Safety, Rehabilitation and Compensation Act 1988 - Guide to the Assessment of the Degree of Permanent Impairment (Second edition) (Cth)
Safety, Rehabilitation and Compensation Act 1988
Subsection 28 (1)
Guide to the Assessment of the
Degree of Permanent Impairment
Comcare prepares the following Guide to the Assessment of the Degree of Permanent Impairment (“second edition of the Guide”) under subsection 28 (1) of Safety, Rehabilitation and Compensation Act 1988.
The second edition of the Guide will come into operation in the manner specified in section 3 of the Introduction to the second edition of the Guide: Application of this Guide.
Dated: 1 September 2005
The seal of Comcare was affixed
in the presence of:
Barbara Bennett
Chief Executive Officer
Guide to
the Assessment
of the Degree of Permanent Impairment
Second edition
Comcare
Acknowledgements
Comcare gratefully acknowledges the valuable contribution to this Guide by:
- Dr Dwight Dowda
- Mr John Trungove
- Sparke Helmore, solicitors
- The Australian Government Solicitor
- All the medical specialists and associations who have provided input and assistance in the compiling of this document over a number of years
Introduction to second edition of the Guide
Page no
1. Authority ............................................................................................... iii
2. Structure of this Guide .................................................................... iii
3. Application of this Guide ................................................................ iv
4. Whole Person Impairment (WPI) ................................................ v
5. Entitlements under the SRC Act .................................................. v
6. Non-economic loss ............................................................................. v
7. Compensation Payable ..................................................................... v
8. Interim and Final Assessments ..................................................... v
9. Increase in Degree of Whole Person Impairment ................ vi
Part 1 – Claims For Permanent Impairment
Other Than Defence-Related Claims............................ 1
Part 2 – ....................................... Defence-related Claims For
Permanent Impairment................................................... 173
1. Authority
Division 4 of Part II (sections 24 to 28) of the Commonwealth’s Safety, Rehabilitation and Compensation Act 1988 (the SRC Act) provides for payment of lump sum compensation for permanent impairment and non-economic loss resulting from a work related injury.
The amount of compensation payable (if any) is to be assessed by reference to the degree of permanent impairment or the degree of non-economic loss determined by Comcare under the provisions of the approved Guide:
“approved Guide” is defined by section 4 of the SRC Act as meaning:
(a) the document, prepared by Comcare in accordance with section 28 under the title “Guide to the Assessment of the Degree of Permanent Impairment”, that has been approved by the Minister and is for the time being in force; and
(b) if an instrument varying the document has been approved by the Minister—that document as so varied.
Authority for this document rests therefore in subsections 28(1), 28(2) and 28(3) of the SRC Act, which provide that:
(1) Comcare may, from time to time, prepare a written document, to be called the “Guide to the Assessment of the Degree of Permanent Impairment”, setting out:
(a) criteria by reference to which the degree of the permanent impairment of an
employee resulting from an injury shall be determined;
(b) criteria by reference to which the degree of non-economic loss suffered by an
employee as a result of an injury or impairment shall be determined; and
(c) methods by which the degree of permanent impairment and the degree of non economic loss, as determined under those criteria, shall be expressed as a percentage.
(2) Comcare may, from time to time, by instrument in writing, vary or revoke the approved Guide.
(3) A document prepared by Comcare under subsection (1), and an instrument under subsection (2), have no force or effect unless and until approved by the Minister
This document is the new Guide to the Assessment of the Degree of Permanent Impairment. It may be referred to as ‘this Guide’ or ‘second edition of the Guide’). This Guide is binding on Comcare, licensed authorities and corporations, and the Administrative Appeals Tribunal (subsection 29 (4).
2. Structure of this Guide
This Guide is divided into two Parts:
Part 1 - Claims for Permanent Impairment other than Defence-related Claims
This Part deals with the assessment of claims other than defence-related claims as defined in Part XI of the SRC Act. That is, claims made under the SRC Act by employees who are not members of the Defence Force.
Part 2 - Defence-related Claims for Permanent Impairment
This Part deals with the assessment of defence-related claims as defined in Part XI of the SRC Act. That is, claims made under the SRC Act by members of the Defence Force in relation to injuries which occurred during defence service before 1 July 2004.
Part 1 of the Guide has three divisions:
DIVISION 1 Division 1 (see Part 1, page 17) is used to assess the degree of an employee’s permanent impairment resulting from an injury;
DIVISION 2 Division 2 (see Part 1, page 151) is used to assess the degree of an employee’s non-economic loss resulting from impairment;
DIVISION 3 Division 3 (see Part 1, page 159) is used to calculate the total entitlement based on the assessments completed in Divisions 1 and 2.
The Principles of Assessment (see page 11) and Glossary (see page 15) in Part 1 of this Guide contain information relevant to the interpretation and application of Part 1, Divisions 1 & 2.
Part 2 of this Guide has two divisions:
DIVISION 1 Division 1 (see Part 2, page 173) is used to assess the degree of an employee’s permanent impairment resulting from an injury; and
DIVISION 2 Division 2 (see Part 2, page 223) is used to assess the degree of an employee’s non-economic loss resulting from impairment;
The Principles of Assessment (see page 176) and Glossary (see page 179) in Part 2 of this Guide contain information relevant to the interpretation and application of Part 2, Divisions 1 and 2.
3. Application of this Guide
The Guide to the Assessment of the Degree of Permanent Impairment prepared by the Commission for the Safety, Rehabilitation and Compensation of Commonwealth Employees under subsection 28 (1) of the Commonwealth Employees’ Rehabilitation and Compensation Act 1988 and approved by the Minister of State for Industrial Relations by notice in writing dated 27 July 1989 is referred to as the “first edition of the Guide”.
Except as provided below, the first edition of the Guide is revoked in relation to determinations made under sections 24, 25 or 27 of the SRC Act in respect of claims under those sections received by the relevant authority after 28 February 2006. Claims under those sections received on or before 28 February 2006 will be determined under the provisions of the first edition of the Guide.
Part 1 of this Guide will apply on and from 1 March 2006 in relation to determinations made under sections 24, 25 or 27 of the SRC Act in respect of claims under those sections, other than defence-related claims, received by the relevant authority after 28 February 2006.
Part 2 of this Guide will apply on and from 1 March 2006 in relation to determinations made under sections 24, 25 or 27 of the SRC Act in respect of defence-related claims under those sections received by the relevant authority after 28 February 2006.
Where a request by an employee pursuant to subsection 25 (1) of the SRC Act is received by the relevant authority after the revocation date but relates to a claim under section 24 that was received by the authority on or before the revocation date, that request will be determined under the provisions of the first edition of the Guide.
Where a claim for compensation pursuant to subsections 25(4) or 25 (5) of the SRC Act (in respect of a subsequent increase in the degree of permanent impairment) is received by the relevant authority after the revocation date, that claim will be determined under the provisions of this Guide, notwithstanding that the initial claim for compensation for permanent impairment may have been determined under the provisions of the first edition of the Guide.
However, where the initial claim for compensation for permanent impairment was determined under the provisions of the first edition of the Guide, in determining whether or not there has been any subsequent increase in the degree of permanent impairment, the degree of permanent impairment or the degree of non-economic loss shall not be less than the degree of permanent impairment or degree of non-economic loss determined under the provisions of the first edition of the Guide unless that determination would not have been made but for a false statement or misrepresentation of a person.
In this Guide, “relevant authority” and “defence-related claims” have the same meaning as defined in section 4 and Part XI of the SRC Act and “revocation date” means 28 February 2006.
4. Whole Person Impairment (WPI)
Prior to 1988, the Compensation (Commonwealth Government Employees) Act 1971 (repealed with the coming into effect of the SRC Act) provided for the payment of lump sum compensation where an employee suffered the loss of, or loss of efficient use of, a part of the body or faculty, as specified in a table of maims. The range of conditions compensated was exclusive and did not reflect the broad range of work-related injuries and diseases.
This Guide, like the first edition, is based on the concept of ‘whole person impairment’. Subsection 24(5) of the SRC Act provides for the determination of the degree of permanent impairment of the employee, that is, the employee as a whole person. The whole person impairment concept, therefore, provides for compensation for the permanent impairment of any body part, system or function to the extent to which it permanently impairs the employee as a whole person.
Whole person impairment is assessed under Division 1 of Parts 1 and 2 of this Guide.
5. Entitlements under the SRC Act
Where the degree of permanent impairment of the employee (other than a hearing loss) determined under subsection 24(5) of the SRC Act is less than 10 per cent, paragraph 24(7) (b) of the Act provides that compensation is not payable to the employee under section 24 of that Act.
Subsection 24(8) of the Act excludes the operation of subsection 24(7) in relation to impairment resulting from the loss, or the loss of the use, of a finger or toe, or the loss of the sense of taste or smell.
For injuries suffered by employees after 1 October 2001, subsection 24(7A) of the Act provides that, if the injury results in a permanent impairment that is a hearing loss, the 10% threshold does not apply. In those cases, subsection 24(7A) provides that there is no compensation payable if the permanent impairment that is binaural hearing loss is less than 5%.
6. Non-economic loss
Subsection 27(1) of the SRC Act provides that where there is liability to pay compensation in respect of a permanent impairment, additional compensation for non-economic loss is payable in accordance with section 27.
Non-economic loss is assessed under Division 2 of Parts 1 and 2 of this Guide.
7. Compensation Payable
The maximum level of payment is prescribed in the legislation and indexed annually on 1 July in accordance with the Consumer Price Index. Compensation is calculated at the rate applicable at the time of the assessment (In Part 1 of this Guide, see Division 3 for calculation of total entitlement).
8. Interim and Final Assessments
On the written request of the employee under subsection 25 (1) of the SRC Act, an interim determination must be made of the degree of permanent impairment suffered and an assessment made of an amount of compensation payable to the employee, where:
· a determination has been made that an employee has suffered a permanent impairment as a result of an injury;
· the degree of that impairment is equal to or more than 10%; and
· a final determination of the degree of permanent impairment has not been made.
When a final determination of the degree of permanent impairment is made, there is payable to the employee, under subsection 25 (3) of the SRC Act, an amount equal to the difference, if any, between the final determination and the interim assessment.
9. Increase in Degree of Whole Person Impairment
Where a final assessment of the degree of permanent impairment has been made and the level of whole person permanent impairment subsequently increases by 10% or more, the employee may request, pursuant to subsection 25 (4) of the SRC Act, another assessment for compensation for permanent impairment and non-economic loss. Additional compensation is payable for the increased level of impairment only.
