DEFENCE COMPENSATION ADVICE - NO 13
">Commonwealth Employees Rehabilitation And Compensation Act 1988
">ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT AND NON-ECONOMIC LOSS
">1. Further to Defence Compensation Advice No 10, enclosed are copies of:
a). Non-Economic Loss (NEL) Questionnaire
b). Non-Economic Loss Point Score System - $ Value
c). Guide to the Assessment to the Degree of Permanent Impairment and Non-Economic Loss Scoresheet
d). Calculation Sheet
e). Extracts of the guide to the assessment of the degree of permanent impairment.
2. As there are insufficient Guides to be provided to all specialists, I recommend that specialists be provided with a copy of the extract of the Guide which includes:
a). Principles of Assessment;
b). Glossary; and
c). Relevant Table(s).
3. Should you have any further queries concerning this matter, contact Mr Paul Ontong on 062-668639.
D.J. WHITEHEAD
DOHC
October 1989.
">Impairment and Non-Economic Loss
Impairment means "the loss, loss of use, damage or malfunction, of any part of the body, bodily system or function or part of such system or function". It relates to the health status of an individual and includes anatomical loss, anatomical abnormality, physiological abnormality and psychological abnormality, Throughout this guide emphasis is given to loss function as a basis of assessment of impairment and as far as possible objective criteria have been used.
Impairment is measured against its effect on personal efficiency in the `activities of daily living' in comparison with a normal healthy person. The measure of `activities of daily living' is a measure of primary biological and psychosocial function such as standing, moving, feeding and self care.
Non-economic loss, which is assessed in accordance with Part B of the Guide, is a subjective concept of the effects of the impairment on the employee's life. It includes pain and suffering, loss of amenities of life, loss of expectation of life and any other real inconveniences caused by the impairment.
Whilst `activities of daily living' are used to assess impairment they should not be confused with `lifestyle effects' which are used to assess non-economic loss. `Lifestyle effects' are a measure of an individual's mobility and enjoyment of, and participation in, recreation, leisure activities and social relationships. It is emphasised that the employee must be aware of the losses suffered. While employees may have equal ratings of impairment it would not be unusual for them to receive different ratings for non-economic loss because of their different lifestyles.
Employability and Incapacity
The concepts of `employability ' and `incapacity' are not included in the assessment of impairment and non-economic loss. Incapacity is influenced by factors other than the degree of impairment and is compensated by weekly payments which are in addition to these payments.
Permanent
Permanent means "likely to continue indefinitely". In determining whether an impairment is permanent regard shall be had to:
- the duration of the impairment
- the likelihood of improvement in the employee's condition
- whether the employee has undertaken all reasonable rehabilitative treatment for the impairment; and
- any other relevant matters
An impairment will generally be regarded as permanent when the recovery process has been completed, i.e. when the full and final effects of convalescence, the natural healing process and active (as opposed to palliative) medical treatment has been achieved.
The Impairment Tables
Part A of the Guide is based on the concept of `whole person impairment' which is drawn from the American Medical Association's Guides.
Evaluation of a whole person impairment is a medical appraisal of the nature and extent of the effect of an injury or disease on a person's functional capacity and activities of daily living.
As with the American Medical Association's Guides, Part A of this guide is structured by assembling detailed descriptions of impairments into groups according to body system and expressing the extent of each impairment as a percentage value of the functional capacity of a normal healthy person. Thus a percentage value can be assigned to an employee's impairment by reference to the relevant description in this guide.
Gradations of Impairment
Each table contains impairment values at gradations of 5% or multiples of five percent. Where it is not clear which of two impairment values is more appropriate, Comcare has the discretion to determine which value properly reflects the degree of impairment.
There is no discretion to choose an impairment value not specified in the Guide. For example, where 10% and 20% are specified values there is no discretion to determine impairment as 15%.
