Permanent impairment entitlements: know the tricks, know your rights

Process for impairment benefits

Getting through a permanent impairment assessment in Victoria is not as straight forward as many injured workers may think. There are – unfortunately – many dirty tactics routinely used by so called “independent assessors” (and of course the hand that feeds them, namely the workcover insurance) used to deliberately downgrade your permanent injuries, all in the name of insurance profits (minimising your payout/legitimate compensation).

Permanent impairment entitlements: know the tricks, know your rights

Stabilisation of injuries

The assessment of permanent impairment can only be made when a worker’s injuries has stabilised. Usually this can not be done until 12 months (1 year) after the date of the injury; and, from my own dreadful experience, I urge all injured workers to WAIT and to be PATIENT because serious injury can develop – I am living proof of it.

TIP:

tipFor some injured workers, it is not immediately apparent whether they suffer a serious injury. Often an injury will be troublesome and cause some ongoing pain and restrictions, but it is uncertain whether it will meet the strict legal test (quantitative, which consists of obtaining a whopping 30% total body impairment via IME or Medical Panel assessment, or via the more difficult qualitative test in court of “serious injury” test).

As a worker only gets to apply for a serious injury once it is important that the claim is not made prematurely.

An example of such a case: an injured worker in his late 30’s had initially injured his back at work lifting a heavy device in 2001. He had a short time off work and then despite some ongoing pain in his back, returned to normal duties. He continued on like this for many years. At times he would have flare ups of back pain that kept him out of work for a few weeks a time, but mostly he was able to manage things. However by 2010, his condition had deteriorated so badly that he required surgery to be performed to his back. He has since been able to return to work and therefore his claim was for pain and suffering only.

In advising him on his rights, his lawyers told him of the option to apply for a serious injury certificate at an earlier time, but we always felt concerned that due to his young age, his condition may worsen significantly. Sadly for him that is what happened. By having held off his claim, it meant that when he did proceed with it, he was able to get proper compensation for his all of his pain and suffering, including the need for surgery. He settled his claim this week for $160,000.

An injured worker has 6 years to lodge a serious injury claim in Victoria.  As long as the worker’s limitations period is protected, there should be no rush to lodge a serious injury claim – unless of course the worker wants to. Sadly for most workers, injuries frequently get worse over time and for the serious injury consequences to be fully apparent, it is often better not to rush these cases. This story (and my own story) is reminder of that.

TIP

It is, in my humble and injured opinion, also extremely important that you have a good, non-shark, empathic and smart lawyer on your side.

tipNot only will your lawyer be able to list ALL the injuries you have sustained (i.e. a shoulder injury can be extended to a wrist, elbow, hand injury, there can be CRPS, neck issues, and let’s not forget the psychological injuries etc etc), but your lawyer will also act in your best interest and time the lodgement of a permanent impairment claim properly.

Procedures for impairment benefit claims

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12.2 Process for impairment benefits

 

Please note the most important part of this procedure and that is that you have the right to DISPUTE any and all “independent assessments”.

You need to remember that permanent impairment assessments conducted by so called “independent assessors” are, in fact, nothing else but the same as the so called “independent doctors” (IMEs) the workcover insurers so often love to send you to, except that they “have undertaken a test to assess you under the AMA guides 4th edition”, ahum.

The insurer will choose who will assess you, er… that’s right. I remember having been sent to an “Occupational Physician” for my initial permanent impairment assessment! That’s right a “doctor” who has never ever operated on a shoulder, who is not an orthopedic surgeon, and yet he was allowed to assess an extremely complex shoulder injury with many many complications…?

In other words, many so called independent assessors will not give you the honest and true permanent impairment rating you legitimately deserve. They will not cut off the hand that feeds them (insurers), same as most IMEs. This is the case, not only for physical injuries but also for psychological/psychiatric injuries.

I still remember my first psychiatric impairment assessment, done by one of the rudest IME shrinks I have ever come across. Yet this man was allowed to decide, within 30 minutes, whether I suffered from a primary and/or a secondary psychological injury, and if so by how much percentage!

Reading his report was like a “kick in the guts” and I felt physically ill for days if not weeks afterwards. I could not believe that “independent permanent impairment assessors” could get away with THAT!

What I am trying to convey here is that you need to know the tricks of the dirty insurance trade and know your rights. If you undergo an “independent” permanent impairment assessment, make sure you obtain a copy of the report, study it to death, and if it is wrong or feels wrong, please DISPUTE it at all costs. It is your right.

To dispute an independent assessment the matter simply gets referred to a medical panel, and although I cannot say that all medical panels are truly honest, most are close to the truth and certainly heaps better than “independent assessors”.

It may take years to  achieve the required “injury stable” status, and a couple of full medical panels,be patient and hang on.

The discrepancy between the “independent assessment” and the medical panel’s impairment rating can be pretty shocking.  We know of many cases where there was greater than 5% WPI between the IME physical assessment and panel and more than 18% WPI for primary psychological injuries!

I’d say SHAME on all those “independent permanent impairment assessors” out there, playing with the lives of injured workers for the sake of a quick buck!

Never ever sign a notice of assessment, no matter how desperate you are for money. Wait, and FIGHT and may you WIN.

 

There is much more information available about the whole process of impairment benefits on the online Claims Manual (VIC) –> “Entitlements –> Impairment”.

 

[Post pre-dictated by workcovervictim and entered on behalf of workcovervictim]

 



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One Response to “Permanent impairment entitlements: know the tricks, know your rights”

  1. A permanent impairment assessment shouldn’t be managed by the insurer, we all know those criminals will do all they can to penalise your claim.

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    Xchangingvictim November 3, 2012 at 4:11 pm