For injuries suffered by employees after 1 October 2001, pursuant to subsection 25 (5) of the SRC Act, if the injury results in a permanent impairment that is a hearing loss, there may be a further amount of compensation payable if there is a subsequent increase in the binaural hearing loss of 5% or more.
See section 3 above (Application of this Guide) as to assessments of the degree of permanent impairment made under the first edition of the Guide.
PART 1
CLAIMS FOR
PERMANENT IMPAIRMENT
OTHER THAN DEFENCE-RELATED
CLAIMS
PART 1
Table of Contents
List of Tables and Figures..................................................................................... 5
List of references..................................................................................................... 9
Principles of Assessment................................................................................. 11
Glossary................................................................................................................. 15
Division 1 Assessment of the Degree of an Employee’s
Permanent Impairment Resulting from an Injury......... 17
Chapter 1 – The Cardiovascular System............................... 19
Chapter 2 – The Respiratory System..................................... 29
Chapter 3 – The Endocrine System........................................ 35
Chapter 4 – Disfigurement and Skin Disorders................... 41
Chapter 5 – Psychiatric Conditions........................................ 45
Chapter 6 – The Visual System............................................... 47
Chapter 7 – Ear, Nose and Throat Disorders...................... 59
Chapter 8 – The Digestive System.......................................... 65
Chapter 9 – The Musculoskeletal System............................. 73
Chapter 10 – The Urinary System........................................... 119
Chapter 11 – The Reproductive System............................... 123
Chapter 12 – The Neurological System................................. 129
Chapter 13 – The Haematopoietic System............................ 147
Division 2 Guide to the Assessment of Non-Economic Loss........ 151
Division 3 Calculation of Total Entitlement....................................... 159
Index to Part 1...................................................................................................... 161
Appendix 1: Combined Values Chart........................................................... 169
PART 1
List of Tables and Figures
Division 1 – Assessment of Degree and Employee’s Permanent Impairment Resulting from Injury
Chapter 1 – The Cardiovascular System
Figure 1-A: Activities of Daily Living............. 19
Figure 1-B: Symptomatic Level of Activity
in METS According to Age and
Gender ........................................... 21
Table 1.1: Coronary Artery Disease ............. 21
Table 1.2.1: Diastolic Hypertension ................ 23
Table 1.2.2: Systolic Hypertension ................. 24
Figure 1-C: Definitions of Functional Class .. 25
Table 1.3: Arrhythmias ................................... 25
Table 1.4 Peripheral Vascular Disease
of the Lower Extremities .............. 26
Table 1.5: Peripheral Vascular Disease
of the Upper Extremities 26
Figure 1-C: Definitions of Functional Class.. 27
Table 1.6: Raynaud’s Disease ....................... 27
Chapter 2 – The Respiratory System
Table 2.1: Conversion of Respiratory
............................... Function Values to
............................... Impairment ..................................... 31
Figure 2-A: ......... Calculating Asthma Impairment
............................... Score ............................................... 32
Table 2.2: ............ Whole Person Impairment
............................... Derived from Asthma
............................... Impairment Score .......................... 32
Figure 2-B: ......... Calculating Obstructive Sleep
............................... Apnoea Score ................................ 33
Table 2.4 ............. Whole Person Impairment
............................... Derived from Obstructive
............................... Sleep Apnoea Score ..................... 33
Chapter 3 – The Endocrine System
Table 3.1 Thyroid and Parathyroid
Glands ............................................. 36
Table 3.2 Adrenal Cortex and Medulla ....... 37
Table 3.3: Pancreas (Diabetes Mellitus)....... 38
Table 3.4: Gonads and Mammary Glands .... 39
Chapter 4 – Disfigurement and Skin Disorders
Table 4.1: Skin Disorders ............................... 42
Figure 4-A: Activities of Daily Living............. 42
Table 4.2: Facial Disfigurement ..................... 43
Table 4.3: Bodily Disfigurement.................... 43
Chapter 5 – Psychiatric conditions
Figure 5-A: Activities of Daily Living............. 45
Table 5.1: Psychiatric conditions ................. 45
Chapter 6 – The Visual System
Figure 6-A: Steps for Calculating
Impairment of the Visual
System ............................................ 49
Table 6.1: Conversion of the Visual
System to Whole Person
Impairment Rating ......................... 49
Figure 6-B: Revised LogMar Equivalent for Different Reading Cards 50
Figure 6-C: Percentage Loss of Central
Vision in One Eye ......................... 51
Figure 6-D: Normal Extent of the Visual
Field................................................. 52
Figure 6-E: Percentage Loss of Ocular
Motility of one Eye in
Diplopia Fields............................... 53
Figure 6-F: Calculation of Visual System Impairment for Both Eyes 55
Chapter 7 – Ear, Nose and Throat Disorders
Table 7.2: Tinnitus........................................... 60
Table 7.3: Olfaction and Taste....................... 60
Table 7.4: Speech............................................. 61
Table 7.5: Air Passage Defects...................... 62
Table 7.6: Nasal Passage Defects.................. 62
Table 7.7: Chewing and Swallowing............. 63
Chapter 8 – The Digestive System
Figure 8-A: Activities of Daily Living............. 65
Figure 8-B: Body Mass Index Criteria............. 66
Table 8.1: Upper Digestive Tract:
Oesophagus, Stomach,
Duodenum, Small Intestine
and Pancreas.................................. 67
Table 8.2: Lower Gastrointestinal Tract:
Colon and Rectum......................... 68
Table 8.3: Lower Gastrointestinal Tract:
Anus................................................ 70
Table 8.4: Surgically Created Stomas............ 70
Table 8.5: Liver (Chronic Hepatitis and Parenchymal Liver Disease) 71
Table 8.6: Biliary Tract.................................... 72
Table 8.7: Hernias of the Abdominal
Wall.................................................. 72
List of Tables and Figures continues over page
Part 1
List of Tables and Figures
(continued)
Chapter 9 – The Musculoskeletal System
Figure 9-A Activities of Daily Living............. 74
Figure 9-B Tables of normal ranges of
motion of joints.............................. 74
Table 9.1: Feet and Toes................................. 77
Table 9.2: Ankles ............................................ 78
Table 9.4: Knees............................................... 79
Table 9.4: Hips.................................................. 80
Table 9.5: Lower Extremity Amputations..... 81
Figure 9-C: Grading System.............................. 82
Table 9.6.1: Spinal Nerve Root Impairment Affecting the Lower Extremity 82
Table 9.6.2a: Sensory Impairment due to
Peripheral Nerve Injuries
Affecting the Lower
Extremities....................................... 83
Table 9.6.2b: Motor Impairment due to
Peripheral Nerve Injuries
Affecting the Lower
Extremities....................................... 83
Table 9.7: Lower Extremity Function............. 85
Table 9.8.1a: Abnormal Motion/Ankylosis
of the Thumb –
IP and MP joints............................ 87
Table 9.8.1b: Radial Abduction/Adduction/ Opposition of the Thumb –
Abnormal Motion/Ankylosis...... 88
Table 9.8.1c: Abnormal Motion/Ankylosis
of the Fingers –
Index and Middle Fingers............. 89
Table 9.8.1d: Abnormal Motion/Ankylosis
of the Fingers –
Ring and Little Fingers.................. 89
Table 9.8.2a: Sensory Losses in the Thumb..... 92
Table 9.8.2b: Sensory Losses in the Index &
Index & Middle Fingers................ 92
Table 9.8.2c: Sensory Losses in the Little
Finger............................................... 92
Table 9.8.2d: Sensory Losses in the Ring
Finger............................................... 92
Table 9.9.1a: Wrist Flexion/Extension................ 94
Table 9.9.1b: Radial and Ulnar Deviation
of Wrist Joint.................................. 94
Table 9.10.1a: Elbow Flexion/Extension............... 96
Table 9.10.1b: Pronation and Supination of
Forearm............................................ 96
Table 9.11.1a: Shoulder Flexion/Extension.......... 98
Table 9.11.1b: Shoulder Flexion/Extension
Internal/External Rotation of Shoulder 98
Table 9.11.1c: Abduction/Adduction of
Shoulder.......................................... 99
Table 9.12.1: Upper Extremity
Amputations................................. 100
Table 9.12.2: Amputation of Digits.................. 100
Figure 9-D: Grading System............................ 101
Table 9.13.1: Cervical Nerve Root
Impairment.................................... 102
Table 9.13.2a: Specific Nerve Lesions Affecting
the Upper Extremities –
Sensory Impairment..................... 104
Table 9.13.2b: Specific Nerve Lesions
Affecting the Upper Extremities –
Motor Impairment........................ 104
Figure 9-E Diagnostic Criteria for CRPS...... 106
Figure 9-F Impairment Grading for CRPS.... 106
Table 9.14 Upper Extremity Function........... 109
Table 9.15: Cervical Spine –
Diagnosis-Related Estimates..... 114
Table 9.16: Thoracic Spine –
Diagnosis-Related Estimates..... 115
Table 9.17: Lumbar Spine –
Diagnosis-Related Estimates..... 116
Table 9.18: Fractures of the Pelvis................ 117
Chapter 10 – The Urinary System
Table 10.1: The Upper Urinary Tract............ 120
Table 10.2: Urinary Diversion........................ 120
Table 10.3: Lower Urinary Tract.................... 122
Chapter 11 – The Reproductive System
Table 11.1.1: Male Reproductive Organs –
Penis.............................................. 124
Table 11.1.2: Male Reproductive Organs – Scrotum 124
Table 11.1.3: Male Reproductive Organs –
Testes, Epididymes and
Spermatic Cords........................... 125
Table 11.1.4: Male Reproductive Organs – Prostate and Seminal
Vesicles......................................... 125
Table 11.2.1: Female Reproductive
Organs – Vulva and Vagina....... 126
Table 11.2.2: Female Reproductive
Organs – Cervix and Uterus....... 127
Table 11.2.3: Female Reproductive
Organs – Fallopian Tubes
and Ovaries................................... 128
Chapter 12 – The Neurological System
Figure 12-A: Activities of Daily Living........... 130
Table 12.1.1: Permanent Disturbances of
Levels of Consciousness
and Awareness............................ 131
List of Tables and Figures continues over page
Part 1
List of Tables and Figures
(continued)
Table 12.1.2: Epilepsy, Seizures and
Convulsive Disorders................. 131
Table 12.1.3: Sleep and Arousal Disorders..... 132
Table 12.2: Impairment of Memory,
Learning, Abstract Reasoning
and Problem Solving Ability...... 133
Figure 12-B: Clinical Dementia Rating
(CDR)............................................. 134
Table 12.3.1: Comprehension of Speech
and Language Symbols.............. 136
Table 12.3.2: Production of Speech and
Language Symbols...................... 138
Table 12.4: Emotional or Behavioural Impairments 139
Table 12.5.1: The Olfactory Nerve (I)............... 140
Table 12.5.3: The Trigeminal Nerve (V)........... 141
Table 12.5.4: The Facial Nerve (VII)................. 142
Table 12.5.5: The Auditory Nerve (VIII).......... 143
Figure 12-C: % WPI Modifiers for
Episodic Conditions.................... 144
Table 12.5.6: The Glossopharyngeal,
Vagus, Spinal Accessory
and Hypoglossal Nerves
(IX, X, XI and XII)....................... 145
Table 12.6: Neurological Impairment of
the Respiratory System............... 145
Table 12.7: Neurological Impairment of
the Urinary System...................... 145
Table 12.8: Neurological Impairment of
the Anorectal System.................. 146
Table 12.9: Neurological Impairment
Affecting Sexual Function.......... 146
Chapter 13 – The Haematopoietic System
Table 13.1: Anaemia........................................ 147
Figure 13-A: Activities of Daily Living........... 148
Table 13.2: Leukocyte Abnormalities or
Disease.......................................... 149
Table 13.3: Haemorrhagic Disorders and
Platelet Disorders......................... 150
Table 13.4: Thrombotic Disorders................. 150
Division 2 – Guide to the Assessment of
Non-Economic Loss
Table B1: Pain................................................ 152
Table B2: Suffering........................................ 153
Table B3.1: Mobility......................................... 155
Table B3.2: Social Relationships.................... 155
Table B3.3: Recreation and Leisure
Activities....................................... 155
Table B4: Other Loss.................................... 156
Table B5: Loss of Expectation of Life......... 156
B6: Worksheet Calculation of
non-economic loss...................... 157
Division 3 – Final Calculation of Entitlements
Under Section 24 and Section 25
C1: Worksheet Final Calculation of
Entitlements.................................. 159
Appendices
Appendix 1 Combined Values Chart.............. 169
PART 1
List of references
Abramson MJ et al, 1996, Aust NZ J Med, 26, 697-701.
