WorkCover impairment assessments
A WorkCover impairment assessment is a medical assessment that occurs as part of the impairment lump sum claim process.
It is an assessment completed by a specialist doctor.
The impairment assessment involves this specialist doctor putting a percentage figure on your injury (or injuries) that you are claiming as part of the impairment claim.
The rest of this page will explore impairment assessments further.
Table of Contents
WorkCover impairment assessments are central to impairment benefit lump sum claims
A WorkCover impairment assessment is central to an impairment lump sum claim (sometimes referred to as an impairment benefit lump sum claim).
When you complete a WorkCover impairment claim form you will need to specify the injuries (and/or conditions and illnesses) that you are claiming are related to your employment and that will be assessed as part of the impairment lump sum claim.
Once the claim form gets sent off, the WorkCover insurer will organise at least one appointment for you to be medically assessed by a specialist doctor (this is the impairment assessment).
This doctor should be a specialist in treating the injury that you are claiming.
If you are claiming more than one injury, illness or condition under the impairment claim, potentially you may need to undergo more than one WorkCover impairment assessment.
The doctor that performs the assessment will have been trained in evaluating and grading injuries in accordance with the Guides to the Evaluation of Permanent Impairment, Fourth Edition.
What happens during the assessment?
You will likely have seen an independent medical examiner (IME) organised by the insurer during the claim determination period.
There will be some similarities between that assessment and the impairment assessment.
For one, many of the doctors who perform the initial assessment during the claim determination period will be the doctors who perform impairment assessments.
Note however that you will in most instances not see the same doctor as you have previously seen.
Secondly, there will be some similarities in the process. The doctor will ask you similar questions; for example, regarding the nature of your work and how the injury happened.
During a WorkCover impairment assessment, the doctor that is assessing you is primarily interested in two things.
Injury related to employment
The first is whether the claimed injury (or injuries) is/are related to your employment, and therefore is an injury that the WorkCover insurer should accept liability for in relation to the impairment claim.
In the medical report of the doctor, he or she will specifically comment on what the connection is between the injury and the work you were doing.
The WorkCover insurer will consider this when determining whether to accept liability relating to the injury as part of the impairment claim.
Typically, if you are just claiming the injury that your claim was accepted for only, for example, a shoulder injury, then, in most instances, there will be no issue regarding liability under an impairment claim. These injuries will normally be accepted as part of the impairment claim.
An issue may arise in relation to liability however if you are claiming an injury that the WorkCover insurer has not previously accepted liability for.
For example, if you originally had a right shoulder injury that was accepted, and under an impairment claim you are claiming, in addition to the right shoulder, a left shoulder injury.
Or if because of an injury you developed stomach issues related to pain killing medication use.
On the notice of entitlement which is the document that you will receive after the impairment claim from the insurer, the WorkCover insurer will list what injuries they have accepted liability for, and what injuries they have rejected liability for relating to the impairment claim.
Whole person impairment
The doctor will need to determine, as part of the WorkCover impairment assessment, what your whole person impairment rating is.
The doctor, depending upon the nature of the injury, illness or condition, will perform relevant tests to try and determine your whole person impairment rating.
The doctor will do so in accordance with the Guides to the Evaluation of Permanent Impairment (under the Victorian WorkCover scheme, the fourth edition of the guides is used).
These guides, for all injuries, other than psychiatric injuries, direct people that are performing impairment assessments as to how to grade injuries.
Once the doctor has performed the relevant tests, he or she will calculate your whole person impairment rating.
The doctor will then produce a medical report and will send this medical report to the WorkCover insurer.
Generally speaking, the doctor performing the WorkCover impairment assessment will send off his or her report to the insurer within one to four weeks.
Once the assessment has been received by the insurer, they will send you a notice of entitlement, which outlines their offer to you taking into account what the doctor has said in their report and what they have assessed your whole person impairment rating to be.
Sometimes what can happen is the WorkCover insurer can write to the impairment assessor and ask them to clarify an issue, or more than one issue, and the WorkCover impairment assessor will produce a supplementary report.
A WorkCover impairment assessment is a medical assessment that a person will undergo as part of their impairment lump sum claim.
The aim of the impairment assessment is for the doctor to allocate a percentage figure on the injuries that a person is claiming are related to their employment and which form part of the WorkCover impairment claim.