment not permanent (interim assessment inappropriate);

-apply transitional provisions ie assess under 1972 Act (s. 39) or disallow because impairment became permanent before 1 December 1988 and

was not of a kind listed in sections 39 to 42;

-proceed to assess entitlement under section 24 to 25 (based on the available evidence or upon the collection of further evidence from the treating

doctor or an independent specialist) - prima facie, claim has been established.

Interim determination:  An interim determination of the degree of permanent impairment shall be made where -

-it is determined that an employee is suffering from a permanent impairment as a result of an injury;

-it is assessed that the degree of impairment is 10 % or more but a final determination has not been made; and

-a written request is received from the employee before the final determination is made.

If, on the evidence, the decision maker is satisfied that an interim award should be made, the following steps should be taken:

-Calculate entitlement under Part A of Guide.

-Determine degree of impairment.

-Write to claimant.

-If claimant makes a written request for interim award - determine and provide claimant with reasons.

-Set review date and re-submit file.  The review date is based on the advice received from the specialist.

-Arrange payment within 30 days.

Such interim amount of compensation is then deducted from any final payment.  When a final assessment is made, no further amount of compensation is payable unless the increase in the degree of impairment is 10% or more.

Referral to independent specialist:  When a bona fide claim has been established, assessment of the entitlement can proceed either based on the available evidence or upon the collection of further evidence from the treating doctor or  an independent specialist.

If it is decided that the claim should be assessed by a specialist, the following steps should be taken:

-Identify appropriate speciality(ies) and appropriate Guide Table(s).

-Arrange appointments directly with the specialist.

-Advise the claimant of the specialist appointment and appointment with Comcare for interview to complete the NEL Questionnaire.  Interview

with Comcare must precede specialist examination.

-Interview claimant or have an independent specialist do so - complete NEL Questionnaire.

-Prepare the case summary for the independent specialist.

-Refer the case to the specialist(s) - include copies of relevant Guide Tables and extracts from the Guide.

Evaluation of specialist report:  The specialist report should be examined to ensure that it is complete and provides a sound basis for deciding the claim for permanent impairment.  If clarification is needed this should be sought immediately - preferably through discussion with the specialist or, if necessary, independent medical advice, such as from the Australian Government Health Service.

Determination:  A determination is made as to the degree, expressed as a percentage, of permanent impairment of the employee resulting from the injury under the provisions of the approved Guide.  The amount of compensation is the same percentage of the maximum amount as the percentage assessed to be the degree of permanent impairment.

If, after evaluation, the decision maker is satisfied that the available evidence provides a firm basis for final determination of entitlement to a permanent impairment payment, calculate entitlement as set out on Score Sheet in the Guide in the case of a single impairment and the Combined Value Charts  where there is more than one impairment.  Assess the degree of the Non-Economic Loss using the Score Sheet in the Guide (an Excel version of which is easily accessed in Key to Quality under the heading '1988 PI Calculation' in the 'Permanent Impairment Guide' folder).  Reasons for assessment are to be recorded on the sheet.

Summary of possible actions after medical assessment

Advice to Claimant:  An initial advice should be sent to the claimant with a copies of the documents considered in the determination.

If the claimant elects to receive compensation under the SRC Act, payment of the lump sum amount is arranged.  If the claimant elects to initiate common law action, compensation is not payable under section 24, 25 or 27 in respect of the injury.  The election is irrevocable.

Payment:  Payment should be arranged concurrently with the section 27 award (ie a single cheque).  The payment is then processed on PRACSYS.

PROCEDURE FOR ASSESSMENT OF HEARING LOSS

Refer to the LIP for a full explanation of the procedure for assessment of hearing loss, including the streamlined approach to decision making.

Maximum benefits payable under sections 24 and 27

The maximum amounts to be used in the calculation of an entitlement are the amounts applicable as at the date of the assessment.