American Academy of Sleep Medicine, 1999, ‘Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research’, 1999, Sleep, 22, 667-689.
American Medical Association, 1995, Guides to the Evaluation of Permanent Impairment, 4th edition, Chicago: American Medical Association.
American Medical Association, 2001, Guides to the Evaluation of Permanent Impairment, 5th edition, Chicago: American Medical Association.
American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986, ‘Evaluation of impairment/disability secondary to respiratory disorders’, Am Rev Respir Dis, 133, 1205-09
American Thoracic Society, 1993, ‘Guidelines for the evaluation of impairment/disability in patients with asthma’, Am Rev Respir Dis, 147, 1056-61.
Cummings J, Mega M, Gary K, Rosenberg-Thompson S, Carusi D, Gornbein J, ‘The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia’, Neurology, 1994, 44, 2308-2314.
Ensalada LH, ‘Complex regional pain syndrome’, in Brigham CR, ed, The Guides Casebook, Chicago, Ill: American Medical Association, 1999, 14.
Johns MW, 1991, ‘A new method for measuring daytime sleepiness: the Epworth sleepiness scale’, Sleep, 14, 540-5.
Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current version and scoring rules’, Neurology, 43(11), 2412-2414.
National Asthma Council, 2002, Asthma Management Handbook 2002, 5th edition, Melbourne: National Asthma Council of Australia.
PART 1
Principles of Assessment
Page no.
1. Impairment and Non-Economic Loss ..................................... 11
2. Employability and Incapacity ..................................................... 12
3. Permanent Impairment ................................................................. 12
4. Pre-Existing Conditions and Aggravation ............................ 12
5. The Impairment Tables ................................................................ 12
6. Malignancies and conditions resulting in major
systemic failure................................................................................ 13
7. Percentages of Impairment ......................................................... 13
8. Comparing Assessments under Alternative Tables .......... 13
Combined Values 9. ............................................................................ 13
10. Calculating the Assessment ........................................................ 14
11. Ordering of Additional Investigations .................................... 14
12. Exceptions to use of this Guide ................................................. 14
Impairment and Non-Economic Loss1.
Under subsection 4(1) of the SRC Act, impairment means ‘the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function’. It relates to the health status of an individual and includes anatomical loss, anatomical abnormality, physiological abnormality, and psychological abnormality. The degree of impairment is assessed by reference to the impact of that loss on the normal efficient functioning of the whole person.
Non-economic loss is assessed in accordance with Part 1, Division 2 (page 151) of this Guide, and deals with the effects of the impairment on the employee’s life. Under subsection 4(1) of the SRC Act, for an employee who has suffered an injury resulting in a permanent impairment, it means:
‘loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware’.
Non-economic loss may be characterised as the ‘lifestyle effects’ of an impairment. ‘Lifestyle effects’ are a measure of an individual’s mobility and enjoyment of, and participation in, social relationships, and recreation and leisure activities. The employee must be aware of the losses suffered. While employees may have equal ratings of whole person impairment it would not be unusual for them to receive different ratings for non-economic loss because of their different lifestyles.
Employability and Incapacity2.
The concepts of ‘employability’ and ‘incapacity’ are not the tests for the assessment of impairment and non-economic loss. Incapacity is influenced by factors other than the degree of impairment and is compensated by weekly payments which are separate and independent to permanent impairment entitlements.
Permanent Impairment3.
Compensation is only payable for impairments which are permanent. Under subsection 4(1) of the SRC Act ‘permanent’ means ‘likely to continue indefinitely’. Subsection 24(2) of the SRC Act provides that for the purposes of determining whether an impairment is permanent, the following matters shall be considered:
(a) the duration of the impairment;
(b) the likelihood of improvement in the employee’s condition;
(c) whether the employee has undertaken all reasonable rehabilitative treatment for the
impairment; and
(d) any other relevant matters.
Thus, a loss, loss of the use, damage, or malfunction, will be permanent if it is likely, in some degree, to continue indefinitely. For this purpose, regard shall be had to any medical opinion concerning the nature and effect (including possible effect) of the impairment, and the extent, if any, to which it may reasonably be capable of being reduced or removed.
Pre-Existing Conditions and Aggravation4.
Where a pre-existing or underlying condition is aggravated by a work-related injury, only the impairment resulting from the aggravation is to be assessed. However, an assessment should not be made unless the effects of the aggravation of the underlying or pre-existing condition are considered permanent. In these situations, the pre-existing or underlying condition would usually have been symptomatic prior to the work-related injury and the degree of permanent impairment resulting from that condition is able to be accurately assessed.
If the employee’s impairment is entirely attributable to the pre-existing or underlying condition, or to the natural progression of such a condition, the assessment for permanent impairment is nil.
Where the pre-existing or underlying condition was previously asymptomatic, all the permanent impairment arising from the work-related injury is compensable.
The Impairment Tables5.
Part 1, Division 1 of this Guide is based on the concept of whole person impairment which is drawn from the American Medical Association’s Guides to the Evaluation of Permanent Impairment (see the 5th edition, 2001).
Division 1 assembles into groups, according to body system, detailed descriptions of impairments. The extent of each impairment is expressed as a percentage value of the whole, normal, healthy person. Thus, a percentage value can be assigned to an employee’s impairment by reference to the relevant description in this Guide.
It may be necessary in some cases to have regard to a number of Chapters within Part 1 of this Guide when assessing the degree of whole person impairment which results from an injury.
Where a table specifies a degree of impairment because of a surgical procedure, the same degree of impairment applies if the same loss of function has occurred due to a different medical procedure or treatment.
Malignancies and conditions resulting in major systemic failure6.
Conditions such as cancer, HIV infection, diabetes, asbestosis, mesothelioma and others, often with terminal consequences, may result in failure or impairment of multiple body parts or systems.
Assessments should be made of the impairment suffered in each of the affected body parts and systems and combined using the Combined Values Chart in Part 1, Appendix 1.
Percentages of Impairment7.
Each table in Part 1, Division 1 contains impairment values expressed as percentages. Where a table is applicable in respect of a particular impairment, there is no discretion to choose an impairment value not specified in that table. For example, where 10% and 20% are the specified values, there is no discretion to determine the degree of impairment as 15%.
Comparing Assessments under Alternative Tables8.
Unless there are instructions to the contrary, where two or more tables (or combinations of tables) are equally applicable to an impairment, the decision-maker must assess the degree of permanent impairment under the table or tables which yields or yield the most favourable result to the employee.
Combined Values9.
Impairment is system or function based. A single injury may give rise to multiple losses of function and, therefore, multiple impairments. When more than one table applies in respect of that injury, separate scores should be allocated to each functional impairment. To obtain the whole person impairment in respect of that injury, those scores are then combined using the Combined Values Chart (see Part 1, Appendix 1) unless the notes in the relevant section specifically stipulate that the scores are to be added (For instance, see 9.8.1 at page 87).
Where two or more injuries give rise to the same whole person impairment only a single rating should be given. For example, impairments resulting from separate injuries to the left and right knees are initially assessed separately under Tables 9.3 and then, in accordance with the notes at Part 1 – Introduction to Chapter 9 on page 74, the impairments are combined using the Combined Values Chart to obtain the overall impairment for the lower extremity function which is taken to be a single whole person impairment. Alternatively, a whole person impairment value can be obtained using the method set out in Table 9.7 (which treats the injuries to both knees as the same impairment*) and this value can then be compared to the combined value previously obtained to determine which is the most beneficial. [* The notes on page 84 to Table 9.7 provide: ‘A single assessment only may be made under Table 9.7, irrespective of whether one or two extremities are affected by the injury’]
However, where two or more injuries give rise to different whole person impairments, each injury is to be assessed separately and the final scores for each injury (including any combined score for a particular injury) added together.
It is important to note that whenever the notes in the relevant section refer to combined ratings, the Combined Values Chart must be used, even if no reference is made to the use of that Chart.
Calculating the Assessment10.
Where relevant, a statement is included in the Chapters of Part 1, Division 1 which indicates:
· the manner in which tables within that Chapter may (or may not) be combined;
· whether an assessment made in that Chapter can be combined with an assessment made in another Chapter in assessing the degree of whole person impairment.
