Principles of Assessment

1. Impairment and Non-Economic Loss
2. Employability and Incapacity
3. Permanent Impairment
4. Pre-Existing Conditions and Aggravation
5. The Impairment Tables
6. Malignancies and conditions resulting in major systemic failure
7. Percentages of Impairment
8. Comparing Assessments under Alternative Tables
9. Combined Values
10. Calculating the Assessment
11. Ordering of Additional Investigations
12. Exceptions to use of this Guide

 

1. Impairment and Non-Economic Loss

Under section 3 of the Seafarers Act, impairment means ?the loss, the loss of the use, or the damage or malfunction, of any part of the body or of the whole or part of any bodily 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 Division 2 of this Guide, and deals with the effects of the impairment on the employee?s life. Under section 3 of the Seafarers Act, non economic loss, for 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?.

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.

2. Employability and Incapacity

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.

3. Permanent Impairment

Compensation is only payable for impairments which are permanent. Under section 3 of the Seafarers Act ?permanent? means ?likely to continue indefinitely?. Subsection 39(2) of the Seafarers 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.

4. Pre-Existing Conditions and Aggravation

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.

5. The Impairment Tables

Division 1 of this Guideis 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 5^th 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 this Guidewhen 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.

6. Malignancies and conditions resulting in major systemic failure

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 Appendix 1.

7. Percentages of Impairment

Each table in 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%.

8. Comparing Assessments under Alternative Tables

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.

9. Combined Values

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 Appendix 1) unless the notes in the relevant section specifically stipulate that the scores are to be added (For instance, see 9.8.1).

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 ? 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 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.

10. Calculating the Assessment

Where relevant, a statement is included in the Chapters of 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 of this Guide.

11. Ordering of Additional Investigations

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 this Guide.

12. Exceptions to use of thisGuide

In the event that an employee?s impairment is of a kind that cannot be assessed in accordance with the provisions of thisGuide, 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 Chapter 9 ? 9.13.3 Complex Regional Pain Syndrome).

Any reference in thisGuideto 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 section 3 of the Seafarers 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.
Impairment	means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of the whole or part of any bodily 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 anything 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.
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.