5.6 Calculating Amount of PI Compensation Payable
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Last amended: 14 February 2011
5.6.1 Initial Permanent Impairment Compensation Payment
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Where a person receives an initial PI compensation payment under section 68 of the MRCA [3], the amount payable is calculated as follows:
- assess WPI which results from the person's accepted conditions using GARP M;
- ascertain the lifestyle effects of all accepted conditions using Chapter 22 of GARP M;
- use Chapter 23 of GARP M to find the appropriate compensation factor for the combined impairment points and lifestyle rating; and
- multiply the compensation factor by the current maximum MRCA periodic payment to calculate the gross weekly MRCA payment.
Note that section 69 of the MRCA requires that initial payment of PI compensation under section 68 can only be made when the impairment suffered by the person constitutes at least 10 impairment points (except in cases where the impairment relates to a loss of hearing, the loss, or the loss of the use of a finger or toe, or the loss of the sense of taste or smell, in which case it is 5 impairment points). The same also applies to compensation for “aggravations” under section 70 of the MRCA.
5.6.2 Additional PI Compensation Payment
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Where a person who has already received a PI compensation lump sum or is receiving periodic PI compensation payments claims additional compensation under section 71 of the MRCA [3], the additional amount payable is calculated as follows:
- assess WPI which results from the person's accepted conditions using GARP M;
- ascertain the lifestyle effects of all conditions using Chapter 22 of GARP M;
- use Chapter 23 of GARP M to find the appropriate compensation factor for the combined impairment points and lifestyle rating;
- multiply the compensation factor by the current maximum MRCA periodic payment to calculate the gross weekly MRCA payment; and
- subtract from the gross weekly amount the weekly PI that the client is receiving or would be receiving if they had not converted their payment to a lump sum.
The remaining amount is the weekly amount of PI payable for the additional compensation.
Note that for “additional” compensation to be payable under section 71, the increase in the person's overall impairment rating from another service injury or disease (or the deterioration of an original condition) only needs to constitute 5 impairment points. The same also applies to additional compensation for “aggravations” under section 72 of the MRCA.
Note also that where a person's existing MRCA compensation for a cause of action has been subject to recovery based on receipt of compensation from another source for that same cause of action, the impairment - and therefore the impairment points - attributable to that condition still exist and must be taken into account for any future payment of additional compensation.
Gold Card eligibility where an impairment rating drops below 60 points
Section 281 of the MRCA states that a person is entitled to a Gold Card when assessed at 60 or more impairment points and where the impairment continues to constitute 60 or more impairment points.
When a person is reassessed under s71 and the reassessment results in a level of impairment falling below 60 points, it would be appropriate to consider the previous rating as being the continuing level of impairment for compensation and entitlement purpsoses. This will mean that the existing points can be assigned (allowing the Gold Card eligibility to remain unchanged) and the claim disallowed on the basis that there has not been an increase of 5 points.
5.6.3. Age of medical evidence
Ultimately, the currency of a piece of medical evidence is entirely dependent on context. There is no set policy rule about how current a piece of evidence must be in order to be utilised for assessment purposes. Instead, the delegate must use their discretion, and, where necessary, liaise with the client and medical professionals to determine whether a piece of medical evidence is appropriate for the case.
First and foremost, where these is a question around the currency of the evidence, as delegates we should be consulting with the clients around whether the client themselves is happy for the evidence in question to be used. A piece of evidence that is many years old may still form a picture of the client’s impairment that the client accepts.
An important question to ask in these cases is the following: Does the evidence in question allow you to be reasonably satisfied that the legislative and policy criteria have been met and that the evidence is appropriate for the client at this point in time?
Another rule of thumb: if there is a PI determination that a condition is permanent and stable at a particular level, and there is no other requirement to reassess the condition (ie for GARP apportionment purposes), the evidence is probably indefinitely useable.
Similarly, if the indication is that the report was only valid at a specific point in time, the evidence is potentially not useable.
5.6.4 Reassessment of Tinnitus
Where a person, before the introduction of the policy requiring the use of objective testing (i.e. the TFI or similar), already attained an impairment rating of 15 points for tinnitus (being the maximum points available under GARP), the Department’s approach is that no further testing or investigation is necessary.
A similar principle applies where a person, before the introduction of the policy requiring the use of objective testing, was rated at 5 or 10 points. Where the veteran subsequently requests a reassessment for MRCA PI purposes, then the condition is subject to a reassessment, and the Department should use the current testing guidelines to re-examine the condition.
If, upon reassessment, the evidence indicates the veteran’s impairment would be assessed under the TFI or similar below the level at which they were previously determined, the Department’s approach is that the rating for tinnitus should remain at the existing level and not reduced.
This non-reduction approach is to acknowledge that tinnitus was deemed permanent and stable on the evidence at the previously assessed level based on the policy around tinnitus assessments in force at the time. Due to the nature of tinnitus, a veteran’s perception and reaction to tinnitus may fluctuate, but it can never be eliminated.
In summary, if upon reassessment the delegate finds the impairment has fallen below the previous rating, the Department should use the previous rating and not reduce the rating.
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/19376%23comment-form
[2] https://clik.dva.gov.au/user/login?destination=comment/reply/19368%23comment-form
[3] http://www.comlaw.gov.au/Series/C2004A01285
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/19373%23comment-form