There are some special circumstances where addition of scores rather than combination is required. These circumstances are specified in the relevant sections and tables in Part 1 of this Guide.
Ordering of Additional Investigations11.
As a general principle, the assessing medical practitioner should not order additional radiographic or other investigations solely for impairment evaluation purposes, unless the investigations are specifically required in the relevant chapter of Part 1 of this Guide.
Exceptions to use of Part 1 of this Guide12.
In the event that an employee’s impairment is of a kind that cannot be assessed in accordance with the provisions of Part 1 of this Guide, the assessment is to be made under the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.
An assessment is not to be made using the American Medical Association’s Guides to the Evaluation of Permanent Impairment for:
· mental and behavioural impairments (psychiatric conditions);
· impairments of the visual system;
· hearing impairment; or
· chronic pain conditions, except in the case of migraine or tension headaches. (For complex regional pain syndromes affecting the upper extremities, see Part 1, Chapter 9 – 9.13.3 Complex Regional Pain Syndrome, see page 105).
Any reference in this Guide to the American Medical Association’s Guides to the Evaluation of Permanent Impairment is a reference to the edition current at the time of assessment, unless there is reference to a specific edition.
Glossary
Definitions in italics are from subsection 4(1) of the SRC Act.
Activities of Daily Living are those activities that an employee needs to perform to function in a non-specific environment (that is, to live). Performance of Activities of Daily Living is measured by reference to primary biological and psychosocial function.
Ailment means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development).
Disease means
(a) any ailment suffered by an employee; or
(b) the aggravation of any such ailment;
being an ailment or an aggravation that was contributed to in a material degree by the employee’s employment by the Commonwealth or a licensed corporation.
Impairment means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function.
Injury means
(a) a disease suffered by an employee; or
(b) an injury (other than a disease) suffered by an employee,
being a physical or mental injury arising out of, or in the course of, the employee’s employment; or
(c) an aggravation of a physical or mental injury (other than a
disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee’s employment), being an aggravation that arose out of, or in the course of, that employment;
but does not include any such disease, injury or aggravation suffered by an employee as a result of reasonable disciplinary action taken against the employee or failure by the employee to obtain a promotion, transfer or benefit in connection with his or her employment.
Loss of Amenities means the effects on mobility, social relationships and recreation and leisure activities.
Non-economic loss in relation to an employee who has suffered an injury resulting in a permanent impairment, means loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware.
Glossary continues on following page
Glossary (continued)
Pain means physical pain.
Suffering means the mental distress resulting from the accepted conditions or impairment.
Whole person impairment (or WPI) means the medical effects of an injury or disease. WPI is based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment. WPI is a medical quantification of the nature and extent of the effect of an injury or disease on a person’s functional capacity including Activities of Daily Living. This Guide presents descriptions of impairments in chapters and tables according to body system. The extent of each impairment is expressed as a percentage value of the functional capacity of a normal healthy person.
PART 1
Division 1
Assessment of the Degree
of an Employee’s Permanent Impairment
Resulting from an Injury
Chapter 1 – The Cardiovascular System
Page no.
1.0 Introduction............................................................................................. 19
1.1... Coronary Artery Disease................................................................... 21
1.2.... Hypertension.......................................................................................... 23
1.2.1 Diastolic Hypertension...................................................................... 23
1.2.2 Systolic Hypertension........................................................................ 24
1.3 .. Arrhythmias............................................................................................ 25
1.4 .. Peripheral Vascular Disease of the Lower Extremities........ 26
1.5 ... Peripheral Vascular Disease of the Upper Extremities......... 26
1.6 .. Raynaud’s Disease............................................................................... 27
1.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-14) and the definitions contained in the Glossary (see pages 15-16).
WPI ratings derived from tables in this Chapter may be combined with WPI ratings from other tables where there is co-existent disease (for example, cardiomyopathy, ischaemic heart disease, congenital heart disease, valvular heart disease).
‘Activities of Daily Living’ are activities which an employee needs to perform to function in a non-specific environment (that is, to live). Performance of Activities of Daily Living is measured by reference to primary biological and psychosocial function.
For the purposes of Chapter 1, Activities of Daily Living are those in Figure 1-A (see below).
Figure 1-A: Activities of Daily Living
Activity Examples Self care, personal hygiene. Bathing, grooming, dressing, eating, eliminating. Communication. Hearing, speaking, reading, writing, using keyboard. Physical activity. Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising. Sensory function. Tactile feeling. Hand functions. Grasping, holding, pinching, percussive movements, sensory discrimination. Travel. Driving or travelling as a passenger. Sexual function. Participating in desired sexual activity. Sleep. Having a restful sleep pattern. Social and recreational. Participating in individual or group activities, sports activities, hobbies. Chapter 1 does not cover impairments arising from cardiomyopathy, congenital heart disease, valvular heart disease, and pericardial heart disease. Where relevant, the degree of impairment arising from these conditions should be assessed in accordance with the appropriate table from the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.
For post-thrombotic syndrome, assessments under Tables 1.4 and 1.5 (peripheral vascular disease, see page 26) are an alternative to Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System). WPI ratings from Tables 1.4 and 1.5 must not be combined with a WPI rating from Table 13.4. Tables 1.4 and 1.5 should be used as the primary guide for assessing peripheral complications of thrombosis.
Employees who have permanent cardiac limitation secondary to massive pulmonary embolism should be assessed under Chapter 1. A WPI rating assessed in these circumstances may not be combined with a rating from Table 13.4.
1.1 Coronary Artery Disease
Steps for assessment are as follows.
Step 1 Using Figure 1-B (see below), determine the symptomatic level of activity in METS according to age and gender. Figure 1-B may be used to assess conditions affecting left ventricular function (LVF) (including ischaemic heart disease, rheumatic heart disease, and hypertension). Step 2 Using Table 1.1 (see below), refer to any one of pathology (column 3), drug therapy (column 4), or intervention (column 5), to identify the degree of impairment within the range of impairments for that symptomatic level of activity.
Figure 1-B (see below) may be used for the assessment of symptomatic impairment caused by ischaemic heart disease, hypertension, cardiomyopathy, or rheumatic heart disease.
Figure 1-B: Symptomatic Level of Activity in METS According to Age and Gender
Age and
Gender
Symptomatic Level of Activity in METS 1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+ 18-30 M D D D C C B B B A A 18-30 F D D C C B B A A A 31-40 M D D D C C B B A A 31-40 F D D C B B B A 41-50 M D D C C B B A A 41-50 F D D C B B A A 51-60 M D D C B B A A A 51-60 F D D C B B A A 61-70 M D D C B B A A 61-70 F D D B B A A 70+ M D C B B A 70+ F D C B A A
Table 1.1: Coronary Artery Disease
See notes to Table 1.1 on following page for further details regarding abbreviations and
symbols used in Columns 3, 4 and 5.
Column 1
% WPI
Column 2
Level of Activity in METS for
Age and Gender
Column 3
Pathology
Column 4
Drug Therapy
Column 5
Intervention
5 A not applicable not applicable not applicable 10 A + + not applicable 15 A ++ ++ PTCA 20 A +++ +++ CABG/Tx 25 B + + not applicable 30 B ++ ++ PTCA 40 B +++ +++ CABG/Tx 50 C + + not applicable 60 C ++ ++ PTCA 65 C +++ +++ CABG/Tx 75 D + + not applicable 85 D ++ ++ PTCA 95 D +++ +++ CABG/Tx
Notes to Table 1.1
1. In Table 1.1, not applicable means the criterion is not applicable to the specified level of impairment.
2. Pathology – Column 3.
(i) Coronary Artery Disease:
+ either <50% stenosis in one or more coronary arteries, or single vessel disease > 50% stenosis (except proximal left anterior descending [LAD] and left main coronary artery [LMCA]);
++ either >50% stenosis in two vessels, or >50% stenosis in proximal LAD, or <50% stenosis in LMCA;
+++ either >50% stenosis in 3 vessels, or LMCA >50% stenosis, or severe diffuse end organ disease.
(ii) Ischaemic Left Ventricular Dysfunction:
+ left ventricular ejection fraction (LVEF) 40-50%;
++ LVEF 30-40%;
+++ either LVEF < 30%, or LV aneurysm.
(iii) Myocardial Infarction (MI):
+ no previous MI;
++ previous possible MI (equivocal changes in ECG/cardiac enzymes);
+++ previous definite MI (unequivocal changes in ECG/cardiac enzymes: typical evolution of ST/T segments, or development of significant Q waves, or enzyme rise > 3 times upper limit of normal).
(iv) Arrhythmias
Assessed under Table 1.3 – Arrhythmias (see page 25).
3. Drug Therapy (continuous) – Column 4.
+ one or two drugs;
++ three or four drugs;
+++ five or more drugs.
4. Intervention – Column 5.
PTCA means percutaneous transluminal coronary angioplasty and/or stenting.
CABG means coronary artery bypass grafting.
Tx means heart transplant.
1.2 Hypertension
Either diastolic hypertension (section 1.2.1 below) or systolic hypertension (section 1.2.2, see following page) may be assessed, whichever provides the highest WPI rating.
1.2.1 Diastolic Hypertension
Hypertensive cardiomyopathy can be assessed using the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.
Functional class (determined in accordance with Figure 1-B, see page 21) is the primary criterion for assessment. Level of diastolic blood pressure (DBP) and therapy (see Table 1.2.1 below) are secondary criteria for assessment.
For assessment use either usual DBP, or therapy, for a given functional class, whichever provides the greater WPI rating. If DBP is consistently >120 on optimal therapy, one higher functional class may be assigned.
Table 1.2.1: Diastolic Hypertension
See note immediately following Table 1.2.1 for explanation of symbols
used in the final column (Drug Therapy).
% WPI Level of Activity in METS for
Age and Gender
Usual DBP
Drug Therapy
5 A >90 + 10 A >100 ++ 15 A >110 +++ 20 B >90 + 25 B >100 ++ 30 B >110 +++ 35 C >90 + 40 C >100 ++ 45 C >110 +++ 50 D >90 + 55 D >100 ++ 60 D >110 +++ Note to Table 1.2.1
1. Drug Therapy (continuous) – final column of Table 1.2.1:
+ one drug;
++ two drugs;
+++ three or more drugs.
1.2.2 Systolic Hypertension
Hypertensive cardiomyopathy can be assessed using the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.
Functional class (determined in accordance with Figure 1-B, see page 21) is the primary criterion for assessment. Level of systolic blood pressure (SBP) and therapy (see Table 1.2.2 below) are secondary criteria for assessment.
