Workers’ Compensation and Rehabilitation Regulation 2014


Queensland Crest
Workers’ Compensation and Rehabilitation Regulation 2014

Part 1 Preliminary

1Short title

This regulation may be cited as the Workers’ Compensation and Rehabilitation Regulation 2014.

2Commencement

This regulation commences on 1 September 2014.

3Definitions

Schedule 13 defines particular words used in this regulation.

4WorkCover’s capital adequacy—Act, s 453(b)

For section 453(b) of the Act, WorkCover maintains capital adequacy if WorkCover’s total assets are at least equal to its total liabilities.

Part 2 Employer insurance

Division 1 Policies and premium assessments

5Application for policy

An application for a WorkCover policy must be made to WorkCover in the approved form.

6Policies and renewals

(1)On payment of the premium shown as payable in a premium notice issued by WorkCover to an employer, WorkCover must issue to the employer a policy, in the approved form, for the period of insurance stated in the notice.
(2)A policy has no effect until—
(a)WorkCover receives the premium payable to WorkCover for the policy or the policy’s renewal; or
(b)WorkCover enters into an instalment plan.

7Assessment of premium

(1)This section does not apply to a policy for household workers.
(2)WorkCover must assess the premium payable under a policy for each period of insurance shown in a premium notice.

8Declaration of wages

(1)This section does not apply to an employer who employs only household workers.
(2)Each employer, other than a self-insurer, must, on or before 31 August in each year, lodge with WorkCover a declaration of wages so WorkCover can assess the employer’s premium.
(3)The declaration must be in—
(a)the approved form; or
(b)with WorkCover’s approval—another form acceptable to WorkCover.
(4)If an employer does not comply with subsection (2), the employer must pay an additional premium under schedule 1.
(5)The additional premium payable under schedule 1 is the amount specified opposite the time after 31 August in a year when the employer complies with subsection (2).

9Value of board and lodging

(1)This section applies if an employer provides, or is to provide, board to a worker during a period of insurance.
(2)The value of board provided is taken to be wages paid, or to be paid, by the employer to the worker.
(3)For each week the employer provides, or is to provide, board, the value of board is at least equal to—
(a)the weekly allowance for board provided for under the industrial instrument governing the calling in which the worker is engaged; or
(b)if paragraph (a) does not apply—6% of QOTE.
(4)In this section—
board means accommodation, meals, laundry services or any other entitlement having a monetary value provided when lodging.

10Payment of premium by instalments

(1)WorkCover may accept payment of a premium by instalments under an instalment plan approved by WorkCover if WorkCover is satisfied that payment of the premium by the due date would impose financial hardship on the employer.
(2)The instalment plan is subject to the following conditions—
(a)interest at a rate specified by WorkCover’s board by gazette notice must be added to the amount of each instalment;
(b)interest must be calculated from the due date;
(c)the interest rate that applies at the start of the instalment plan remains constant until the plan ends;
(d)on acceptance of the instalment plan, the employer must, if required by WorkCover, enter into a payment arrangement acceptable to WorkCover;
(e)if an instalment of premium is not paid on or before the due date for payment of the instalment—
(i)the total amount of unpaid instalments and interest on outstanding instalments to that day immediately becomes payable to WorkCover; and
(ii)an additional premium under section 11 applies to the unpaid instalments and interest; and
(iii)the policy for which the premium is payable stops having effect; and
(iv)the employer contravenes section 48 of the Act.

11Additional premium for late payment of premium—Act, ss 61 and 62

(1)This section applies if, on or before the due date, an employer does not pay—
(a)the amount of premium payable under a premium notice; or
(b)the amount by which a final assessment of premium by an industrial magistrate or the Industrial Court is more than the amount of premium paid under section 551(4) of the Act.
(2)However, this section does not apply if—
(a)the employer employs only household workers; or
(b)WorkCover has accepted payment of the amount under an instalment plan and instalments are paid under the plan.
(3)For sections 61 and 62 of the Act, the additional premium payable is—
(a)if the amount is paid to WorkCover within 30 days after the due date—5% of the amount; or
(b)if the amount is paid to WorkCover after 30 days but within 60 days after the due date—10% of the amount; or
(c)if the amount is paid to WorkCover after 60 days after the due date or if no payment is made—10% of the amount plus interest at the annual rate mentioned in section 10(2)(a) for the period from the due date, or a later date decided by WorkCover, until the amount and all additional premium is paid to WorkCover.

