Permanent impairment assessment

Medical practitioner guidelines for assessing permanent impairment

The requirements for assessment of permanent impairment (PI) of workers are set out under the Workers' Compensation and Rehabilitation Act 2003 (the Act). The legislation prescribes the use of the Table of Injuries and the American Medical Association Guides for the Evaluation of Permanent Impairment 4th Edition (AMA Guides 4th Edition).

All medical reports requested by insurers within the Queensland workers' compensation scheme must also conform to these legislative provisions.

When asked to assess whether a claimant has a PI, usually at the request of an insurer, the assessing medical practitioner must consider the following:

1. For visual injuries use the methodology of the ophthalmologists' guide in conjunction with the Table of Injuries Part 3 under the Workers' Compensation and Rehabilitation Regulation 2003 (the Regulation).
2. For hearing loss use the NAL hearing loss tables in conjunction with the Table of Injuries Part 3.
3. For all other physical injuries and psychiatric/psychological injuries use the methodology of the AMA Guides 4th Edition and then;
4. Determine the interaction between the Table of Injuries Schedule 2 under the Regulation and the applicable guides to derive the final PI % and PI code.

In keeping with the legislative provisions and the applicable guides, the final report must encompass the following:

• a medical history
• details of the clinical evaluation, such as the range of movement, neurological findings and any relevant investigations
• whether the injury is stable and stationary
• methodology used (with reference to AMA Guides 4th Edition chapter, section and table)
• conclusions with reasons
• the nature of the PI (description of work related medical injury/illness) and calculation of the applicable degree of PI.

As part of the above, the following inclusions are essential for workers' compensation reports:

• comments on the work-related medical diagnosis
• consideration of any pre-existing PI (apportionment for prior injuries/illness).

Permanent impairment assessment reports that comply with the above are paid at a higher level than other medical reports. If the report does not comply, the insurer may request further details before payment for the complete report is processed.

Medical practitioners who are unfamiliar with the PI assessment structure according to the AMA Guides 4th Edition and/or the Queensland workers' compensation reporting format. This in-depth format is designed to include the above essential features in a structured format when assessing permanent impairment.

Legislation Relating to Permanent Impairment Assessment

The requirements for assessment of permanent impairment of workers are set out under sections 178, 179 and 186 of the Act. Section 179(3) instructs that, "the degree of permanent impairment must be assessed in the way prescribed under a regulation".

The Regulation s92 refers to the use of the Table of Injuries as set out in Schedule 2. The Regulation further refers to the use of the AMA Guides 4th Edition and states that:

"The methods used in assessing the degree of permanent impairment resulting from an injury mentioned in part 1,2,4,or 6 are the methods stated in the AMA Guides" s92(3).

"The methods that must be used in assessing the degree of permanent impairment resulting from an injury mentioned in the Table of Injuries, Part 3 are the methods stated in the ophthalmologists guide or hearing loss tables" s92(6).

Where there is inconsistency between the Table of Injuries and the AMA Guides 4th Edition, ophthalmologist guides or hearing loss tables, the Table of Injuries prevails.