Table 1.2.2: Systolic Hypertension
See note immediately following Table 1.2.2 for explanation of symbols
used in the final column (Drug Therapy).
% WPI Symptomatic Level of Activity in METS for Age and Gender Usual SBP
Drug Therapy
5 A >160 + 10 A >160 ++ 15 A >160 +++ 20 B >170 + 25 B >170 ++ 30 B >170 +++ 35 C >180 + 40 C >180 ++ 45 C >180 +++ 50 D >190 + 55 D >190 ++ 60 D >190 +++ Note to Table 1.2.2
1. Drug Therapy (continuous):
+ one drug;
++ two drugs;
+++ three or more drugs.
1.3 Arrhythmias
Underlying cardiac disease can be assessed using other tables in Chapter 1.
Functional class (determined under Figure 1-C below), and therapy (see Table 1.3 below), are used to determine the WPI rating.
Figure 1-C: Definitions of Functional Class
Functional Class Symptoms I No limitation of physical activity. II Slight limitation of physical activity.
Comfortable at rest and with ordinary, light Activities of Daily Living.
Greater activity causes symptoms.
III Marked limitation of physical activity.
Comfortable at rest.
Ordinary activity causes symptoms.
IV Inability to carry out any physical activity without discomfort.
Table 1.3: Arrhythmias
See note immediately following Table 1.3 for explanation of symbols
used in the final column (Therapy).
% WPI Functional Class Therapy 5 I Nil 10 I Drug(s) 15 I Surgery/cath/PPM/Device 20 II Nil 30 II Drug(s) 40 II Surgery/cath/PPM/Device 45 III Nil 50 III Drug(s) 55 III Surgery/cath/PPM/Device 60 IV not applicable Note to Table 1.3
1. Therapy – column 3:
‘cath’ means either catheter ablation or catheter-associated therapy for arrhythmia;
‘PPM’ means permanent pacemaker;
‘Device’ means implanted defibrillator.
1.4 Peripheral Vascular Disease of the Lower Extremities
Amputations should not be assessed under Table 1.4. They should be assessed under Table 9.5: Lower Extremity Amputations (see page 81, Chapter 9 – The Musculoskeletal System).
A WPI rating from Table 1.4 must not be combined with a WPI rating from Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System).
Table 1.4: Peripheral Vascular Disease of the Lower Extremities
% WPI Signs and Symptoms 0 The employee experiences neither intermittent claudication nor pain at rest. 5 The employee has no difficulty with distances but experiences ischaemic pain on climbing either steps or gradients. 10 The employee experiences claudication on walking 200 metres or more at an average pace on level ground. 20 The employee experiences claudication on walking more than 100 but less than 200 metres at average pace on level ground. 30 The employee experiences claudication on walking more than 75 but less than 100 metres at average pace on level ground. 40 The employee experiences claudication on walking more than 50 but less than 75 metres at average pace on level ground. 50 The employee experiences claudication on walking more than 25 but less than 50 metres at average pace on level ground. 60 The employee experiences claudication on walking less than 25 metres at average pace on level ground. 70 The employee experiences ischaemic pain at rest.
1.5 Peripheral Vascular Disease of the Upper Extremities
Amputations should not be assessed under Table 1.5. They should be assessed under Table 9.12.1: Upper Extremity Amputations, or Table 9.12.2: Amputation of Digits (see page 100, Chapter 9 – The Musculoskeletal System).
A WPI rating from Table 1.5 must not be combined with a WPI rating from Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System).
Table 1.5 Peripheral Vascular Disease of the Upper Extremities
% WPI Symptoms Signs 5 Either no claudication or transient oedema. Calcification of arteries on X-ray. 10 Either no claudication or persistent oedema controlled by support. Dilatation of either arteries or veins. 15 As above. Either loss of pulse or healed ulcer or surgery. 20 Either claudication on strenuous exercise or persistent oedema uncontrolled by support. Either calcification of arteries on X-ray or dilatation of either arteries or veins. 30 As above. Superficial ulcer. 40 As above. Either deep or widespread ulcer or surgery. 45 Claudication on mild-moderate exertion. Either calcification of arteries on X-ray or dilatation of either arteries or veins. 50 As above. Superficial ulcer. 55 As above. Either deep or widespread ulcer or surgery. 60 Rest pain/unable to exercise. not applicable
1.6 Raynaud’s Disease
Functional class (determined according to Figure 1-C below) is the primary criterion for assessment. Signs of vasospastic disease and therapy (see Table 1.6 below) are secondary criteria for assessment.
Figure 1-C: Definitions of Functional Class
See note to Figure 1-C immediately following Figure.
Functional Class Symptoms I No limitation of physical activity. II Slight limitation of physical activity.
Comfortable at rest and with ordinary, light Activities of Daily Living.
Greater activity causes symptoms.
III Marked limitation of physical activity.
Comfortable at rest.
Ordinary activity causes symptoms.
IV Inability to carry out any physical activity without discomfort. Note to Figure 1-C
1. Figure 1-C also appears in Section 1.3 – Arrhythmias, page 25. It is repeated here for ease of reference.
Table 1.6: Raynaud’s Disease
See note immediately following Table 1.6.
% WPI Functional Class Signs Therapy 5 I Nil. Nil. 10 I Nil. Drug(s). 15 I Nil. Surgery. 20 II Neither ulceration nor trophic changes. Drug(s). 25 II Either ulceration or trophic changes. Drug(s). 30 II not applicable Surgery. 35 III Neither ulceration nor trophic changes. Drug(s). 40 III Either ulceration or trophic changes. Drug(s). 45 III not applicable Surgery. 50 IV not applicable not applicable Note to Table 1.6
1. Therapy – final column of Table 1.6:
Surgery includes sympathectomy and local debridement;
Drug(s) means continuous therapy with one or more drugs.
Chapter 2 – The Respiratory System
Page no.
2.0 Introduction............................................................................................. 29
2.1 .. Assessing Impairment to Respiratory Function....................... 29
2.1.1 .. Measurements................................................................................. 29
2.1.2 .. Methods of Measurement.............................................................. 30
2.1.3... Impairment Rating........................................................................... 30
2.2... Asthma and other Hyper-reactive Airways Diseases............. 31
2.3... Lung Cancer and Mesothelioma.................................................... 32
2.4... Breathing Disorders Associated with Sleep............................... 33
2.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-14) and the definitions contained in the Glossary (see pages 15-16).
The measure of impairment is the reduction in physiological function below that found in health.
Respiratory impairment is quantified by the degree to which measurements of respiratory function are changed by the compensable injury or injuries, relative to values obtained in a healthy reference population.
Conditions such as chronic obstructive airways disease and chronic bronchitis are to be assessed according to the methods used to measure loss of respiratory function.
Employees who have permanent respiratory limitation secondary to massive pulmonary embolism should be assessed under Chapter 2. Any WPI rating awarded in these circumstances must not be combined with a WPI rating from Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System).
2.1 Assessing Impairment to Respiratory Function
2.1.1 Measurements
The most commonly recommended measurements for determining respiratory impairment are:
· spirometry with measurement of the forced expiratory volume at 1 second (FEV1) and forced vital capacity (FVC); and
· the transfer factor, or diffusing capacity of the lung, for carbon monoxide (TlCO), measured by the single breath method.
However, the measurements used must be derived from either:
· the tests prescribed below where relevant (for example, in assessing asthma); or
· where a test is not prescribed, from tests appropriate to assessing the impairments caused by the particular compensable condition or conditions.
Other measurements commonly used to assess impairment include:
· the lung volumes;
· total lung capacity (TLC) and residual volume (RV); and
· the response to a maximum exercise test including measurement of the oxygen consumption at the maximum workload able to be achieved (vO2max), and the degree of arterial oxygen desaturation during exercise.
On occasion, other measurements may be needed to define impairment accurately. For example:
· the elastic and flow resistive properties of the lungs;
· respiratory muscle strength;
· arterial blood gases;
· polysomnography (sleep studies);
· echocardiography with estimation of pulmonary artery pressure; and
· quantitative ventilation-perfusion scans of the lung.
Measurement of the partial pressures of oxygen and carbon dioxide in arterial blood (PaO2 and PaCO2 respectively) are not usually required to assign impairment accurately. However, individual variation may result in severe impairment in gas exchange when other measures of function indicate moderate impairment only. Arterial PaO2 of <55 mm Hg and/or PaCO2 >50 mm Hg, despite optimal treatment, is evidence of severe impairment and attracts a WPI rating of 70%.
Measurements of arterial blood gases should be performed on two occasions with the employee seated.
Methods of Measurement2.1.2
Measurements must be performed in a manner consistent with the methods used by a respiratory function laboratory accredited by one or more of the following bodies:
· the Thoracic Society of Australia and New Zealand;
· the Australian Sleep Society; or
· the Australian Council on Health Care Standards.
Methods of measurement should conform to internationally recognised standards in relation to the equipment used, the procedure, and analysis of the data. Reference values (‘predicted’ normal values) should be representative of the healthy population and be appropriate for ethnicity where possible. Laboratories providing measurements used to assess impairment should state the source of each method of measurement, and the source of the reference values used.
2.1.3 Impairment Rating
Several professional groups have published criteria for rating the severity of impairment based on spirometry, gas transfer and vO2max. These professional groups include the Thoracic Society of Australia and New Zealand (Abramson, 1996), the American Thoracic Society (American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986), and the American Medical Association (2001). In general, measurements are expressed as a percentage of the predicted value (%P) and, where several measurements are performed, the most abnormal result is used to classify the degree of impairment.
Severity of impairment is rated as shown in Table 2.1 (see following page). This generic table can be used to assign WPI ratings using any valid measurement for which there is predicted normal data.
Table 2.1: Conversion of Respiratory Function Values to Impairment
See note immediately following Table 2.1
% WPI Respiratory Function %P 0 >85 10 85 to 76 20 75 to 66 30 65 to 56 40 55 to 51 50 50 to 44 60 45 to 41 70 40 to 36 80 35 Note to Table 2.1
1. %P = percentage of mean value for healthy individuals of the same age, height and sex.
2.2 Asthma and other Hyper-reactive Airways Diseases
Impairment due to asthma can be confounded by the natural history of occupational asthma, by variably severe airflow obstruction, and therefore variable FEV1, and by response to treatment.