12Premium for appeals—Act, s 569(2)(a)

(1)For section 569(2)(a) of the Act, premium, for an employer for a period of insurance, is an amount calculated using the formula—

equation

(2)In subsection (1)—
rate means the rate for the employer’s industry or business specified in the notice under section 54 of the Act that applies to the period of insurance.
wages means—
(a)the wages of the employer for the preceding period of insurance; or
(b)if the employer has only been insured for part of a period of insurance—a reasonable estimate of the wages of the employer for the period of insurance.

13Former employer may apply to cancel policy

(1)This section applies if a person (a former employer) wishes to cancel a policy because the person has stopped employing workers.
(2)This section does not apply to a former employer of only household workers.
(3)The former employer must give WorkCover—
(a)written notice that the former employer—
(i)stopped employing workers on and from a date stated in the notice; and
(ii)wishes to cancel the policy; and
(b)written details of—
(i)the address to which any document addressed to the former employer may be sent; and
(ii)the former employer’s wages in relation to the period (last employment period) starting on 1 July last preceding the day on which employment of workers stopped and ending on that day.

14Cancellation of policy if workers no longer employed

(1)This section applies if—
(a)a person (a former employer) has notified WorkCover under section 13(3) that the former employer has stopped employing workers; or
(b)WorkCover is satisfied, after making reasonable enquiries, that a person (also a former employer) has stopped employing workers.
(2)WorkCover may cancel the former employer’s policy.
(3)WorkCover must assess the premium payable by the former employer for the period during which the Act required the former employer to maintain a policy.
(4)If the premium paid by the former employer for the last employment period is—
(a)greater than the amount of premium assessed under subsection (3)—WorkCover must refund the amount overpaid to the former employer; or
(b)less than the amount of premium assessed under subsection (3)—the former employer must pay WorkCover the amount of the deficit on or before the due date under a final premium notice issued for the amount of the deficit.
(5)Nothing in this section is taken to limit chapter 2, part 3, division 2 of the Act.

Division 2 Employer excess

15Excess period—Act, s 65(2)

For section 65(2) of the Act, the prescribed amount is the lesser of the following—
(a)QOTE;
(b)the amount of weekly compensation payable to a worker under chapter 3, part 9 of the Act.

Division 3 Self-insurance

16Application fees—Act, s 70(c)

For section 70(c) of the Act, the prescribed fee is—
(a)for a single employer—$15,000; or
(b)for a group employer—$20,000.

17Annual levy—Act, s 81(2)

(1)For section 81(2) of the Act, the prescribed way to calculate the annual levy is using the formula—

Formula

(2)In subsection (1)—
estimated claims liability means estimated claims liability calculated under part 3, division 4 stated in the most recent actuarial report agreed by the Regulator, or decided by the arbiter, under that division, before a date fixed by the Regulator by gazette notice.
rate means the rate published in the gazette notice under section 81 of the Act for the particular financial year.

18Provisional annual levy—not agreed or decided

(1)This section applies if—
(a)the Regulator and the self-insurer have not agreed on the calculation of estimated claims liability under part 3, division 4; and
(b)the arbiter has not decided the estimated claims liability.
(2)The Regulator may use the estimated claims liability amount (the provisional annual levy) assessed by the approved actuary to ensure the self-insurer’s compliance with section 81 of the Act.

