The assessment of whole person impairment (“WPI”) can have an impact on a worker’s compensation claim and the ongoing benefits they may receive. The worker’s lawyers usually investigate the assessment of WPI. However, in some cases, the workers’ compensation insurer may obtain their own assessment to determine the worker’s ongoing benefits. If there are discrepancies between the assessments, an Application to Resolve a Dispute (ARD) can be filed in the Personal Injury Commission to determine the worker’s WPI.
The assessment is conducted by a medical assessor who is trained, approved, and accredited to assess WPI. WPI is evaluated according to the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment (“the Guidelines”), which is largely based on the American Medical Association Guidelines for Evaluation of Permanent Impairment, 5th Edition. If there is a discrepancy or deviation, the specific variance is defined within the Guidelines, and the procedures outlined in each section are to be followed and given precedence.
How does WPI affect weekly benefits?
0% - 20%:
A worker may be entitled to receive up to 130 weeks of weekly wage loss benefits.
To continue receiving these benefits for 130-260 weeks, the worker must either be unfit for all work and unlikely to work again or work 15 hours or more per week, earning at least $202.00 (indexed).
If a worker’s injuries are assessed as being less than or equal to 20% WPI, the weekly wage loss benefits are capped at a maximum of 260 weeks (or 5 years). However, this is subject to the above conditions and the production of certificates of capacity that certify the worker’s capacity.
21% or greater:
If a worker’s injuries are assessed as being greater than 20% WPI, weekly wage loss benefits may continue beyond 260 weeks. However, this is subject to the insurer conducting a work capacity assessment and the production of certificates of capacity
How does WPI impact on treatment expenses?
0% - 10%:
If a worker has not received an assessment of WPI or if they are assessed as having between 0% – 10% WPI, treatment expenses will cease two years after the last date the worker received weekly wage loss benefits (or the date of injury if no wage loss benefits were received).
11% - 20%:
If a worker has received an assessment between 11% – 20% WPI, treatment expenses will cease five years after the last date the worker received weekly wage loss benefits (or the date of injury if no wage loss benefits were received).
21% or greater:
If a worker is assessed as having greater than 20% WPI (i.e., 21% or greater), there is no time limit for claiming treatment expenses. However, the insurer must determine that the medical expenses are reasonably necessary.
There are exceptions to the time limitations for medical expenses, including provisions for crutches, artificial members, home or vehicle modifications, secondary surgery directly consequential to earlier surgery (approved within two years), and other specified treatments, subject to the insurer’s approval.
How does WPI impact on worker’s ability to claim lump sum compensation?
If a worker’s injuries are assessed as being greater than 10% WPI (i.e., 11% or greater), they may be entitled to pursue a claim for lump sum compensation. This is contingent on the insurer’s agreement or the Personal Injury Commission determining the worker’s level of impairment.
If a worker’s primary psychological injuries are assessed as being at least 15% WPI, they may be entitled to pursue a claim for lump sum compensation. This is contingent on the insurer’s agreement or the Personal Injury Commission determining the worker’s level of impairment.
It’s important to note that physical and psychological injury assessments resulting from the same incident cannot be combined to achieve a higher assessment of WPI.
How does WPI affect worker’s ability to claim Work Injury Damages?
If it is agreed or determined that a worker suffers from at least 15% WPI, they may be entitled to bring a separate claim for work injury damages based on negligence.
For further assistance, please contact Jameson Law.