WorkCover and whole person impairment

Whole person impairment (WPI) is a percentage figure based on a medical assessment or assessments performed by doctors who have undergone training in assessing injuries in accordance with the American Medical Association Guides to Permanent impairment. It is essentially a way to grade injuries and conditions that may relate to your employment.

There are a few different ways in which whole person impairment is relevant under the Victorian WorkCover system. These are;

• Determining whether you have an entitlement to weekly payments after 130 weeks (if you haven’t returned to work)
• Determining whether you have an entitlement to weekly payments after 130 weeks (if you have returned to work) 
• In relation to your claim for impairment benefits
• In relation to obtaining a serious injury certificate (which forms part of a common-law claim).

Determining whether you have an entitlement to weekly payments after 130 weeks (if you haven’t returned to work)

If you’ve been in receipt of weekly payments for 130 weeks, and if you 130 week mark arises on or after 31 March 2024, in order to remain on payments you’ll need to be assessed as having a whole person impairment rating of 21% or greater (in addition to having no capacity for work).

Determining whether you have an entitlement to weekly payments after 130 weeks (if you have returned to work) 

If your 130 week mark arises on or after 31 March 2024 and you have returned to work – working at least 15 hours per week but not working to your pre injury extent, and you’re not capable of undertaking further additional employment or work which would increase your earnings, if you want to claim payments from the insurer you’ll need to be assessed as having a 21% or greater whole person impairment rating.

Whole person impairment and impairment benefit claims

If you suffer an injury or condition connected to your employment, you are entitled to bring a claim for non-economic loss called a claim for impairment benefits.

In order to bring a claim, need to have an injury or condition that results in permanent impairment that reaches a threshold level of impairment.

An impairment claim is commenced by completing the relevant claim form and serving it on the WorkCover insurance company.

The WorkCover insurance company will then organise an assessment for you to see a specially trained doctor.

If you have more than one Injury or condition, maybe required to see more than one doctor.

Before you can be assessed by the doctor your injury needs to be stabilised which means that it has basically improved to the full extent and there is not likely to be any significant fluctuation with the injury into the future.

How is the whole person impairment determined in impairment claims?

The doctors that you see relating to your impairment claim a specially trained doctors.

They have undergone special training that will enable them to grade work related injuries or conditions.

For this reason, only certain doctors are able to perform a whole person impairment assessment.

You are sent to these doctors by the insurance company. They select the doctors that you will see.

Doctors will assess your injury or injuries in accordance with the American Medical Association Guides to Permanent Impairment (AMA guides) fourth addition.

This is a book used by medical practitioners that will enable them to put figures on injuries or conditions.

Depending upon the specific injury or condition, there are a set of guidelines outlined in the AMA guides that instructs the doctor what tests to do, what symptoms are relevant and provides general guidelines in how to assess injuries,

The AMA guides has been used in workers compensation jurisdictions around the world for decades.

Depending upon the nature of your injury or condition the doctor will perform a number of different tests which will be outlined in the AMA guides.

At the end of the assessment the doctor will then produce a report that outlines the nature of your injury or condition, some background history and importantly a whole person impairment rating.

This report will then be sent off to the insurance company.

If you are to see more than one doctor, then the insurance company will wait to receive all of the medical assessments before combining each of the assessments into one overall figure.

This overall figure is your whole person impairment rating.

What is the importance of the whole person impairment rating in impairment claims?

Put simply, the whole person impairment rating is what the compensation amount in an impairment claim is based on.

You will not be entitled to claim an impairment benefit unless you go through the whole person impairment assessment process.

Depending upon the nature of your injury or condition, there will be a compensation table that lists all of the percentage figures from 0 to 100. Each of those percentage figures will match up to a compensation amount.

To be entitled to compensation under an impairment claim, you must meet the following minimum threshold levels;

• For a physical injury (Not relating to injury to the spine), you must be assessed as having a whole Person impairment rating of 10% or more.
• For a physical injury relating to the spine, you must be assessed as having a whole person impairment rating of 5% or more.
• For a psychological injury, you must be assessed as having a 30% or more whole person impairment rating. Importantly, for psychological injuries, you can only be compensated for primary impairment and not secondary impairment.

An example of a primary impairment would be if you were working as a nurse and you were attacked by a person which caused you a psychological injury of some description.

An example of a secondary impairment would be if you suffered a physical injury and as a consequence of that physical injury you became depressed.

Whole person impairment and serious injury 

A lump sum claim under the WorkCover system is a common law claim.

In order to succeed in a common law claim, you must have a ‘serious injury’.

There are two ways that you can show that you have a serious injury.

The first way is the most common way. It’s via the narrative test. This involves telling your story and demonstrating the impact that the injury or condition has had on your life and will likely on your life into the future.

The second way that you can show that you have a serious injury is by being assessed as having a 30% or greater whole person impairment rating.

So, if you were assessed as having an overall whole person impairment rating of 30% or greater, then you will automatically be considered as having a serious injury for the purposes of a common law claim.

Conclusion

Whole person impairment is an important aspect of the WorkCover system.

Whole person impairment is a percentage figure that is determined by medical assessments performed by specially trained doctors. It is used to grade injuries and conditions.

In the Victorian WorkCover system, whole person impairment is relevant for determining entitlement to weekly payments after 130 weeks, both for those who have and have not returned to work.

It is also used to determine lump sum amounts payable by way of impairment claims, and if a person is assessed as having a 30% or greater whole person impairment, then they are deemed as having a ‘serious injury’, which is a requirement of success in a common law claim.