SIRA Logo

Medical assessor guidance note 21

Digestive system: use of medications and the upper gastrointestinal tract

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 publically 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 8 page 50.

The American Medical Association Guides to the Evaluation of Permanent Impairment, 4th edition (AMA 4 Guides): Chapter 10 Table 2, page 239.

Background

Frequently following a motor accident anti-inflammatory medications are prescribed or taken which may cause symptoms or signs of oesophageal and/or gastric disease. However, symptoms or signs of oesophageal and/or gastric disease due to anti-inflammatory medication may be reversible upon cessation of the medication or following appropriate treatment. Furthermore, other diseases, such as infection with Helicobacter pylori, may cause similar signs or symptoms.

Issue requiring clarification

Taking account of the above information Medical Assessors must determine whether there is an impairment, and if so whether the impairment is caused by the motor accident and whether it is permanent and able to be assessed.

Preferred interpretation

Is there an impairment caused by the motor accident

For a diagnosis of oesophageal and/or gastric disease due to anti-inflammatory medication there must be a history, which may be confirmed within the documents, that the onset of specific upper digestive tract signs or symptoms was contemporaneously related to the use of anti-inflammatory medication post motor accident. Additionally, consideration should be given to a differential diagnosis, such as bacterial infection, which should be confirmed by a history and/or documentation.

Is the impairment permanent?

To determine whether or not any impairment is permanent, there should be consideration of the current condition with regard to current treatment, any ongoing treatment and/or any proposed treatment (by their General Practitioner or specialist) and the efficacy of any current and/or proposed treatment.

Assessment of impairment

In cases where there is a clear relationship between the onset of specific symptoms, the commencement of anti-inflammatory medication and continuing use of anti-inflammatory medication, the Medical Assessor may regard this injury as a Class 1 impairment (Table 2 p 239 AMA 4 Guides) and depending on the specificity and severity of symptoms may assess the impairment in the lower range of this category (for example 0% to 2% WPI).

In cases where there are clearly severe and specific signs or symptoms of oesophageal and/or gastric disease, with or without complications such as gastric bleeding, these claimants may be assessed as having a Class 2 impairment, (Table 2 p239 AMA 4 Guides),  noting that they must fulfil the requirements of Table 2 Class 2.

Note: Table 2 requires the presence or absence of several factors including: symptoms and signs of upper digestive tract disease, continuous treatment and weight loss.

The Medical Assessor should provide reasons explaining why they determined the selected Table, Class and degree of permanent impairment with reference to the presence or absence of all requirements listed in the relevant Table.

Justification for preferred interpretation 

The preferred interpretation and methodology as outlined above is suggested to promote consistency of assessment.


Issued by:

Injury Strategy Branch

November 2015