The following examples provide guidance on how to apply the policy when assessing claims for NEL, in particular where the claimant has suffered multiple injuries, each of which will need to be assessed separately.
Example 1
Multiple injuries – similar injuries with different lifestyle effects
A veteran previously received compensation for permanent impairment and NEL in relation to their left knee injury. The NEL rating in the ‘B’ amount assessment, specifically for recreation and leisure activities attracted a rating of three because they were unable to continue playing golf.
Some years later, the veteran lodges a second claim for permanent impairment in relation a right knee injury. In the assessment, the employee is again entitled to NEL compensation and in the questionnaire when noting down the effects on their ‘recreational and leisure activities’ put down a further score of three.
While a veteran can receive NEL scores in the ‘B’ amount for multiple injuries which exceeds a score of five in total, they may want to distinguish the NEL scores for that category for the new right knee injury are distinct from the causes of NEL in respect of the left knee injury.
A review of the evidence provided by the veteran and their treating medical practitioner demonstrated that the injury to the right knee meant the veteran was no longer able to continue playing the drums. In this case, the delegate has been able to examine the evidence and ensure the NEL score for this claim only took into account the lifestyle effects that resulted from the injury to their right knee (a score of three) and did not include any pre-existing lifestyle effects of the veteran’s left knee injury on their ability to pursue/maintain recreational and leisure pursuits.
Example 2
Multiple injuries – similar injuries with same lifestyle effects
A veteran previously received permanent impairment and NEL compensation in relation to their left knee injury. The NEL rating in the ‘B’ amount assessment, specifically for recreation and leisure activities attracted a rating of three because they were unable to continue playing golf.
Some years later, the veteran lodges a second claim for permanent impairment in relation to a right knee injury. In the assessment, the employee is again entitled to NEL compensation and in the questionnaire when noting down the effects on their ‘recreational and leisure activities’ put down a further score of three. The evidence provided by the client states that the injury to the right knee has contributed to their inability to play golf.
In this case, the delegate examined the evidence and identified that the claimant’s self-assessed NEL score for the right knee includes pre-existing lifestyle effects that arose from the claimant’s left knee injury on their ability to pursue/maintain recreational and leisure pursuits. The delegate must make a separate determination as to the effect of the right knee injury, which should not take into account the lifestyle effects that arose from the previous left knee injury. In these circumstances, the delegate should ask the veteran to clarify whether the right knee injury discretely affects other recreation and leisure activities, i.e. other than golf, that would support a score of 3 in respect of this new injury.
Example 3
Multiple injuries – different injuries with different lifestyle effects
A veteran has previously been found eligible to receive permanent impairment and NEL compensation in relation to a knee injury. The NEL rating for this injury in relation to recreation and leisure attracted a rating of three due to an inability to continue playing netball and compete in athletics. At that time, netball and athletics were considered by the veteran as significantly satisfying and rewarding activities, and alternative activities were not considered or required by the veteran as a result.
A year later, the veteran was found eligible to receive permanent impairment and NEL compensation in relation to their wrist injury. In the assessment of NEL, the veteran completes the questionnaire and answers in relation to ‘recreational and leisure activities’ a score of three. In the intervening time between the veteran suffering the knee injury and the wrist injury, the veteran modified their recreational pursuits as a result of the knee injury, and took up guitar lessons and art classes, which is now significantly impacting upon by the wrist injury.
The delegate may be concerned that the person’s two NEL claims exceed the maximum score of five in relation to ‘recreation and leisure’, and, that both the ‘three’ scores refer to the veteran being unable to undertake any alternative satisfying or rewarding activities, however a score of three for each separate injury is possible, so long as the evidence supports each score being given in relation to each injury. The delegate undertakes further review of the evidence to consider if the rating of three for the wrist injury is reasonable, and accepts the second claim and NEL score as it is attributed to their inability to play guitar and continue art classes. There is a clear difference and justification for the loss of lifestyle effect suffered as a result of the wrist injury, which has not been considered in respect of the knee injury.
Example 4
Multiple injuries – different injuries with same lifestyle effects
A veteran has previously been found eligible to receive permanent impairment and NEL compensation in relation to their accepted right leg above knee amputation. The NEL rating for this injury in relation to mobility attracted a rating of four due to the veteran not being able to be fitted with a prosthesis, not being able to drive and being confined to a wheelchair.
The veteran makes a second claim for osteoarthritis of the right hip. In the assessment of NEL, the veteran completes the questionnaire and answers in relation to mobility a score of three with supporting comments that the veteran is unable to drive.
In this case, the delegate may be concerned that there is insufficient evidence to confirm how the osteoarthritis of the right hip causes an effect on the veteran’s inability to drive and therefore a score of 3 for mobility. As such, the delegate should conduct further investigations and contact the veteran for additional information to support a score of three for mobility before making a determination in relation to the score. The focus in this scenario should be on the specific lifestyle effect of the osteoarthritis of the right hip condition on the veteran’s mobility. After conducting further investigations, the delegate is able to confirm the osteoarthritis of the right hip limits the veteran’s ability to be a passenger in a vehicle and use most forms of public transport, and therefore is able to determine a score of three for mobility.
Example 5
Multiple injuries – different injuries with different lifestyle effects
A veteran has previously been found eligible to receive permanent impairment and NEL compensation in relation to a lower back injury. The NEL payment included compensation for the effects on ‘mobility’ and the rating received was two.
The veteran makes a subsequent claim for permanent impairment and NEL compensation in relation to their vision impairment. In completing the NEL questionnaire, the client gives a rating of three for this injury in relation to mobility due to their inability to use most forms of transport and requiring assistance from others when moving around.
The delegate may be concerned that the veteran’s two NEL claims have high scores for ‘mobility’ and possibly the veteran was already compensated for the loss to their mobility in the first claim. By examining all the evidence the delegate is able to be reasonably satisfied that the score of three for the new injury should be awarded. In this case the delegate observed that the NEL score for the back injury regarding mobility was attributable to the veteran’s physical restriction with walking which often required rest breaks when moving around their environment, however, the eye condition (resulting in vision impairment) gave rise to different impacts on the claimant’s mobility that, in themselves, gave rise to a score of 3 in relation to mobility.