19Adjusted annual levy—agreed

(1)If the Regulator and the self-insurer agree under section 62 on the estimated claims liability amount (agreed amount), the Regulator must give the self-insurer an adjusted levy notice based on the agreed amount within 14 days after the Regulator and the self-insurer agree to the amount.
(2)If the agreed amount is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the provisional annual levy and the amount of the annual levy actually payable by the self-insurer.
(3)If the agreed amount is less than the provisional annual levy paid by the self-insurer, the Regulator must pay the self-insurer the difference between the actual annual levy payable and the amount paid as the provisional annual levy.

20Adjusted annual levy—not agreed but decided

(1)This section applies if the Regulator and the self-insurer do not agree to an amount under section 19 and the amount (the decided adjusted amount) decided by the arbiter under section 63(1) is not the same as the amount of the estimated claims liability used to calculate the provisional annual levy.
(2)If subsection (1) applies, the Regulator must give the self-insurer an adjusted levy notice based on the decided adjusted amount within 14 days after the Regulator or the self-insurer receives notice of the amount.
(3)If the amount of the adjusted levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the provisional annual levy and the amount of the annual levy actually payable by the self-insurer.
(4)If the amount of the adjusted levy is less than the provisional annual levy paid by the self-insurer, the Regulator must pay the self-insurer the difference between the actual annual levy payable and the amount paid as the provisional annual levy.

21Additional amount for late payment of levy—Act, s 82(1)

For section 82(1) of the Act, the additional amount payable is—
(a)if the amount is paid to the Regulator within 30 days after the due date—5% of the amount; or
(b)if the amount is paid to the Regulator after 30 days but within 60 days after the due date—10% of the amount; or
(c)if the amount is paid to the Regulator after 60 days after the due date or if no payment is made—10% of the amount plus interest at a rate specified by the Regulator by gazette notice for the period from the due date, or a later date decided by the Regulator, until the amount and all additional amounts are paid to the Regulator.

22Conditions of licence—Act, s 83

For section 83(1)(a) of the Act, a self-insurer’s licence is subject to the condition that the self-insurer must lodge with the Regulator, for each year or part of a year of the licence, a declaration in the approved form of the self-insurer’s wages.

s 22 amd 2016 Act No. 44 s 49

23Premium payable after cancellation of self-insurer’s licence—Act, s 98

(1)For section 98 of the Act, the premium payable by the former self-insurer for the first 2 periods of insurance after cancellation is to be calculated according to the method and at the rate specified by WorkCover, by gazette notice under section 54 of the Act, as if the employer were a new employer.
(2)However, the rate under subsection (1) must not be less than the rate calculated using the formula—

Formula

(3)In subsection (2)—
administrative costs means the administrative costs associated with claims incurred during the final period of licence, calculated by multiplying payments + liability by 0.095.
final period of licence means—
(a)for an employer licensed as a self-insurer for 3 or more years immediately before cancellation of the licence—3 years; or
(b)for an employer licensed as a self-insurer for less than 3 years immediately before cancellation of the licence—the period of the licence.
liability means an actuarial estimate of the outstanding liability at the end of the self-insurer’s licence for claims incurred during the final period of licence, excluding liability for the excess period.
payments means the actual payments made by the former self-insurer, less recoveries received and payments made that are the equivalent of amounts payable for the excess period, for claims incurred during the final period of licence.
wages means the wages of the self-insurer during the final period of licence.

24Deemed levy for appeals—Act, s 569(2)(a)

(1)The deemed levy, for a self-insurer for a financial year of the self-insurer’s licence, is an amount calculated using the formula—

equation

(2)In this section—
estimated claims liability means estimated claims liability calculated under part 3, division 4 that was used to calculate the annual levy under section 17.
rate means the rate published in the gazette under section 81 of the Act for the particular financial year.

Part 3 Calculation of self-insurer’s liability

Division 1 Outstanding liability

Subdivision 1 Preliminary

25Calculation of outstanding liability—Act, s 87(2)

For section 87(2) of the Act, the amount of a self-insurer’s outstanding liability must be calculated under this division.

