You are here
5.2 Entitlement to Permanent Impairment Compensation
Under section 68 of MRCA, the Commonwealth is liable to pay PI compensation to a person if:
- liability has been accepted for one or more conditions;
- a claim for PI compensation has been lodged;
- as a result of the accepted condition(s), the person has suffered an impairment which constitutes a minimum number of IPs;
- the impairment is likely to continue indefinitely; and
- the condition has, or, if more than one condition has been accepted, all of the conditions have, stabilised.
More information on how a claim for PI compensation can be lodged can be found at Chapter 2.1.8.
Successive PI claims during an appeal period – section 322 ‘same matter’
Broadly speaking, the intention of section 322 is to prohibit the making of multiple simultaneous claims, but does not necessarily preclude a person from making subsequent claims.
A client can make a PI claim for any new or aggravated condition/s other than the condition/s subject to a current appeal, or that are within the 12 month appeal period;
A client is not able to make a subsequent PI claim which relates to the same condition/s that have been previously determined and are either under active appeal or within the appeal period.
Section 68 of the MRCA operates, and is supplemented by section 71, to provide permanent impairment compensation with reference to the ‘whole of person impairment’ as a result of the accepted service-related injuries or diseases. The Act expressly contemplates that a person’s permanent impairment compensation would be adjusted where there are subsequent conditions accepted by the Commission. Therefore the same matter provisions are not designed to prevent a subsequent claim for PI compensation in respect of conditions that were not the subject of the initial compensation claim.
A client recently had liability accepted for osteoarthritis of the right knee and lumbar spondylosis, and subsequently submits a claim for compensation for permanent impairment. While an assessment is still ongoing for these 2 conditions, the client’s liability claim for posttraumatic stress disorder is accepted and submits a further claim for permanent impairment for the condition.
The claimant can submit a claim for permanent impairment for the posttraumatic stress disorder. Where the Commission has accepted liability for the condition, it then forms part of the ‘compensable conditions’ in section 68 of the MRCA, and the permanent impairment of the claimant would then be assessed on the basis of all three conditions.
A client submits a claim for permanent impairment for two accepted conditions, general anxiety disorder and sensorineural hearing loss. An assessment is made and the client is found to have 40 impairment points.A month following this determination, the client submits a claim for a PI with respect of a new condition, bilateral osteoarthritis for which liability was accepted after the initial PI determination.
The client is not prevented under section 322(4) from submitting a claim for additional permanent impairment compensation, because once liability for the new condition is accepted by the Commission, it constitutes ‘one or more additional service injuries or diseases of the person’ for the purposes of section 71 of the MRCA. The ‘person’s overall impairment’would then be assessed on the basis of all three conditions, and the amount of compensation would added together with the permanent impairment compensation for the ‘original compensable conditions’, up to the maximum prescribed by section 74.
Practically, the impairment points found in the original determination (i.e. 40 points) should be added to the impairment points awarded with respect of the new condition following an assessment to find the degree of impairment resulting from that condition.
A client submits a claim for permanent impairment for their accepted conditions, general anxiety disorder and sensorineural hearing loss.An assessment is made and the client is found to have 40 impairment points. The client lodges an appeal with respect of the determination with the VRB. Two months later, liability is accepted for a new condition, bilateral osteoarthritis and the client submits a claim for a PI with respect of the condition.
As above, the client is not prevented from submitting a claim for permanent impairment compensation with respect of the new condition. Section 71(1) will apply and the additional impairment from the additional service injury or disease should be assessed and compensated where the person meets the 5 point impairment threshold.
A client recently had liability accepted for lumbar spondylosis, hearing loss and tinnitus and subsequently submits a claim for compensation for permanent impairment. The claim is finalised and the person is offered compensation under section 68 with respect of the conditions. Six months later the client submits a further claim for permanent impairment compensation for the accepted conditions, during this period the client has not had liability accepted for any other service-related conditions.
The claimant is not entitled to claim for additional permanent impairment for the three accepted conditions. The same matter provisions apply here and the client is still within the 12 month appeal period with respect of the section 68 determination. The client will only be entitled to claim for additional compensation if liability is accepted for a new condition, or after the appeal period expires.
A client submits a claim for permanent impairment for the accepted condition of major depressive disorder.An assessment is made, and it is found the condition is permanent but not yet stable, so interim compensation is offered on the basis of 30 impairment points. The client lodges an appeal with respect of the determination with the VRB. Six months later, liability is accepted for two new conditions, rotator cuff syndrome of the left shoulder and subacromial bursitis of the left shoulder. The client submits a new claim for a PI with respect of the left shoulder conditions.
The previous interim determination of compensation will not preclude the assessment of additional compensation payable to the client, and they can make a valid claim for permanent impairment compensation with respect of their two newly accepted conditions.
The original interim determination and impairment points with respect of the major depressive will remain and is a matter for the VRB to consider.
Practically, where there is a permanent impairment with respect of the left shoulder conditions, the impairment points found in the original interim determination (i.e. 30 points) should be added to the impairment points awarded for the new conditions. Where the degree of impairment constitutes a 5 point increase overall, the person will have met threshold and be entitled to additional compensation. The calculation of compensation payable will be based on the difference of impairment between the 30 points and the new overall impairment rating with the inclusion of the left shoulder conditions. The delegate will able to award the amount of compensation payable by way of a further section 75 determination.