SIRA Logo

NSW workers compensation guidelines for the evaluation of permanent impairment

These guidelines explain permanent impairment assessment in the NSW workers compensation system. This is the fourth edition of these guidelines, published in April 2016.

Download a PDF of this document in full.

Click here to read the foreword

The State Insurance Regulatory Authority (SIRA) has issued the 4th edition of the NSW workers compensation guidelines for the evaluation of permanent impairment (Guidelines) for assessing the degree of permanent impairment arising from an injury or disease within the context of workers’ compensation. When a person sustains a permanent impairment, trained medical assessors must use the Guidelines to ensure an objective, fair and consistent method of evaluating the degree of permanent impairment.

The Guidelines are based on a template that was developed through a national process facilitated by Safe Work Australia. They were initially developed for use in the NSW system and incorporate numerous improvements identified by the then WorkCover NSW Whole Person Impairment Coordinating Committee over 13 years of continuous use. Members of this committee and of the South Australia Permanent Impairment Committee (see list in Appendix 2) dedicated many hours to thoughtfully reviewing and improving the Guidelines. This work is acknowledged and greatly appreciated.

The methodology in the Guidelines is largely based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th Edition (AMA5). The AMA guides are the most authoritative and widely used in evaluating permanent impairment around the world. Australian medical specialists representing Australian medical associations and colleges have extensively reviewed AMA5 to ensure it aligns with clinical practice in Australia.

The Guidelines consist of an introductory chapter followed by chapters dedicated to each body system.

The Introduction is divided into three parts. The first outlines the background and development of the Guidelines, including reference to the relevant legislative instrument that gives effect to the Guidelines. The second covers general assessment principles for medical practitioners applying the Guidelines in assessing permanent impairment resulting from work-related injury or disease. The third addresses administrative issues relating to the use of the Guidelines.

As the template national guideline has been progressively adapted from the NSW Guideline and is to be adopted by other jurisdictions, some aspects have been necessarily modified and generalised. Some provisions may differ between different jurisdictions. For further information, please see the Comparison of Workers’ Compensation Arrangements in Australia and New Zealand report, which is available on Safe Work Australia’s website.

Publications such as this only remain useful to the extent that they meet the needs of users and those who sustain a permanent impairment. It is, therefore, important that the protocols set out in the Guidelines are applied consistently and methodically. Any difficulties or anomalies need to be addressed through modification of the publication and not by idiosyncratic reinterpretation of any part. All queries on the Guidelines or suggestions for improvement should be addressed to SIRA at contact@sira.nsw.gov.au.

11. Haematopoietic system

AMA5 Chapter 9 (p 191) applies to the assessment of permanent impairment of the haematopoietic system, subject to the modifications set out below. Before undertaking an impairment assessment, users of the Guidelines must be familiar with:

  • the Introduction in the Guidelines
  • chapters 1 and 2 of AMA5
  • the appropriate chapter(s) of the Guidelines for the body system they are assessing
  • the appropriate chapter(s) of AMA5 for the body system they are assessing.

The Guidelines take precedence over AMA5.

Introduction

12.1 AMA5 Chapter 9 (pp 191–210) provides guidelines on the method of assessing permanent impairment of the haematopoietic system. Overall, that chapter should be followed when conducting the assessment, with variations indicated below.

12.2 Impairment of end organ function due to haematopoietic disorder should be assessed separately, using the relevant chapter of the Guidelines. The percentage whole person impairment (WPI) due to end organ impairment should be combined with any percentage WPI due to haematopoietic disorder, using the combined values table in AMA5 (pp 604–06).

Anaemia

12.3 Table 12.1 (below) replaces AMA5 Table 9-2 (p 193).

Table 12.1: Classes of anaemia and percentage whole person impairment

Class 1: 0-10% WPIClass 2: 11-30% WPIClass 3: 31-70% WPIClass 4: 71-100% WPI

No symptoms

and

haemoglobin 100-120g/L

and

no transfusion required

Minimal symptoms

and

haemoglobin 80-100g/L

and

no transfusion required

Moderate to marked symptoms

and

haemoglobin 50-80g/L before transfusion

and

transfusion of 2 to 3 units required, every 4 to 6 weeks

Moderate to marked symptoms

and

haemoglobin 50-80g/L before transfusion

and

transfusion of 2 to 3 units required, every 2 weeks

12.4 The assessor should exercise clinical judgement in determining WPI, using the criteria in Table 12.1. For example, if comorbidities exist which preclude transfusion, the assessor may assign class 3 or class 4, on the understanding that transfusion would under other circumstances be indicated. Similarly, there may be some claimants with class 2 impairment who, because of comorbidity, may undergo transfusion.

12.5 Pre-transfusion haemoglobin levels in Table 12.1 are to be used as indications only. It is acknowledged that for some claimants, it would not be medically advisable to permit the claimant’s haemoglobin levels to be as low as indicated in the criteria of Table 12.1.

12.6 The assessor should indicate a percentage WPI, as well as the class.

Polycythaemia and myelofibrosis

12.7 The level of symptoms (as in Table 12.1) should be used as a guide for the assessor in cases where non-anaemic tissue iron deficiency results from venesection.

White blood cell diseases

12.8 In cases of functional asplenia, the assessor should assign 3% WPI. This should be combined with any other impairment rating, using the Combined Values Table in AMA5 (pp 604–06).

Haemorrhagic and platelet disorders

12.9 AMA5 Table 9-4 (p 203) is to be used as the basis for assessing haemorrhagic and platelet disorders.

12.10 For the purposes of the Guidelines, the criteria for inclusion in class 3 of AMA5 Table 9-4 (p 203) are:

  • symptoms and signs of haemorrhagic and platelet abnormality
  • requires continuous treatment
  • interference with daily activities; requires occasional assistance.

12.11 For the purposes of the Guidelines, the criteria for inclusion in class 4 of AMA5 Table 9-4 (p 203) is:

  • symptoms and signs of haemorrhagic and platelet abnormality
  • requires continuous treatment
  • difficulty performing daily activities; requires continuous care.

Thrombotic disorders

12.12 AMA5 Table 9-4 (p 203) is used as the basis for determining impairment due to thrombotic disorder.