Subdivision 2 Actuarial calculations and reports

26Appointment of actuary

WorkCover and the employer must each appoint an actuary to calculate an outstanding liability amount.

27Regulator to give actuary information

The Regulator must give each appointed actuary the information necessary to enable the actuaries to calculate the employer’s outstanding liability within the time mentioned in section 29(3).

28Actuarial calculation

A calculation of the outstanding liability must—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the outstanding liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the employer’s claims experience from claims incurred before the employer becomes or became a self-insurer; and
(g)be based on data as at the assessment day.

29Actuarial report

(1)For each calculation of an outstanding liability amount the appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the employer; and
(ii)the average amount of claims for damages against the employer; and
(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the employer; and
(v)the frequency of claims for damages against the employer; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including accuracy of the data;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.
(3)Each appointed actuary must prepare the actuarial report within 35 days after the day a self-insurer lodges an application for self-insurance.

30Summary report

(1)The appointed actuaries must jointly prepare a summary report that—
(a)includes the individual actuarial reports; and
(b)states how the individual reports agree or differ and the reasons for the difference.
(2)The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the employer within 2 months after the day the application for self-insurance is lodged.

31Agreement on amount

WorkCover and the employer may agree on the employer’s outstanding liability having regard to the summary report.

32Reference to arbiter if no agreement on amount

(1)WorkCover or the employer may advise the Regulator that WorkCover and the employer do not agree on the outstanding liability amount.
(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the outstanding liability amount.

33Payment of amount

(1)WorkCover must pay the outstanding liability amount—
(a)agreed to by WorkCover and the employer; or
(b)if there is no agreement—decided by the arbiter.
(2)WorkCover must pay the employer—
(a)75% of the outstanding liability amount on the day the licence commences; and
(b)the balance within 1 month after the day the licence commences.
(3)WorkCover’s actuary must adjust the outstanding liability amount paid to the employer to take into account—
(a)compensation and damages payments made between the assessment day and the day the employer becomes liable for the employer’s outstanding liability amount; and
(b)claims lodged against the employer between the assessment day and the day the employer becomes liable for the employer’s outstanding liability amount.

34Transfer of claims information

WorkCover must give the employer claims information in relation to the employer’s outstanding liability before the day the licence commences.

Division 2 Total liability

Subdivision 1 Preliminary

35Calculation of total liability after change in self-insurer’s membership—Act s 90(9)

For section 90(9) of the Act, the amount of total liability after a change in the self-insurer’s membership must be calculated under this division.

Subdivision 2 Actuarial calculations and reports

36Appointment of actuary

The relevant parties must each appoint an actuary to calculate the total liability amount.

37Relevant parties to give actuaries information

The relevant parties must give each appointed actuary, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 39(3).

38Actuarial calculation

A calculation of the total liability amount must—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the outstanding liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the claims experience of the employer or member of a group employer that is the subject of the transfer of liability; and
(g)be based on data as at the assessment day.

39Actuarial report

(1)For each calculation of a total liability amount the appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the employer; and
(ii)the average amount of claims for damages against the employer; and
(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the employer; and
(v)the frequency of claims for damages against the employer; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including its accuracy;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.
(3)Each appointed actuary must prepare the actuarial report within 35 days after the consent day.

40Summary report

(1)The actuaries must jointly prepare a summary report that—
(a)includes the individual actuarial reports; and
(b)states how the individual reports agree or differ.
(2)The actuaries must give a copy of the completed summary report to the parties and the Regulator within 2 months after the consent day.

41Agreement on amount

The relevant parties may agree on the total liability amount having regard to the summary report.

42Reference to arbiter if no agreement on amount

(1)A relevant party may advise the Regulator that the parties do not agree on the total liability amount.
(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the total liability amount.

