As an allied health provider you will be often called upon to
provide goal oriented rehabilitation focusing on return to work.
Where the worker's injury is complex and an ongoing impairment is
likely, the allied health provider's aim will be to maximise the
worker's independent functioning and may include ongoing advice to
the injured worker to assist with the understanding of their
impairment.
You will deliver effective messages to the worker by ensuring you
have an understanding of the difference between impairment and
disability within the workers' compensation setting.
The terms impairment and disability are often interchanged, but in
fact their meanings differ substantially.
While both concepts are about illness and injury, one of the key
differences is impairment should reflect an objective assessment
and disability is a more subjective determination. Impairment is
more about a medical model, whereas disability has more to do with
a social model involving interaction with the person's environment
and community.
Psychiatrist Jill Reddan, a current member of our General Medical
Assessment Tribunal, agrees there can be a significant level of
confusion about the difference between impairment and
disability.
'I think there can be confusion not just within the medical
community but also the general community,' Dr Reddan says.
'It's important to understand impairment is an objective construct
defined as 'a loss, loss of use, or derangement of any body part,
organ system or organ function'. 1
'Disability is evaluated by non-medical means and is defined as
'an alteration of an individual's capacity to meet personal, social
or occupational demands because of an impairment'.2
Dr Reddan explains that sometimes an individual who has sustained
an injury may feel confused that an impairment rating assigned by a
medical practitioner or a tribunal does not adequately reflect the
full impact upon his or her life of the injury.
'This is because an impairment rating cannot take into account all
of the unique implications of an injury to the individual. There is
no way of rating disability and the very same injury can have very
different implications for different individuals'.
'Impairment is a structured and objective-based assessment,
whereas disability determination takes into account what the loss
means to the individual,' Dr Reddan explains.
Under the Queensland workers' compensation scheme, a medical
practitioner may be asked by an insurer to assess a worker's injury
to decide if the injury has resulted in a degree of permanent
impairment (impairment that is stable and stationary).
Dr Reddan explains the assessment of the degree of permanent
impairment, if any, can be a difficult task and it requires
considerable experience in assessing the effects of injury which is
one of the reasons why assessment of impairment is a task for
medical practitioners.
Dr Reddan says while the definition of impairment concentrates on
loss after an injury it's also important to focus on the level of
function that remains after an injury.
'It has been my personal experience that very often, the higher
the level of impairment the more the injured individual will focus
on the remaining abilities.
'I think it's very important when you are treating someone to
focus on the positives and to help them overcome the problem or the
injury rather than staying fixated on it,' Dr Reddan says.
1,2 Cocchiarella, L & Andersson, G 2000, Guides to the
Evaluation of Permanent Impairment, 5th edn, AMA Press, United
States of America.
Case studies
The following two examples will help to show the difference
between impairment and disability. In both cases the injured
workers have permanent impairment but only one has a
disability.
1. David is a carpenter who works for a business that builds
roofing frames. David had an accident at work and the tips of two
fingers on his left hand (non-dominant hand) were amputated. David
had surgery and physiotherapy and went back to work on suitable
duties for a period of time. He is now at work performing the same
job and activities he did before the accident. David has a
permanent impairment from his injury (loss of part of two fingers
on his left hand) and an entitlement to lump sum compensation.
However, he does not have a disability because he is able to work
as before and the injury has not affected his personal, social or
work skills.
2. Mary is a concert pianist employed in an orchestra. She had an
accident at work and also lost the tips of two fingers on her right
hand (dominant hand). Mary had surgery and rehabilitation but is
unable to continue as a concert pianist as a result of losing her
fingertips. Mary also has a permanent impairment from her injury
(loss of part of two fingers on her right hand) but unlike David,
she has a disability because the injury has affected her personal,
social and work skills. As a consequence, she cannot continue as a
concert pianist.
