Date amended:
Current RMA Instruments
Reasonable Hypothesis SOP

15 of 2024

Balance of Probabilities SOP

16 of 2024

Changes from previous Instruments

ICD Coding
  • ICD-10-AM Codes: S00, S01, S05, S10, S11, S20, S21, S30, S31, S40, S41, S50, S51, S60, S61, S70, S71, S80, S81, S90, S91
  • (other codes may apply for deeper injuruies)
Brief description

The cut, stab, abrasion and laceration SOPs covers injuries that penetrate or abrade the skin (or surface of the eye), including injuries that extend through the skin and involve deeper structures, but not including bruises and burns.  Before applying this SOP, consider whether, in someone with multiple traumatic injuries, there is another injury-related SOP that better fits the claim or that should also be applied.  Whether more than one SOP should be applied for a multiple injury scenario from one incident will depend on the circumstances of the case.  Seek medical advice if in doubt.

The names of this SOP should not be used as a diagnostic label for claims.  The diagnostic label should be changed to one (or more) that accurately describes the relevant injury or injuries.

Confirming the diagnosis

The diagnosis can be confirmed based on a record of injury or report from a medical practitioner.  Specialist opinion is not required.

Other SOPs that may be relevant when dealing with acute traumatic injury causing a cut, stab, abrasion or laceration
  • Concussion
  • Moderate to severe traumatic brain injury
  • Fracture
  • External bruise
  • External burn
  • Explosive blast injury
  • Friction burns 
  • Gunshot injury
Conditions not covered by cut, stab, abrasion and laceration SOP
  • external bruise *
  • external burn *
  • "lacerations" of internal organs from non-skin-penetrating injuries*# - explosive blast injury SOP may apply
  • wounds caused by gunshot, missile, or explosive device or fragment thereof* - gunshot injury or explosive blast injury SOP

* another SOP applies

 # non-SOP condition

Clinical onset

Clinical onset will be at the time of the relevant injury.

Clinical worsening

The SOPs have only an inability to obtain appropriate clinical management factor for clinical worsening.  Lack of appropriate treatment at the time of or shortly after a (non-service-related) injury could result in worsening, including death.