43Payment of amount

(1)The old insurer must pay the total liability amount to the new insurer for the total liability—
(a)agreed to by the old insurer and the new insurer; or
(b)if there is no agreement—decided by the arbiter.
(2)The old insurer must pay the total liability amount—
(a)within 3 months after the consent day; or
(b)on a later day agreed to by the parties.
(3)The old insurer’s actuary must adjust the liability amount paid to the new insurer to take into account—
(a)compensation and damages payments made between the assessment day and the day the new insurer assumes liability; and
(b)claims lodged against the employer or member between the assessment day and the day the new insurer assumes liability.
(4)The old insurer must advise the Regulator of the following no later than the day the total liability amount is paid—
(a)the total liability amount;
(b)the day the new insurer assumes liability;
(c)details of the parties and the member leaving or becoming part of the self-insurer.

44Transfer of claims information

The old insurer must give the new insurer claims information in relation to the liability no later than the day the total liability amount is paid.

Division 3 Liability after cancellation of self-insurer’s licence

Subdivision 1 Preliminary

45Calculation of liability after cancellation—Act, s 102(3)

For section 102(3) of the Act, the amount for a former self-insurer’s liability must be calculated under this division.

Subdivision 2 Actuarial calculations and reports

46Appointment of actuary

WorkCover and a former self-insurer must each appoint an actuary to calculate the former self-insurer’s liability amount.

47Former self-insurer to give actuaries information

The former self-insurer must give the actuaries, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 49(3).

48Actuarial calculation

A calculation of a former self-insurer’s liability amount must—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the outstanding liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the employer’s claims experience from claims incurred before the employer becomes or became a self-insurer; and
(g)be based on data as at the assessment day.

49Actuarial report

(1)For each calculation of a former self-insurer’s liability amount the appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the employer; and
(ii)the average amount of claims for damages against the employer; and
(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the employer; and
(v)the frequency of claims for damages against the employer; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including its accuracy;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.
(3)Each appointed actuary must prepare an actuarial report within 35 days after the cancellation day.

50Summary report

(1)The appointed actuaries must jointly prepare a summary report that—
(a)includes the individual actuarial reports; and
(b)states how the individual reports agree or differ.
(2)The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the former self-insurer within 2 months after the cancellation day.

51Agreement on amount

WorkCover and the former self-insurer may agree on the former self-insurer’s liability amount having regard to the summary report.

52Reference to arbiter if no agreement on amount

(1)WorkCover or the former self-insurer may advise the Regulator that WorkCover and the former self-insurer do not agree on the self-insurer’s liability amount.
(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the self-insurer’s liability amount.

53Payment of amount

(1)The former self-insurer’s liability amount the former self-insurer must pay WorkCover is—
(a)the amount (the agreed amount) agreed to by WorkCover and the former self-insurer; or
(b)if there is no agreement, the amount (the decided amount) decided by the arbiter.
(2)The former self-insurer’s actuary must adjust the amount to take into account—
(a)compensation and damages payments made between the assessment day and the cancellation day; and
(b)claims lodged against the former self-insurer between the assessment day and the cancellation day.

Division 4 Estimated claims liability

Subdivision 1 Preliminary

54Calculation of estimated claims liability—Act, s 84(3)(b)

For section 84(4)(b) of the Act, the amount of the estimated claims liability must be calculated under this division.

s 54 amd 2016 Act No. 44 s 53 sch 1

Subdivision 2 Actuarial calculations and reports

55Approved actuary

The approved actuary must calculate the estimated claims liability amount.

56Self-insurer to give Regulator and approved actuary information

The self-insurer must give the self-insurer’s data to the Regulator and the approved actuary, in the form approved by the Regulator.

57Actuarial calculation

A calculation of a estimated claims liability amount must—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the self-insurer’s claims experience; and
(g)be based on the self-insurer’s data as at—
(i)the last day of the financial quarter immediately before the anniversary of the day the renewed licence commences; or
(ii)another day fixed by the Regulator.

58Actuarial report

(1)For each calculation of an estimated claims liability amount the approved actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the employer; and
(ii)the average amount of claims for damages against the employer; and
(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the employer; and
(v)the frequency of claims for damages against the employer; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including its accuracy;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.

