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4.3.2 Criteria for making an interim assessment
4.3.2 Criteria for making an interim assessment
The veteran suffers from a permanent impairment as a result of an injury
An interim payment of compensation may be payable in cases where a veteran’s impairment is permanent, but the final degree of impairment is not yet known. This may be due to the veteran undergoing active medical treatment and/or the natural healing process of the injury or disease, and is commonly referred to as the ‘stable’ status of the injury or disease.
Whether an impairment is stable is a separate issue to whether an impairment is permanent. For interim compensation to be payable under section 25, the impairment must still be permanent but is not required to be stable.
When assessing whether an injury or disease suffered by a veteran results in a permanent impairment for the purposes of determining the amount of compensation payable under section 24 of the DRCA, there are a number of important matters for the decision maker to consider, including whether the impairment is permanent.
Under DRCA, the term permanent is defined as ‘likely to continue indefinitely’.
In accordance with subsection 24(2) of the DRCA, determining whether an impairment is permanent requires an evaluation of the following key issues:
- 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.
This means that when deciding whether an impairment is likely to continue indefinitely (i.e. permanent), a consideration is made to whether the impairment is likely to improve or cease (i.e. stable). Stable simply means ‘it is unlikely to improve to any major degree,’ and relates to the evaluation of points two and three set out above. Therefore, when deciding whether an impairment is stable, a decision maker must consider whether reasonable medical and rehabilitative treatment may alter the degree of impairment.
When it is determined the veteran has not undergone all reasonable medical treatment and there is a likelihood the impairment will improve, it may not be possible to determine the final degree of impairment and an interim assessment may be more appropriate.
For more detail about the four key issues when considering permanence, see Chapters 3.3.3 to 3.3.8 of the DRCA PI Policy Manual.
The impairment is not stable and a final determination is not appropriate
Interim permanent impairment compensation may be payable where a person’s impairment is not yet stable because they are still undertaking active treatment which may improve the degree of impairment, and on this basis the level of impairment cannot be determined for the purpose of making final determination of permanent impairment compensation.
Under no circumstances should an interim payment be made on the basis of an expected future deterioration or increase in the degree of impairment. Many permanent impairments gradually and naturally deteriorate over time, and this gradual deterioration doesn’t mean the impairment is not stable.
As noted above, the provisions under section 25 and the payment of interim permanent impairment compensation ensure that veterans undergoing rehabilitative treatment and waiting for their impairment to stabilise can still access an amount of compensation.
However, when the ultimate outcome of the medical intervention is known, usually when the medical practitioner is able to determine the resulting impairment rating after the recovery process and active medical treatment is completed, then it may be more appropriate to make a final determination of permanent impairment compensation under section 24.
The impairment is expected to stabilise at 10% WPI or more
Section 24(7) of the DRCA provides that interim compensation is not payable where the Commission determines the final degree of impairment is less than 10% whole person impairment. This means that the delegate should be satisfied that there is no reasonable possibility of improvements that would result in the degree of permanent impairment subsequently decreasing below 10% due to active medical treatment.
Ultimately, if the medical evidence confirms the impairment is permanent, but not yet stable, and the final degree of impairment will not decrease below 10% (however the final outcome or impairment rating is not known) then it is appropriate for the delegate to determine an interim compensation payment.
If the medical evidence confirms however that the final impairment rating is likely to decrease below 10%, then Section 24(7) provides that compensation is not payable.
For further information about contacting clients notifying them of the outcome of their claim, including when making negative decisions, refer to the Communication Procedures in the Military Compensation Reference Library.