Aggravation
An assessment should not be made unless the effects of an aggravation are considered permanent. If the employee's impairment is entirely attributable to a pre-existing or underlying condition, or to the natural progressing of such a condition the assessment for permanent impairment should be nil.
Where it is possible to isolate the compensable effects of an injury upon pre-existing or underlying condition the assessment of the degree of permanent impairment should reflect only the impairment due to those compensable effects.
GLOSSARY
Activities of Daily Living:
Activities of daily living are activities which an individual needs to perform to function in a nonspecific environment i.e. to live. The measure of activities of daily living is a measure of primary biological and psychosocial function. They are;
Ability to receive and respond to incoming stimuli
Standing
Moving
Feeding (includes eating but not the preparation of food)
Control of bladder and bowel
Self care (bathing dressing etc)
Sexual function
Ailment:
means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden or gradual development).
Disease:
means
(a). any ailment suffered by an employee; or
(b). the aggravation of any such ailment; being an ailment or an aggravation that was contributed to in a material degree by the employee's employment by the Commonwealth.
Impairment:
means the loss, the loss of the use, or the damage or malfunction, of any bodily system or function or part of such system or function.
Injury:
means
(a). a disease suffered by an employee; or
(b). an injury (other than a disease) suffered by an employee, being a physical or mental injury (or the aggravation of such an injury) arising out of, or in the course of, the employee's employment;
but does not include any such disease or injury suffered by an employee as a result of reasonable disciplinary action taken against the employee to obtain a promotion, transfer or benefit in connection with his or her employment.
Loss of Amenities:
means the effects on mobility, social relationships and recreation and leisure activities.
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) of which the employee is aware.
Pain and Suffering:
includes physical pain as well as mental distress resulting from the accepted conditions or impairment. For example, grief, anguish, fear, frustration, humiliation, embarrassment etc.
Whole Person Impairment
means the medical effects of an injury or a disease and is drawn from the American Medical Association Guides where it is there referred to as `whole man' impairment. Evaluation of whole person impairment is a medical appraisal of the nature and extent of the effect of an injury or disease on a person's functional capacity and on the activities of daily living. The Guides are structured by assembling detailed descriptions of impairments into groups according to body system and expressing the extent of each impairment as a percentage value of the functional capacity of a normal healthy person. Thus a percentage value can be assigned to an employee's impairment by reference to the relevant description in this Guide.
NON - ECONOMIC LOSS
POINT SCORE SYSTEM - $ VALUES
Table 1: Pain and suffering
|
Pain |
1 point = $538 |
|
Suffering |
1 point = $538 |
Table 2: Loss of amenities
|
Mobility |
1 point = $646 |
|
Social relationships |
1 point = $646 |
|
Recreation/leisure |
1 point = $646 |
Table 3: Other loss
|
Other loss |
1 point = $1076 |
Table 4: Loss of expectation of life
|
1 point = $1076 |
FORM 6.3: GUIDE TO THE ASSESSMENT OF THE DEGREE OF PERMANENT
IMPAIRMENT AND NON ECONOMIC LOSS SCORESHEET
Claimant's full name: Date of birth:
File ref: Accepted conditions:
SECTION 1 - NON-ECONOMIC LOSS (PART B OF GUIDE)
(SCORES TO BE CIRCLED)
PART 1: PAIN AND SUFFERING
A. Pain
SCORE:
0. No pain experienced
1. Intermittent attacks of pain of nuisance value only. Can be ignored when activity commences
2. Intermittent attacks of pain. Not easily tolerated, but short lived. Responding fairly readily to treatment
3. Episodes of pain more persistent. Not easily tolerated. Treatment, if available, of limited benefit