For hyper-reactivity of airways due to occupational exposures, assessment of impairment is made after:
· the diagnosis and cause are established;
· exposure to the initiating factors eliminated; and
· appropriate treatment of asthma implemented.
Appropriate treatment follows the guidelines in the Asthma Management Handbook 2002 (National Asthma Council, 2002, 5th ed, Melbourne: National Asthma Council of Australia), a later edition of those guidelines, or later guidelines widely accepted as representing best practice by the medical profession.
Permanent impairment should not be assessed until 2 years after cessation of exposure as severity may improve during this period.
An impairment rating scale is set out in Figure 2-A and Table 2.2 (both on following page). The scale used in Figure 2-A and Table 2.2 is modified to account for frequency of increased impairment from asthma despite optimal treatment.
A score reflecting impairment from asthma is calculated by:
· adding the points scored for reduction in FEV1 %P;
· and either
· change in FEV1 with bronchodilator (reversibility);
or
· degree of bronchial hyperreactivity defined by the cumulative dose of metacholine, or histamine, required to decrease baseline FEV1 by at least 20%;
· and
· measurement of FEV1, or peak flow (PF) rate, measured by the employee morning and evening, before and after aerosol bronchodilator, for at least 30 days.
The number of days on which any valid measurement of FEV1 or PF is less than 0.85 x the mean of the six highest values of FEV1 or PF during the monitoring period is to be expressed as a percentage of total days in the monitoring period.
The maximum impairment score from Figure 2-A below is 11. One additional point is given, yielding a score of 12, if asthma cannot be controlled adequately with maximal treatment. The score from Figure
2-A is converted to a WPI rating using Table 2.2 (below).
Figure 2-A: Calculating Asthma Impairment Score
See notes immediately following Figure 2-A
Score FEV1, % P
After Bronchodilator
DFEV1, % Change in FEV1 with Bronchodilator PD20
OR mmol
% of Days Lowest FEV1* is 0.85 Highest FEV1 0 >85 <10 >4.0 <6 1 76 to 85 10 to 19 0.26 to 4.0 6 to 24 2 66 to 75 20 to 29 0.063 to 0.25 25 to 34 3 56 to 65 30 0.062 35 to 44 4 55 45 Notes to Figure 2-A
1. Figure 2-A is based on scales proposed by: the American Thoracic Society (1993), as adapted in Tables 5-9 and 5-10 of
American Medical Association’s Guides to the Evaluation of Permanent Impairment (5th edition, 2001); and the Thoracic
Society of Australia and New Zealand (Abramson, 1996).
2. %P = percent predicted normal value.
3. PD20 = cumulative dose of inhaled metacholine aerosol causing a 20% decrease in FEV1.
4. * monitored twice daily before and after aerosol bronchodilator for at least 30 days during adequate
treatment.
5. % of days = proportion of days any value of FEV1 (or of peak flow rate) is less than highest repeatable FEV1
(or peak flow rate) x 0.85.
Table 2.2: WPI Derived from
Asthma Impairment Score
% WPI Asthma Impairment Score 0 0 10 1 20 2 30 3 40 4 45 5 50 6 55 7 60 8 65 9 70 10 75 11 80 12 2.3 Lung Cancer and Mesothelioma
Employees with lung cancers (other than mesothelioma) are considered severely impaired at the time of diagnosis and are given a WPI rating of 70%.
If there is evidence of tumour, or if tumour recurs one year after diagnosis is established, then the employee remains severely impaired and the WPI rating is increased to 80%.
Employees with mesothelioma are considered severely impaired and a WPI rating of 85 % is awarded upon diagnosis.
2.4 Breathing Disorders Associated with Sleep
Some disorders such as obstructive sleep apnoea, central sleep apnoea, and hypoventilation during sleep, can cause impairment which is not quantifiable by standard measurements of respiratory function such as spirometry, diffusing capacity, or response to exercise.
Obstructive sleep apnoea should be assessed using Table 2.4 below. Central sleep apnoea should be assessed using Table 12.1.3: Sleep and Arousal Disorders (see page 131, Chapter 12 – The Neurological System).
An overnight sleep study is used to define the severity of sleep-related disorders of breathing and can be used to define impairment after appropriate treatment has been implemented. During the overnight sleep study there is continuous monitoring of breathing pattern, respiratory effort, arterial oxygen saturation, electrocardiogram, and sleep state. Results of sleep studies cannot readily be expressed in terms of a percentage of predicted values. Consequently, impairment is rated by assigning scores to the degree of abnormality at sleep study (Figure 2-B, and Table 2.4, below). These ratings are based on frequency of disordered breathing, frequency of sleep disturbance, degree of hypoxaemia and, as appropriate, hypercapnoea during sleep. In addition, degree of daytime sleepiness is assessed using the Epworth sleepiness scale (Johns, 1991).
Where vascular morbidity is present (for example, high blood pressure, myocardial infarction, or stroke) and is attributable to sleep apnoea, impairment should be assessed against the relevant table in Chapter 1 – The Cardiovascular System (see page 19).
The total score derived from Figure 2-B below is the sum of the scores from each column: the maximum score is 12. This score is converted to a WPI rating using Table 2.4 below.
Figure 2-B: Calculating Obstructive Sleep Apnoea Score
See notes immediately following Figure 2-B.
Score Epworth Sleepiness Score Apnoeas + Hypopnoeas/hr of Sleep Respiratory Arousals*/hr of Sleep Cumulative Sleep Time, mins, with SaO2 <90% # 0 <5 <5 <5 0 1 5 to 10 5 to 15 5 to 15 <15 2 11 to 17 16 to 30 16 to 30 15 to 45 3 >17 >30 >30 >45 Notes to Figure 2-B
1. *An arousal within 3 seconds of a sequence of breaths which meet the criteria for an apnoea, an hypopnoea, or a respiratory effort related arousal, as defined by the American Academy of Sleep Medicine (1999).
2. SaO2 = arterial oxygen saturation measured with a pulse oximeter.
Table 2.4: WPI Derived from Obstructive Sleep Apnoea Score
% WPI Sleep Apnoea Score 0 0 10 1 20 2 30 3 40 4 45 5 50 6 55 7 60 8 65 9 70 10 75 11 80 12
Chapter 3 – The Endocrine System
Page no.
3.0 Introduction............................................................................................. 35
3.1 . Thyroid and Parathyroid Glands................................................... 36
3.2 .. Adrenal Cortex and Medulla............................................................ 37
3.3 .. Pancreas (Diabetes Mellitus)........................................................... 38
3.4 .. Gonads and Mammary Glands....................................................... 39
3.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-15) and the definitions contained in the Glossary (see pages 15-16).
The degree of impairment caused by secondary conditions (such as peripheral neuropathy, or peripheral vascular disease) accompanying an endocrine system condition must also be assessed under the relevant tables in other Chapters, including tables in Chapter 10 – The Urinary System (see page 119).
In this circumstance, using the Combined Values Chart (Appendix 1), WPI ratings derived from the relevant tables in other Chapters are combined with WPI ratings from tables in Chapter 3.
3.1 Thyroid and Parathyroid GlandsHyperthyroidism is not considered to cause permanent impairment because the condition is usually amenable to treatment. Where visual and/or cosmetic effects resulting from exophthalmos persist following correction of the hyperthyroidism, a WPI rating may be derived from:
· Chapter 4 – Disfigurement and Skin Disorders (see page 41); and/or
· Chapter 6 – The Visual System (see page 47, section 6.5 - Other Conditions Causing Permanent Deformities Causing up to 10% Impairment of the Whole Person).
Hyperparathyroidism is usually amenable to correction by surgery. If surgery fails, or the employee cannot undergo surgery for sound medical reasons, long-term therapy may be needed. If so, permanent impairment can be assessed after medication, in accordance with the criteria in Table 3.1 below.
Where an employee has more than one of the conditions in Table 3.1 below, combine the WPI ratings using the Combined Values Chart (see Appendix 1).
Permanent secondary impairment resulting from persistent hyperparathyroidism (such as renal calculi or renal failure) should be assessed under the relevant system (for example, Chapter 10 – The Urinary System, see page 119).
Table 3.1 Thyroid and Parathyroid Glands
% WPI Criteria 0 Hyperparathyroidism – symptoms and signs readily controlled by medication or other treatment such as surgery.
Hypoparathyroidism – symptoms and signs readily controlled by medication.
Hypothyroidism adequately controlled by replacement therapy.
15 Hypothyroidism where the presence of a disease in another body system prevents adequate replacement therapy.
Hyperparathyroidism – persisting mild hypercalcaemia, despite medication.
Hypoparathyroidism – symptoms and signs such as intermittent hyper or hypocalcaemia not readily controlled by medication.
30 Hyperparathyroidism – persisting severe hypercalcaemia with serum calcium above 3.0mmol/l, despite medication. 3.2 Adrenal Cortex and Medulla
Where Cushing’s syndrome is present, Table 3.2 below should be used to evaluate impairment from the general effects of hypersecretion of adrenal steroids (for example, myopathy, easy bruising, and obesity).
Using the Combined Values Chart (see Appendix 1), WPI ratings derived from Table 3.2 may be combined with WPI ratings for specific associated secondary impairments (for example, fractures or diabetes mellitus).
Table 3.2 Adrenal Cortex and Medulla
% WPI Criteria 0 Cushing’s syndrome – surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH secretion.
Phaeochromocytoma – benign tumour, surgically removed or removable where the duration of hypertension has not led to the development of permanent cardiovascular disease.
5 Hypoadrenalism – symptoms and signs readily controlled with replacement therapy.
Cushing’s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15 mg of prednisolone per day) where glucocorticoids will be required long-term.
10 Cushing’s syndrome – surgically corrected by removal of pituitary adenoma or adrenal carcinoma. 15 Cushing’s syndrome – due to:
· bilateral adrenal hyperplasia treated by adrenalectomy; or
· large doses of glucocorticoids (for example, equivalent of at least 15 mg of prednisolone per day) where glucocorticoids will be required long-term; or
· inadequate removal of source of ectopic ACTH secretion.
Phaeochromocytoma – malignant tumour where signs and symptoms of catecholamine excess can be controlled with blocking agents.
Hypoadrenalism – recurrent episodes of adrenal crisis during acute illness or in response to significant stress.
70 Phaeochromocytoma – metastatic malignant tumour where signs and symptoms of catecholamine excess cannot be controlled with blocking agents or other treatment.
3.3 Pancreas (Diabetes Mellitus)
Where diabetic retinopathy has led to visual impairment, the visual impairment should be assessed using Chapter 6 – The Visual System (see page 47).