59Copy of actuarial report to Regulator and self-insurer

The approved actuary must give a copy of the actuarial report to the Regulator and the self-insurer by the day fixed by the Regulator or a later day agreed between the Regulator and the actuary.

60Regulator to advise self-insurer whether agreement on amount

Within 35 days after the approved actuary gives the Regulator a copy of the actuarial report, the Regulator must advise the self-insurer whether the Regulator agrees or does not agree with the approved actuary’s assessment of the estimated claims liability.

61Reference to Regulator’s actuary if no agreement on amount

(1)After receiving a copy of the approved actuary’s report, the Regulator may ask an actuary (Regulator’s actuary) to calculate the amount of the self-insurer’s estimated claims liability and give the Regulator an actuarial report made under section 58.
(2)The Regulator must give the Regulator’s actuary the approved actuary’s report and the self-insurer’s data.

62Agreement on amount

If, at any time, the Regulator and the self-insurer agree on the calculation of estimated claims liability, having regard to the approved actuary’s actuarial report or any Regulator’s actuary’s actuarial report, the estimated claims liability is the amount agreed to by the Regulator and the self-insurer.

63Reference to arbiter

(1)If the Regulator and the self-insurer do not agree on the calculation, the Regulator must refer the approved actuary’s report, the self-insurer’s data and any Regulator’s actuary’s actuarial report to the arbiter for decision.
(2)The Regulator must make the referral within 14 days after the day the Regulator advises the self-insurer that the Regulator does not agree with the self-insurer’s approved actuary’s actuarial report under section 60.

Division 5 Self-insurers who become non-scheme employers

Subdivision 1 Preliminary

64Calculation of non-scheme employer’s liability—Act, s 105I(2)

For section 105I(2) of the Act, the amount for a non-scheme employer’s liability must be calculated under this division.

Subdivision 2 Actuarial calculations and reports

65Appointment of actuary

WorkCover and the non-scheme employer must each appoint an actuary to calculate a non-scheme employer’s liability amount.

66Non-scheme employer to give actuaries information

The non-scheme employer must give the actuaries, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 68(3).

67Actuarial calculation

A calculation of a non-scheme employer’s liability amount must—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the non-scheme insurer’s claims experience; and
(g)be based on data that only relates to the period before the cancellation day.

68Actuarial report

(1)For each calculation of a non-scheme employer’s liability amount each appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the non-scheme employer; and
(ii)the average amount of claims for damages against the non-scheme employer; and
(iii)claims anticipated to have been incurred by the non-scheme employer for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the non-scheme employer; and
(v)the frequency of claims for damages against the non-scheme employer; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including its accuracy;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.
(3)Each appointed actuary must prepare an actuarial report on the actuary’s calculation within 35 days after the cancellation day.

69Summary report

(1)The actuaries must jointly prepare a summary report that—
(a)includes the individual actuarial reports; and
(b)states how the individual reports agree or differ.
(2)The actuaries must give a copy of the summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the cancellation day.

70Agreement on amount

WorkCover and the non-scheme employer may agree on the non-scheme employer’s liability amount having regard to the summary report.

71Reference to arbiter if no agreement on amount

(1)WorkCover or the non-scheme employer may advise the Regulator that WorkCover and the non-scheme employer do not agree on the non-scheme employer’s liability amount.
(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the non-scheme employer’s liability amount.

72Payment of amount

(1)The amount the non-scheme employer must pay WorkCover for the liability is—
(a)the amount (the agreed amount) agreed to by WorkCover and the non-scheme employer; or
(b)if there is no agreement—the amount (the decided amount) decided by the arbiter.
(2)The agreed amount or decided amount paid to WorkCover must be adjusted by the non-scheme employer’s actuary to take into account—
(a)compensation and damages payments made between the assessment day and the cancellation day; and
(b)claims lodged against the non-scheme employer between the assessment day and the cancellation day.

