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

14. Cardiovascular system

AMA5 chapters 3 and 4 (pp 23 and 65) apply to the assessment of permanent impairment of the cardiovascular 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.


15.1 The cardiovascular system is discussed in AMA5 chapters 3 (Heart and Aorta) and 4 (Systemic and Pulmonary Arteries) (pp 25–85). These chapters can be used to assess permanent impairment of the cardiovascular system with the following minor modifications.

15.2 It is noted that in these chapters there are wide ranges for the impairment values in each category. When conducting an assessment, assessors should use their clinical judgement to express a specific percentage within the range suggested.

Exercise stress testing

15.3 As with other investigations, it is not the role of an assessor to order exercise stress tests purely for the purpose of evaluating the extent of permanent impairment.

15.4 If exercise stress testing is available, then it is a useful piece of information in arriving at the overall percentage impairment.

15.5 If previous investigations are inadequate for a proper assessment to be made, the assessor should consider the value of proceeding with the evaluation of permanent impairment without adequate investigations and data (see Chapter 1 of the Guideline – ordering of additional investigations).

Permanent impairment – maximum medical improvement

15.6 As for all assessments, maximal medical improvement is considered to have occurred when the worker’s condition is well stabilised and unlikely to change substantially in the next year, with or without medical treatment.

Vascular diseases affecting the extremities

15.7 Note that in this section, AMA5 tables 4-4 and 4-5 (p 76) refer to percentage impairment of the upper or lower extremity. Therefore, an assessment of impairment concerning vascular impairment of the arm or leg requires that the percentages identified in these tables be converted to whole person impairment (WPI). The table for conversion of the upper extremity is AMA5 Table 16-3 (p 439), and the table for conversion of the lower extremity is AMA5 Table 17-3 (p 527).

Thoracic outlet syndrome

15.8 Impairment due to thoracic outlet syndrome is assessed according to AMA5 Chapter 16, relating to the upper extremities, and Chapter 2 of the Guidelines.