5 % impairment rating under WorkCover
Whole person impairment plays a part in WorkCover claims in a number of different ways. This page sets out when a 5% whole person impairment is relevant and what affect it can have on a claim.
The main reason that someone would be assisted has having a 5% whole person impairment is because they’ve made an impairment claim.
An impairment claim is a no-fault benefit that anyone with an accepted WorkCover claim can pursue.
Table of Contents
Medical and like expenses
Impairment ratings have no bearing on your medical and like treatment through the WorkCover insurer.
Weekly payments
Due to recent changes to the WorkCover legislation, if your entitlement to weekly payments ceases due to reaching 130 weeks of weekly payments, and that date is on or after the 31st of March 2024, impairment ratings are now relevant. This is because the changes to the law now require you to have both:
• no current work capacity and in addition to that,
• a 21% or greater whole person impairment.
If you are assessed at having a 5% whole person impairment either through the impairment benefit process or the assessment process for your weekly payment entitlement, then your entitlement to weekly payments would stop, even if you had no capacity for work.
If your 130 week period is before the 31st of March 2024, then having a 5% impairment would have no impact upon your entitlement to weekly payments, and it would only be assessed on the basis of whether you had no current capacity for work.
Impairment claim
The main reason someone would be assessed as having a 5% whole person impairment is if they lodge an impairment benefit application.
What precisely a 5% impairment settlement will mean for you would depend upon the nature of your injury.
If you have a psychological injury then a 5% whole person primary impairment will not result in you being paid a lump sum.
This is because the impairment threshold for psychological is 30%.
If you have a musculoskeletal injury then a 5% whole person in payment will entitle you to a lump sum. This is further broken down into two components, being whether you have a spinal injury or a non-spinal musculoskeletal injury (such as an injury to your knee, elbow or shoulder).
For spinal injury a 5% whole person in payment will entitle you as follows:
Year of injury 2021/2022 $14,883
Year of injury 2022/2023 $15,257
Year of injury 2023/2024 $16,478
For a musculoskeletal, non-spinal injury, a 5% whole person impairment will entitle you as follows:
Year of injury 2021/2022 $13,530
Year of injury 2022/2023 $13,870
Year of injury 2023/2024 $14,980
If your injury is not psychological and not musculoskeletal or spinal, such as a brain injury or a disease such as Q-fever, then a 5% whole person impairment will not entitle you to any lump sum compensation through the impairment process.
This is because the threshold to obtain a lump sum is 10% whole person impairment.
Serious injury/Common law claims
A 5% whole person impairment rating does not have much bearing on a serious injury application other than it does mean that you are not “deemed” to have a serious injury and instead must go through the alternative test for serious injury, known as the “narrative test”.
You must have a 30% or greater whole person in impairment to satisfy the serious injury test through impairment.
It’s important to note that there is little relevance of your impairment rating if it is under 30% to indicating whether you have a serious injury.
For example, we would not compare your impairment rating of 5% to 30% and believe that such a rating means that you are quite a way off establishing serious injury.
Many injured workers have been assessed as having a 5% (or even lower) level of impairment and succeeded in a serious injury/common law claim.
How are impairments assessed?
Nearly all whole person impairment is assessed in Victoria based upon the American Medical Association Fourth Edition Guides to the Evaluation of Permanent Impairment (we’ll refer to them as the AMA Guides).
Sometimes these guidelines are very restrictive in terms of how an injury is assessed and other times, a medical examiner has more discretion in assessing the level of impairment.
For each type of injury, the AMA Guides sets out the method of assessment that the doctor must apply. This can involve range of motion tests, reflex tests, muscle wasting, visual assessment, assessment of radiology, pin prick testing (for loss of sensation), gait assessment, audiological evaluation and numerous other tests.
Spinal injury and in particular lower back injury is the most common injury that would be assessed at 5% whole person impairment.
A spinal injury to the lumbar spine, is typically assessed at either 0%, 5% or 10% whole person impairment.
Shoulder injuries, ankle injuries and some knee injuries also often receive a 5% whole person impairment.
You should bear in mind that while the impact of an injury on you may be very significant, it does not necessarily mean that your impairment rating will be higher.
It is possible that two people are assessed as having a 5% whole person impairment, but the impact of the injury on one person is moderate, though for the other person the consequences are significant.
Conclusion
A 5% whole person impairment can have an effect on weekly payments, impairment benefits and a serious injury/common law claim.
Being assessed at 5% whole person impairment for an impairment benefit claim will result in compensation being paid to you where you have a spinal or musculoskeletal injury. For other injuries, a 10% greater impairment is required.
