What is 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 relate to your employment.
There are two main components of the Victorian WorkCover system where whole person impairment is very relevant. These are;
- In relation to your claim for impairment benefits (a lump sum claim)
- In relation to obtaining a serious injury certificate (which forms part of a common-law claim for damages).
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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?
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.
If you wish to see the impairment tables, you can visit this page.
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.
After you have gone through the initial assessment process and you have been provided with your impairment rating, if you disagree with the overall whole person impairment rating you can dispute it. This would involve proceeding to the medical panel.
Essentially, the medical panel would review the assessment or assessments that were conducted and provide their own overall whole person Impairment rating.
Whole person impairment rating and serious injury applications
An impairment claim is the first lump sum claim open to people under WorkCover system.
The second lump sum claim open to people to pursue is called a common-law claim for damages.
In order to succeed in a common law claim for damages, one thing that you are required to show is that you have a serious injury that is related to your employment.
There are two ways that you can show that you have a serious injury.
The first way is the most common way. It is called 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 went through the impairment claim process discussed above and if you were assessed as having an overall whole person impairment rating of 30% or greater, then you will automatically be classed as having a serious injury for the purposes of a common-law claim.
If you satisfy this 30% or greater test, then the main thing left to show in order to succeed in a common-law claim for damages is that negligence exists on behalf of another party.