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Medical assessor guidance note 7

Mental and Behavioural Disorders

Psychiatric Impairment Rating Scale

Assessment of the area of function 'Adaptation'

This material is issued by the Motor Accidents Authority under s.65(2) of the Motor Accidents Compensation Act 1999 (the Act) in the interests of promoting accurate and consistent medical assessments under the Act. The interpretation provided here is not legally binding but represents the clinically recommended interpretation in an area where more than one interpretation of existing provisions may be possible. This recommended interpretation is publicly available. Any medical assessment which does not adopt this interpretation should be accompanied by clinical justification for the interpretation adopted, supported by full, robust reasons.

Reference

The Motor Accidents Authority Permanent Impairment Guidelines – Guidelines for the assessment of permanent impairment of a person injured as a result of a motor vehicle accident 1 October 2007 (MAA Guidelines): Chapter 7 Mental and Behavioural Disorders Impairment page 38, clause 7.10 page 38 and Table 7.6 Psychiatric Impairment Rating Scale Adaptation page 43.

Background

Assessment of the area of function 'Adaptation' is sometimes restricted to consideration of impairment within work settings.

Issue requiring clarification

Clause 7.10 of the MAA Guidelines defines 'Adaptation' (also called deterioration or de-compensation in work or work-like settings) as the repeated failure to adapt to stressful circumstances. However, the examples provided in Table 7.6 of the MAA Guidelines relate only to 'work' and ostensibly 'employment'.

In the absence of class descriptors that provide other non-work based examples of 'Adaptation', it is possible that some Assessors may not consider the full gamut of 'Adaptation'.

Recommended method for assessing 'Adaptation'

When using Table 7.6 of the MAA Guidelines, consideration should be given to the claimant's usual pre-injury roles and functions such as paid employment, caring for others, housekeeping, managing personal/family finances, voluntary work, education/study and the discharge of other obligations and responsibilities.

As provided at clause 7.20 of the MAA Guidelines, the Assessor should consider the extent to which the claimant's pre-injury roles and functions have changed as a result of the psychiatric injury, and explain the claimant's current ability to cope with/attend to their usual pre-injury roles and functions, providing relevant examples.

As provided at clause 7.11 of the MAA Guidelines, the impairment is then divided into five classes ranging from no impairment to extreme impairment.

Examples

A person is no longer able to manage their household affairs independently as a result of the psychiatric condition, as they find the responsibility too stressful; their partner now assists with paperwork in regard to pension/tax/Centrelink etc.

A retired person is no longer able to care for grandchildren on a regular basis. Can help out occasionally, but finds it too stressful as a result of the psychiatric condition, to commit to regular childcare.

Justification for preferred interpretation

In the absence of specific non-work based examples for adaptation, the preferred interpretation and methodology is suggested to promote consistency of assessment.


Issued by:

Injury Strategy Branch

May 2012