In August 2015 the NSW Court of Appeal decided that NSW injured workers could not make more than one lump-sum insurance claim. In other words that injured workers could not top up their lump-sum compensation payment if their condition deteriorated. However, yesterday (Monday 26 Oct 15), the state government will make a new regulation to override that court decision in that case, known as Cram Fluid Power v Green.
In most Australian jurisdictions (states and territories), the American Medical Association Guides (AMA Guides) are the accepted assessment tool for injured workers’ permanent impairment rating. The problem with many AMA Guides (especially the older versions in use such as the AMA Guides 4th ed in Victoria) is that the rated impairment does not take into account the impact the impairment has on the injured worker. What should be measured is disability – that is, how the impairment really affects the injured worker.
Many injured workers we interact with want to know what their workcover case is worth. Perhaps not in the beginning of their workcover claim, but it is quite natural for (more seriously) injured workers to think about that and it almost always comes up. However, this is not the most important thing to think about. It is your health you should think about and foremost.
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).
By popular demand, here is the Guide to the evaluation of psychiatric impairment for clinicians (G.E.P.I.C) used today to assess permanent primary and/or secondary psychiatric/psychological conditions suffered as a result from or as a consequence of a workplace injury, by insurance doctors and medical panels.
A very loyal reader and good friend of ours has come across and so kindly shared the User Handbook to the AMA 4th Edition Guide to the Evaluation of Permanent Impairment, which is still used in many states to assess how the whole person impairment is calculated.
AMA Guide 4th Edition evaluation of permanent impairment handbook
Permanent impairment and lumpsum
You may be entitled to a lump sum payment if you are left with a permanent impairment because of your work injury. Unlike a common law damages claim, this is a no fault benefit, so you do not need to establish that your employer has been negligent.
The benefit is calculated in accordance with a formula depending on the level of impairment you are assessed as having. An independent doctor would need to examine you in accordance with a guide published by the American Medical Association (In Victoria and some other Australian states it is the 20 year old 4th edition).
The criteria for entitlement to a lump sum claim are tough and claims can be rejected by WorkSafe. The best rule if you are considering making a lump sum claim is therefore to get legal advice.
As a general rule, you must have suffered 10% physical permanent impairment as assessed by WorkSafe Vic (sometimes 5% for certain injuries like arm, leg, back). Here’s a rough guide:
|30% psychiatric impairment:||$69,540|
Though? Yeah…real tough!
At first glance one would think that we have a what appears to be a reasonable, standard “guide” in place (The AMA guide 4th Edition) to assess the level of permanent impairment for each injured person…
Did you know that the AMA Guides 4th Edition were published in 1993,they are just about 20 years old!
Under the current workers compensation system the kinds of injuries that would be denied compensation include:
- vertebral fractures resulting in up to 25% compression with ongoing pain : 5-8% total body impairment rating!
- spinal fusion requiring multiple surgeries with ongoing pain : up to 14%
- surgically treated disc lesion with ongoing pain: 10%
- pelvic fractures with displacement deformity: 2-10%
- disorders restricting ability to walk up mild gradients and stairs, sit down in deep-chairs, rise to a standing position or walk long distances 1-9%
- brief repetitive or persistent alteration of state of consciousness or awareness 0%-14%
In NSW the new draconian compensation law now also states that lump sum payments are only available for serious permanent injuries, which are defined as greater than 10% WPI.
In Victoria (and most other states) Impairment benefit compensation is determined in accordance with a formula set out by law, dependent of the level of impairment you are assessed as having and the date of your injury. Once the level of impairment is accepted, you cannot negotiate on the amount of compensation that you are entitled to.
To receive any compensation for a psychiatric injury, you need to be assessed as having at least a whopping 30% whole person impairment (primary psychiatric injury).
AMA Guide 4th Edition
This handbook to the AMA “Guides to the Evaluation of Permanent Impairment” 4th Edition is from New Zealand, but they too are based on the AMA 4th Edition & the worksheets & descriptions of how the ‘whole person’ permanent impairment is calculated may just help you to understand the system too!
- can I claim a lumpspum under workcover?
- The current workcover system for impairment rating is not fair at all
- Medical Panel or a judge
- The AMA 4th Edition does not recognise pain
[Post entirely entered by T on behalf of workcovervictim who is suffering from yet another nasty shoulder dislocation… ]
We received an email overnight from an injured worker pointing to a submission as recently made to the Joint Committee into the workers compensation NSW scheme. The submission raises interesting and very important questions, namely that WorkCover states the AMA guide does not recognise (rate) chronic pain and how does this impact injured workers who, for example suffer from -yes, really-debilitating complex regional pain syndrome (CRPS)?