Where diabetes has led to secondary impairment of renal function, that impairment should be assessed using Chapter 10 – The Urinary System (see pages 119).
Using the Combined Values Chart (see Appendix 1), WPI ratings derived under Table 3.1 (see page 36) and Table 3.2 (see page 37) may be combined with WPI ratings from Table 3.3 below.
Microangiopathy may be manifest as retinopathy (background, proliferative, or maculopathy) and/or albuminuria measured with a timed specimen of urine. Where there is an overnight collection, the upper limit of normal is 20 mg/minute. Where a 24 hour specimen is taken, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least 2 out of 3 consecutive urine specimens.
Table 3.3: Pancreas (Diabetes Mellitus)
See notes to Table 3.3 immediately following Table.
% WPI Type Therapy Microvascular Complications 5 Type 2 (NIDDM) Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. Microangiopathy is not present. 10 Type 2 (NIDDM) Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. Microangiopathy and/or significant neuropathy are present. 15 Type 1 (IDDM) Dietary restrictions and insulin give satisfactory control. Microangiopathy is not present. 20 Type 1 (IDDM)
Type 2 (NIDDM)
Dietary restrictions and insulin give satisfactory control
Type 2 (NIDDM) where dietary restrictions & insulin &/or oral hypoglycaemic agents give satisfactory control.
Microangiopathy and/or significant neuropathy are present. 25 Type 1 (IDDM) Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. Microangiopathy is not present. 30 Type 1 (IDDM) Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. Microangiopathy is present. 40 Type 1 (IDDM) Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. Microangiopathy is present as well as significant neuropathy. 50 Symptomatic hypoglycaemia due to metastatic tumour (usually insulinoma), uncontrolled by medication (such as diazoxide). Notes to Table 3.3
1. For the purposes of Table 3.3, the degree of control is defined by reference to the glycated haemoglobin measurement (HbA1c) where:
· 4%-6% is the non-diabetic range;
· <8% is indicative of satisfactory control for the purposes of this table.
2. ‘Significant neuropathy’ means persistent symptoms of peripheral or autonomic neuropathy which interfere with
Part 2 - Combined Values Chart (continued) 51 76 52 76 77 53 77 77 78 54 77 78 78 79 55 78 78 79 79 80 56 78 79 79 80 80 81 57 79 79 80 80 81 81 82 58 79 80 80 81 81 82 82 82 59 80 80 81 81 82 82 82 83 83 60 80 81 81 82 82 82 83 83 84 84 61 81 81 82 82 82 83 83 84 84 84 85 62 81 82 82 83 83 83 84 84 84 85 85 86 63 82 82 83 83 83 84 84 84 85 85 86 86 86 64 82 83 83 83 84 84 85 85 85 86 86 86 87 87 65 83 83 84 84 84 85 85 85 86 86 86 87 87 87 88 66 83 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88 67 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88 89 89 68 84 85 85 85 86 86 86 87 87 87 88 88 88 88 89 89 89 90 69 85 85 85 86 86 86 87 87 87 88 88 88 89 89 89 89 90 90 90 70 85 86 86 86 87 87 87 87 88 88 88 89 89 89 90 90 90 90 91 91 71 86 86 86 87 87 87 88 88 88 88 89 89 89 90 90 90 90 91 91 91 92 72 86 87 87 87 87 88 88 88 89 89 89 89 90 90 90 90 91 91 91 92 92 92 73 87 87 87 88 88 88 88 89 89 89 89 90 90 90 91 91 91 91 92 92 92 92 93 74 87 88 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 75 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94 76 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94 77 89 89 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94 94 95 78 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95 79 90 90 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95 95 96 80 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 95 95 95 95 95 96 96 96 81 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96 82 91 91 92 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96 96 97 97 83 92 92 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 97 97 97 97 84 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 85 93 93 93 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98 86 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 98 98 98 98 87 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98 98 98 98 98 98 88 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 99 89 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 99 99 99 90 95 95 95 95 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 91 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 92 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 93 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 94 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 95 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 96 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 97 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
PART 2
Division 2
Non-Economic Loss
Introduction
The degree of non-economic loss is to be assessed in accordance with this part.
The compensation payable for non-economic loss is divided into two equal amounts. The formula to calculate the total payable in an individual case is:
$ Total = A + B
WHERE A = the percentage assessment of total permanent impairment, multiplied by the first half of the maximum
AND B = a reasonable percentage of the second half of the maximum, having regard to the non-economic loss suffered.
To calculate B, the following tables in this part are used:
Table 1 Pain and Suffering
Table 2 Loss of Amenities
Table 3 Other Loss
Table 4 Loss of Expectation of Life
Table 5 Combined Value Calculation
Table 6 Final calculation
TABLE 1: PAIN AND SUFFERING
Only permanent pain and suffering is considered. Suffering is the mental distress as a result of the accepted conditions (it includes emotional symptoms such as grief, anguish, fear, frustration, humiliation, embarrassment etc).
This table does not include temporary pain and suffering. Nor does it include speculation of future pain and suffering that has not yet manifested itself.
A score out of 5 is assessed for both pain and for suffering. These two scores are then combined with the scores derived from Tables 2, 3 and 4 using the combined value calculation (Table 5).
Pain SCORE DESCRIPTION OF LEVEL OF EFFECT 0 No pain experienced 1 Intermittent attacks of pain of nuisance value only. Can be ignored with activity commences 2 Intermittent attacks of pain. Not easily tolerated, but short lived. Responding fairly readily to treatment 3 Episodes of pain more persistent. Not easily tolerated. Treatment, if available, of limited benefit 4 Pain occurring most of the time. Restrictions on activity. Resistant to treatment 5 Pain continuous and severe. Preventing activity. Uncontrolled by medication
Suffering SCORE DESCRIPTION OF EFFECT 0 No symptoms experienced 1 Symptoms minimal or ill defined. Occur intermittently. No interference with activity. 2 Distinct symptoms. Episodic in nature. Activities reduced during such episodes. Recovers quickly after episodes. 3 Symptoms distinct and varied. Episodes occur regularly. Ability to cope or perform activity effectively reduced during episodes. Needs time to recover between episodes. Treatment of benefit. 4 Symptoms wide ranging. Tend to dominate thinking. Little time when free of symptoms. Difficulty coping or performing activity. Treatment necessary. 5 Constantly focussed on condition. Ruled by emotions. Symptoms predominate over thinking. Unable to cope. Activities severely restricted. Treatment of no real help.
TABLE 2: LOSS OF AMENITIES
Loss of amenities is also known as loss of enjoyment of life.
A score out of 5 is assessed for each of the following:
- mobility;
- social relationships; and
- recreation and leisure activities.
These are then combined with the scores from Tables 1, 3 and 4 using the combined value calculation (Table 5).
Mobility
Concerns the employee’s ability to move around in his or her environment
SCORE DESCRIPTION OF EFFECT 0 No or minimal restrictions on mobility 1 Effects on mobility periodic or intermittent - in between episodes no restrictions. Effects continuing but mild (eg slowing of pace, need for a walking stick) (can do everything, but at a slower pace) 2 Mobility reduced, but remains independent of others both within and outside the home. Can travel but may need to have breaks, special seating etc 3 Mobility markedly reduced. Needs some assistance from others. Unable to use most forms of transport
4 Restricted to home and vicinity. Can only travel with door to door transport. Needs assistance of others 5 Severely restricted mobility (eg bed, chair, room). Dependent on others for assistance. Mechanical devices or appliances used (eg wheelchair, hoist)
Social Relationships
Concerns the employee’s capacity to engage in usual social and personal relationships
SCORE DESCRIPTION OF EFFECT 0 Usual relationships unaffected 1 Minor interference with personal relationships, causing some reduction in social activities and contacts 2 Relationships confined to immediate and extended family and close friends, but unable to relate to casual acquaintances. 3 Difficulty in maintaining relationships with close friends and the extended family 4 Social contacts confined to immediate family 5 Difficulties relating socially to anyone
Recreation and Leisure Activities
Concerns the employee’s ability to maintain customary recreational and leisure pursuits
SCORE DESCRIPTION OF EFFECT 0 Able to follow usual recreation and leisure activities 1 Intermittent interference with activities. In between episodes able to pursue usual activities 2 Interference to activities reduces frequency of activity, but is able to continue. Is able to enjoy alternatives 3 Unable to continue activity. Alternative less rewarding activity possible 4 Range of activities greatly reduced. Needs some assistance to participate 5 Unable to undertake any satisfying or rewarding activities Guide to the assessment of the degree of permanent impairment: Part 2
TABLE 3: Other Loss
This table is used to assess losses of a non-economic nature that are not adequately covered by Table 1, 2 or 4.
A score out of 3 is assessed. This is then combined with the scores derived from Tables 1, 2 and 4. using the combined value calculation (Table 5).
The types of factors which would be considered here may include:
- Dependence upon external life saving or supporting machine (for example, aspirator, respirator, dialysis machine, or any form of electro-mechanical device for the sustenance or extension of activities)
- Dependence upon a specialised diet
- Detrimental effects of climatic features (for example, temperature, humidity, ultra-violet rays, light, noise, dust)
· Move to specially modified premises
________________________________________________________________
SCORE DESCRIPTION OF EFFECT 0 Nil or minimal disadvantages 1 Slight disadvantages 2 Moderate disadvantages 3 Marked disadvantages Guide to the assessment of the degree of permanent impairment: Part 2
TABLE 4; Loss of Expectation of Life
A score out of 3 is assessed. This is then combined with the scores derived from Tables 1, 2 and 3. using the combined value calculation (Table 5). Loss of expectation of life is restricted to a maximum of 3 points because of the value placed on it by the courts in damages cases.
________________________________________________________________
SCORE DESCRIPTION OF EFFECT OF EFFECT 0 Loss of life expectancy of less than 1 year 1 Loss of life expectancy of 1 year to less than 10 years 2 Loss of life expectancy of 10 years to less than 20 years 3 Loss of life expectancy of 20 years or greater Guide to the assessment of the degree of permanent impairment: Part 2
TABLE 5: Combined Value Calculation
This table converts the total of the scores (assessed in Tables 1, 2, 3 and 4) to a percentage of the second half of the maximum lump sum payable for non-economic loss.