4. Pain occurring most of the time. Restrictions on activity. Resistant to treatment
5. Pain continuous and severe. Preventing activity. Uncontrolled by medication
REASON:
B. Suffering
SCORE:
0. No symptoms experienced
1. Symptoms minimal or ill defined. Occur intermittently. No interference with activity
2. Distinct symptoms. Episodic in nature. Activities reduced during such episodes. Recovers quickly after episodes
3. Symptoms distinct and varied. Episodes occur regularly. Ability to cope or perform activity effectively reduced during episodes. Needs time to recover between episodes. Treatment of benefit
4. Symptoms wide ranging. Tent to dominate thinking. Little time when free of symptoms. Difficulty coping or performing activity. Treatment necessary
5. Constantly focused on condition. Ruled by emotions. Symptoms predominate over thinking. Unable to cope. Activities severely restricted. Treatment no real help
REASON:
PART 2: LOSS OF AMENITIES
A. Mobility
SCORE:
0. No or minimal restrictions on mobility
1. Effects on mobility periodic or intermittent - in between episodes no restrictions. Effects continuing but mild (e.g. slowing of pace, need for a walking stick) (can do everything, but at a slower pace)
2. Mobility reduced, but remains independent of others both within and outside the home. Can travel but may need to have breaks, special seating etc
3. Mobility markedly reduced. Needs some assistance from others. Unable to use most forms of transport
4. Restricted to home and vicinity. Can only travel with door to door transport. Needs assistance of others
5. Severely restricted mobility (e.g. bed, chair, room). Dependent on others for assistance. Mechanical devices or appliances used (e.g. wheelchair, hoist)
REASONS:
B. Social Relationships
SCORE:
0. Usual relationships unaffected
1. Minor interference with personal relationships, causing some reduction in social activities and contacts
2. Relationships confined to immediate and extended family and close friends, but unable to relate to casual acquaintances
3. Difficulty in maintaining relationships with close friends and the extended family
4. Social contacts confined to the immediate family
5. Difficulties relating socially to anyone
REASONS:
C. Recreation and Leisure Activities
SCORE
0. Able to follow usual recreation and leisure activities
1. Intermittent interferences with activities. In between episodes able to pursue usual activities
2. Interference to activities reduces frequency of activity, but is able to continue. Is able to enjoy alternatives
3. Unable to continue activity. Alternative less rewarding activity possible
4. Range of activities greatly reduced. Needs some assistance to participate
5. Unable to undertake any satisfying or rewarding activities
REASONS:
D. Other Loss
SCORE
0. Nil or minimal disadvantages
1. Sight disadvantages
2. Moderate disadvantages
3. Marked disadvantages
REASONS:
E. Loss of Expectation of Life
SCORE
0. Loss of life expectancy of less than 1 year
1. Loss of life expectancy of 1 year to less than 10 years
2. Loss of life expectancy of 10 years to less than 20 years
3. Loss of life expectancy of 20 years or greater
SECTION 2 - FINAL CALCULATION USING TABLE 6 OF THE GUIDE
(Parts A and B of Guide)
1. Whole person impairment
Where only one impairment is assessed: % x 86160 = $
2. Whole person impairment
|
Where more than one impairment is |
Impairment A |
% |
|
assessed-refer combined values chart |
Impairment B |
% |
|
Impairment C |
% |
Combined impairment = % x 86160 = $
3. Non-economic Loss - Part A
the percentage applied is that
established under 1 or 2 % x 16155 = $
4. Non-economic Loss - Part B
Table 1 - Pain and Suffering scores
Pain
Suffering
Sub-total x 0.5 =
Table 2 - Amenities of Life scores
Mobility
Social Relationships
Recreation and Leisure Activities
Sub-total x 0.6 =
Table 3 - Other Loss score
Other Loss x 1.0 =
Table 4 - Loss of Expectation of Life
Loss of Expectation score x 1.0 =
Total of Non-economic Loss scores
If score > 15: pay maximum $16,155.00
If score > 15: calculate % of $16,155.00
using following formula:
(total of scores) x 100 = % of $16,155.00 = $
15
Part B NEL Payment $
5. TOTAL PAYABLE (1 or 2 plus 3 and 4) $