Workers Compensation Claims in South Australia – Whole Person Impairment Assessments

What is a ‘Whole Person Impairment (WPI) Assessment’?

If you have a permanent impairment that resulted from a work injury, you may be eligible for a Whole Person Impairment Assessment.

The Whole Person Impairment Assessment will determine whether:

• you are entitled to weekly payments after two years of incapacity;
• you are entitled to ongoing medical and other expenses; and
• you can access lump sum payments for economic and non-economic loss.

How does it work?

Generally, the more serious your injury (or injuries), the higher the permanent impairment rating (and compensation payable) will be.

Under the South Australian Return to Work Act 2015 (SA), a worker is entitled to compensation if they have at least a 5% whole person impairment (or more) for an accepted physical injury.

Unfortunately, no lump sum compensation is payable for psychological injury claims.

Generally, impairment percentages can be combined if physical injuries are a result of the same trauma or cause.

What this means is not straight forward, and there are many decisions currently before the Court testing the meaning of this section of the legislation.

In our experience, the insurer’s ‘default’ position is to not combine injuries that should be, as it results in less compensation being paid to an injured worker.

If you are going through this process, it is crucial to seek advice to ensure that you achieve the maximum amount of compensation payable to you.

The WPI Process

You can request an assessment of whole person impairment once your injury reaches ‘maximum medical improvement’, which means your injury is stable / medically at a point where it is unlikely to change (i.e., it isn’t likely to get much better or worse into the future).

You should contact the Claims Case Manager at your Insurer to arrange for the assessment to be undertaken. It is important to note that you have a choice around what doctor is used to undertake the assessment. There is a long list of accredited doctors to choose from. Again, seeking legal advice throughout this process will help you choose a doctor who is best suited to assess you and your injuries fairly and comprehensively.

The insurer will prepare a letter to the chosen doctor with a summary of your injuries and enclose medical evidence / reports on your file. It is important to ensure that all radiology / medical reports are included so that the doctor can have a solid understanding of your injuries.

You will be asked to provide feedback before the letter is sent to the doctor. Your lawyer should review this draft letter as there are likely going to be technical ‘legal’ issues that will need to be addressed in that feedback.

It is also important that ALL injuries are covered in the assessment, as if not, you could miss out on compensation that is otherwise payable to you.

The doctor will then be asked to perform the assessment following the Permanent Impairment Assessment Guidelines.

Once a Whole Person Impairment Assessment report is received it will be ‘peer reviewed’ (or checked over) by another doctor following Return to Work SA’s protocols.

A formal determination is then made by the compensating authority  following this process.

Why should I engage a lawyer?

You have the right to challenge the determination if it is not correct in law, and a lawyer will be best placed to advise and assist with this process.

Permanent impairment claims are generally complex and involve a number of important considerations. It is important to get good advice and follow the process strictly, as they are usually only paid once.

Frequently, when asked to assess permanent injury claims, insurers understate the extent of a worker’s injury and the extent of the impairment as well as try to separate out injuries which lawfully ought to be combined.

At TGB Lawyers, we frequently assist people with the permanent impairment process and provide advice and assistance with any appeals to the South Australian Employment Tribunal if the Determination has not been calculated appropriately by the insurer.

Get in touch!

If you have a work injury, it is worth seeking legal advice to help you navigate through the complex claims process.

Tindall Gask Bentley has been practising workers compensation law for over 50 years, so don’t hesitate to get in touch with us. You can let us know online that you’d like to chat here and we’ll contact you, or feel free to contact our SA Workers Compensation team on (08) 8212 1077. Alternatively, you can contact Alex Harris direct on aharris@tgb.com.au.