________________________________________________________________
CALCULATION OF TOTAL OF SCORES
Table 1 - Pain and Suffering
(Pain Score ____) x 0.5 = ____
(Suffering Score ____) x 0.5 = ____
Table 2 - Amenities of Life
(Mobility Score ____) x 0.6 = ____
Social Relationships Score ____) x 0.6 = ____
(Recreation and Leisure Activities Score ____) x 0.6 = ____
Table 3 - Other Loss
(Score ____) x 1.0 = ____
Table 4 - Loss of Expectation of Life
(Score ____) x 1.0 = ____
TOTAL OF SCORES = ____
CONVERSION OF TOTAL OF SCORES TO A PERCENTAGEA. If the combined total of scores from Tables 1, 2, 3 and 4 equals or is greater than 15, then 100 percent of the second half of the maximum is payable
OR
B. If the combined total of scores from Tables 1, 2, 3 and 4 is less than 15, then the percentage of the second half of the maximum that is payable is calculated using the following formula:
(total of scores) x 100 15 Guide to the assessment of the degree of permanent impairment: Part 2
TABLE 6: Final Calculation
(benefit levels as from 1 July 2005)*
(1) WHOLE PERSON IMPAIRMENT
(as per Permanent Impairment Questionnaire)____ % x $137,501.12 $__________ (2) FIRST HALF OF $25,781.48 ____ % x $ 25,781.48 $__________ (3) SECOND HALF OF $25,781.48
(as per Non-Economic
Loss Questionnaire)
Table 1 - Pain and Suffering Pain Score ____ Suffering Score ____ Subtotal of Scores ____ x 0.5 = ____ Table 2 - Amenities of Life Mobility Score ____ Social Relationships Score ____ Recreation and Leisure
Activities Score____ Subtotal of Scores ____ x 0.6 = ____ Table 3 - Other Loss Other Loss Score ____ x 1.0 = ____ Table 4 - Loss of Expectation of Life Loss of Expectation Score ____ x 1.0 = ____ TOTAL OF SCORES If Score > 15: pay maximum $25,781.48
If Score < 15: calculate % of $25,781.48
using following formula:
(total of scores) x 100 15 $__________ TOTAL $__________
*These are indexed annually on 1 July in accordance with CPI. Check with Comcare for the latest rates if unsure.
PART 2
Index
A
activities of daily living.............................................. 176
defined.................................................................... 179
acuity, visual, disorders of......................................... 193
aggravation
see Principles of Assessment.............................. 178
ailment
defined.................................................................... 179
amenities, loss of......................................................... 225
defined.................................................................... 179
amputations.................................................................. 202
anaemia......................................................................... 217
anaemia......................................................................... 217
ankle 201
ankylosis
- upper extremity................................................... 200
- lower extremity.................................................... 201
anus 196
ascites........................................................................... 198
assessment, double
see Principles of Assessment.............................. 177
assessments, interim
see Principles of Assessment.............................. 178
assessments of symptomatic activity levels........... 182
asthma........................................................................... 217
B
biliary colic................................................................... 198
biliary tract.................................................................... 198
birth, vaginal delivery................................................. 211
blindness
- colour................................................................... 193
- night..................................................................... 193
C
Cardio-vascular System.............................................. 182
cervical stenosis.......................................................... 211
cervix............................................................................. 211
cheek, depression of................................................... 190
claudication.................................................................. 183
cognitive function....................................................... 213
colic, biliary.................................................................. 198
colon.............................................................................. 196
colostomy..................................................................... 199
colour blindness.......................................................... 193
combined value calculation....................................... 229
combined values chart................................................ 219
communication, and neurological function............. 213
comprehension, and neurological function............. 214
conjunctivitis............................................................... 193
cranial nerves............................................................... 213
D
deep venous thrombosis............................................ 184
depression
- of the cheek......................................................... 190
- of the frontal bones........................................... 190
diabetes mellitus.......................................................... 188
diastasis of rectus....................................................... 199
Digestive System......................................................... 196
disease
defined.................................................................... 179
disfigurement
see facial disfigurement
double assessment
see Principles of Assessment............................. 177
duodenum..................................................................... 196
E
ear.................................................................................. 194
Ear, Nose and Throat Disorders................................ 194
elbow............................................................................. 200
employability
see Principles of Assessment.............................. 177
Endocrine System........................................................ 188
epididymal disease...................................................... 209
epilepsy......................................................................... 217
expectation of life, loss of.......................................... 228
expression, and neurological function..................... 213
F
facial disfigurement..................................................... 190
facial paralysis............................................................. 190
fallopian tubes............................................................. 211
female reproductive system....................................... 211
fingers
see also Principles of Assessment..................... 178
fistulae........................................................................... 199
flail joints...................................................................... 201
G
galactorrhea.................................................................. 212
gastronomy.................................................................. 213
gastrostomy................................................................. 199
glaucoma....................................................................... 193
gynaecomastia............................................................. 212
H
haemodialysis.............................................................. 207
haemopoetic system................................................... 217
headache, tension....................................................... 217
hearing.......................................................................... 194
see also hearing and neurological function...... 214
heart disease
- ischaemic............................................................. 182
- rheumatic............................................................. 182
hemipelvectomy........................................................... 202
herniae........................................................................... 199
hepatic coma................................................................ 198
hepatic insufficiency................................................... 198
hip.................................................................................. 201
hormonal abnormality, male....................................... 209
hyperparathyroidism................................................... 188
hypertension................................................................ 182
I
ileostomy...................................................................... 199
impairment
defined.................................................................... 179
- gradations of,
- permanent,
see Principles of Assessment.............................. 176
impairments, combined
see Principles of Assessment.............................. 177
impotence..................................................................... 209
incapacity
see Principles of Assessment.............................. 177
incontinence
- faecal............................................................ 196, 197
inguinal hernia............................................................. 199
injury
defined.................................................................... 179
interim assessments
see Principles of Assessment.............................. 178
intermittent conditions............................................... 217
intestine, small............................................................. 196
ischaemic heart disease.............................................. 182
ischaemic pain.............................................................. 183
J
jaundice......................................................................... 198
jejunostomy.................................................................. 199
K
kidney............................................................................ 207
knee 201
L
leisure activities, and loss of amenities.................... 226
leucocyte disorders..................................................... 217
limb function
- upper.................................................................... 204
- lower..................................................................... 205
liver 198
loss of amenities.......................................................... 225
defined.................................................................... 179
loss of expectation of life........................................... 228
loss, other
explained............................................................... 227
lower urinary tract....................................................... 208
M
male reproductive system.......................................... 209
malignancies................................................................. 218
memory.................................................................. 213, 216
menopause................................................................... 211
metabolic costs of activities, table of....................... 182
migraine......................................................................... 217
mobility, and loss of amenities.................................. 225motor loss, paralysis, and cranial nerves................. 213
Musculo-skeletal System........................................... 200
N
nasal discharge, post.................................................. 195
neuralgia
- facial..................................................................... 213
- trigeminal............................................................. 213
Neurological Function................................................ 213
neuroses....................................................................... 191
non-economic loss...................................................... 223
defined.................................................................... 179
see Principles of Assessment.............................. 176
nose, disfigurement, loss........................................... 190
nystagmus.................................................................... 193
O
oedema.......................................................................... 184
oesophageal varices................................................... 198
oesophagus.................................................................. 196
oesophogostomy........................................................ 199
olfaction, loss of.......................................................... 195
orbit, disfigurement of................................................ 190
osteoporosis................................................................ 188
otalgia............................................................................ 195
otorrhea......................................................................... 195
ovaries........................................................................... 211
ovulation....................................................................... 211
P
Paget’s disease............................................................ 188
pain................................................................................ 224
defined.................................................................... 179
pancreas........................................................................ 196
paralysis
- facial..................................................................... 190
- neurological function........................................ 213
parathyroid adenoma.................................................. 188
peripheral vascular disease........................................ 183
peritoneal dialysis....................................................... 207
permanent impairment
see Principles of Assessment.............................. 177
pigmentation, facial..................................................... 190
personality disorders.................................................. 191
platelet disorders......................................................... 217
polycythaemia.............................................................. 217
prostate......................................................................... 209
Psychiatric Conditions............................................... 191
psychoses.................................................................... 191
R
range of movement
- upper extremity................................................... 200
- lower extremity.................................................... 200
reasoning, and neurological function.............. 213, 216
recreation, and loss of amenities............................... 226
rectum............................................................................ 196
relationships, social, and loss of amenities............. 225
renal function............................................................... 207
Reproductive System.................................................. 209
Respiratory System..................................................... 185
rheumatic heart disease.............................................. 182
rhinorrhea..................................................................... 195
S
scars, facial, cutaneous.............................................. 190
scrotum......................................................................... 209
seminal abnormality.................................................... 209
seminal vesicles........................................................... 209
sensory loss, and cranial nerves............................... 213
sexual function, male................................................... 209
skin disorders............................................................... 189
shoulder........................................................................ 200
small intestine.............................................................. 196
sneezing........................................................................ 195
spermatic cord disease............................................... 209
spine.................................................................................... 206
but note
- for lesions of sacrum or coccyx see
limb function tables
social relationships, and loss of amenities.............. 225
stoma
- miscellaneous ear, nose and throat
disorders.............................................................. 195
stomach......................................................................... 196
suffering........................................................................ 224
defined.................................................................... 179
swallowing impairment............................................... 213
symptomatic activity levels, assessments of.......... 182
T
taste, loss of................................................................. 195
see also cranial nerves......................................... 213
tension headache........................................................ 217
testis.................................................................................... 209
thrombosis, deep venous........................................... 184
thyroid disease............................................................ 188
tic douloureux.............................................................. 213
tinnitus.......................................................................... 195
toes
see also Principles of Assessment..................... 178
tracheostomy............................................................... 195
transitional cases
see Principles of Assessment.............................. 178
U
ulceration...................................................................... 184
upper extremity............................................................ 200
upper urinary tract....................................................... 207
Urinary System............................................................ 207
urinary tract
- lower..................................................................... 208
- upper.................................................................... 207
uterus............................................................................ 211
V
vagina............................................................................ 211
vaginal delivery........................................................... 211
vascular disease, peripheral....................................... 183
varices, oesophageal.................................................. 198
varicose veins.............................................................. 184
veins, varicose............................................................. 184
ventilatory function.................................................... 185
ventral hernia............................................................... 199
verbal expression, and neurological function......... 215
visual acuity, disorders of.......................................... 193
visual field defects...................................................... 193
Visual System............................................................... 193
vulva.............................................................................. 211
W
whole person impairment
defined.................................................................... 179
see Principles of Assessment.............................. 177
written expression, and neurological function........ 215
wrist 200
0
0
0