This fact sheet explains what will happen when a dispute about the degree of permanent impairment arising from a brain injury is referred to the Dispute Resolution Services division for assessment.
A protocol was developed, following consultation with expert State Insurance Regulatory Authority (SIRA) medical assessors, for the assessment of brain injuries. This protocol is designed to ensure that proper consideration is given to all the symptoms arising from a brain injury and that the degree of permanent impairment is fully assessed.
How the protocol will work
1. Appointments with two medical assessors
Appointments are made with two different medical assessors:
- a medical assessor who is a brain injury specialist, such as a rehabilitation physician, neurologist or neurosurgeon
- a medical assessor who is a psychiatrist, even if a separate psychiatric injury has not been listed by the parties.
2. The brain injury medical assessor
The brain injury specialist will determine whether a brain injury has occurred. Generally there should be evidence of:
- a significant impact to the head, cerebral insult, or high velocity impact, and
- one or more medically verified abnormalities.
The brain injury specialist will consider:
- initial injury records (including Glasgow Coma Score and duration of post-traumatic amnesia)
- radiological investigations (such as CT scans and MRI scans of the brain)
- the results of any psychometric or neuropsychological testing, and
- the findings of their clinical examination.
If the symptoms reported by the injured person can’t be fully explained by a physical brain injury, a psychiatrist will also assess the injured person. The brain injury specialist will indicate in their certificate that an appointment with a psychiatrist is required. The certificate from the brain injury specialist, together with any neuropsychological report will be provided to the parties and to the psychiatrist.
If a separate psychiatric injury has been listed by the parties, an appointment with a psychiatrist will proceed regardless of the findings of the brain injury specialist.
3. The psychiatric appointment
The psychiatrist will determine whether there is a recognised psychiatric condition. If the psychiatrist finds that there is a recognised psychiatric condition related to the motor accident, they will determine the degree of permanent impairment. A separate certificate will be issued by the psychiatrist which will be forwarded to the parties.
4. Neuropsychological testing
If the brain injury specialist or the psychiatrist is unable to make a determination as to whether there is a brain injury or psychiatric injury caused by the motor accident they may request that neuropsychological testing be conducted. SIRA will arrange for neuropsychological testing by a medical assessor who is a neuropsychologist. The brain injury specialist and/or psychiatrist will use this information to complete their assessment. The neuropsychological report will be forwarded to the parties.
5. Medical assessor conferencing
Sometimes an injured person’s presentation is complex and one of the medical assessors may request a teleconference with the other medical assessor (for example, the brain injury specialist may request to discuss the injured person’s presentation with the psychiatrist or the psychiatrist may request to teleconference with the brain injury specialist). This usually occurs prior to the medical assessor(s) issuing their certificate(s). SIRA will advise the parties if this is requested.
6. Reverse brain injury protocol
Sometimes only a psychiatric injury is listed for assessment. If at assessment the psychiatrist suspects that the injured person may have a brain injury that has not been referred for assessment, the psychiatrist may contact SIRA to request that the injured person is assessed by a medical assessor who is a brain injury specialist.