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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.

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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.

17. Appendix 1. Key definitions

TermDefinition

AMA5

The 5th edition of the American Medical Association’s (AMA) Guides to the evaluation of permanent impairment and any published errata.

AMA4

The 4th edition of the American Medical Association’s (AMA) Guides to the evaluation of permanent impairment.

Approved Medical Specialist (AMS)

A senior practising specialist with a sound knowledge of the NSW workers compensation system and workplace based injury management. They are appointed by the Workers Compensation Commission to assess disputes about  medical issues for workers compensation claims lodged on or after 1 January 2002.

Assessor

An assessor will be a registered medical practitioner recognised as a medical specialist.

  • ‘Medical practitioner’ means a person registered in the medical profession under the Health Practitioner Regulation National Law (NSW) No. 86a, or equivalent Health Practitioner Regulation National Law in their jurisdiction with the Australian Health Practitioner Regulation Agency.
  • ‘Medical specialist’ means a medical practitioner recognised as a specialist in accordance with the Health Insurance Regulations 1975, Schedule 4, Part 1, who is remunerated at specialist rates under Medicare.

The assessor will have qualifications, training and experience relevant to the body system being assessed. The assessor will have successfully completed requisite training in using the Guidelines for each body system they intend on assessing. They will be listed as a trained assessor of permanent impairment for each relevant body system(s) on the State Insurance Regulatory Authority website.

Degree of impairment

The degree of permanent impairment as assessed according to section 65 of the Workers Compensation Act 1987.

Injury

A personal injury arising out of or in the course of employment and includes a disease injury.

Maximum medical improvement (MMI)

This is considered to occur when the worker’s condition is well stabilised and is unlikely to change substantially in the next year, with or without medical treatment.

NSW Guidelines

The NSW workers compensation guidelines for the evaluation of permanent impairment.

Secondary injury

Means an injury to the extent that it arises as a consequence of, or secondary to, another injury.

The Act

The Workers Compensation Act 1987

The Workplace Injury Management and Workers Compensation Act 1998

The Workers Compensation Regulation 2010