Subdivision 3 Calculation—finalised non-scheme employer’s liability

73Calculation of finalised non-scheme employer’s liability amount—Act, s 105I(2)

For section 105I(2) of the Act, the amount for finalisation of a non-scheme employer’s liability must be calculated under this subdivision.

74Appointment of actuary

WorkCover and the non-scheme employer must each appoint an actuary, at the end of 4 years after the cancellation day, to calculate the finalised non-scheme employer’s liability amount.

75WorkCover to give actuaries information

WorkCover must give the appointed actuaries the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 77(3).

76Actuarial calculation

(1)For each calculation of a finalised non-scheme employer’s liability amount must the appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the non-scheme insurer’s claims experience; and
(g)apply the same risk free rate of return that was used in the calculation of the non-scheme employer’s liability amount; and
(h)have regard to compensation and damages payments made in relation to the liability between the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability and the end of 4 years after that day; and
(i)be based on data as at the last day of the last financial quarter for which data is available at the end of 4 years after the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability amount.
(3)The data relied on under subsection (2)(i) may only relate to the period before the exit date.

77Actuarial report

(1)For each calculation of a finalised non-scheme employer’s liability amount, each appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the non-scheme employer; and
(ii)the average amount of claims for damages against the non-scheme employer; and
(iii)claims anticipated to have been incurred by the non-scheme employer for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the non-scheme employer; and
(v)the frequency of claims for damages against the non-scheme employer; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the non-scheme employer’s liability amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including its accuracy;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.
(3)Each appointed actuary must prepare an actuarial report on the actuary’s calculation within 35 days after the end of 4 years after the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability.

78Summary report

(1)The actuaries must jointly prepare a summary report that—
(a)includes the individual actuarial reports; and
(b)states how the individual reports agree or differ.
(2)The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the end of 4 years after the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability.

79Agreement on amount

WorkCover and the finalised non-scheme employer liability amount may agree on the finalised non-scheme employer liability amount having regard to the summary report.

80Reference to arbiter if no agreement on amount

(1)WorkCover or the finalised non-scheme employer may advise the Regulator that WorkCover and the finalised non-scheme employer do not agree on the finalised non-scheme employer’s liability amount.
(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the finalised non-scheme employer’s liability amount.

81Payment of amount

(1)If the amount (the agreed amount) agreed to by WorkCover and the non-scheme employer or, if there is no agreement, the amount (the decided amount) decided by the arbiter, for the calculation is more than the non-scheme employer’s liability amount—
(a)the amount the non-scheme employer must pay WorkCover for the non-scheme employer’s liability is the agreed amount or decided amount; and
(b)the non-scheme employer must pay WorkCover—
(i)the difference between the amount of the payment (the interim payment) made under section 72 and the agreed amount or decided amount for the non-scheme employer’s liability; and
(ii)interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return that was used in the calculation of the non-scheme employer’s liability amount.
(2)If the agreed amount or decided amount is less than the interim payment—
(a)the amount the non-scheme employer must pay WorkCover for the non-scheme employer’s liability is the agreed amount or decided amount; and
(b)WorkCover must pay the non-scheme employer—
(i)the difference between the interim payment and the agreed amount or decided amount for the liability; and
(ii)interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return that was used in the calculation of an amount for the liability under subdivision 2.
(3)WorkCover or the non-scheme employer must pay the amount of the difference within 28 days after—
(a)WorkCover and the non-scheme employer agree on the recalculation; or
(b)if there is no agreement, WorkCover or the non-scheme employer receives the statement of the arbiter’s decision about the recalculation.
(4)On payment of the amount—
(a)the non-scheme employer’s liability is finalised for section 105I(5) of the Act; and
(b)no further amount is payable for the liability.

Division 6 Total liability—member of a group who becomes non-scheme employer

Subdivision 1 Preliminary

82Calculation of non-scheme members’ total liability—Act, s 105O(3)(a)

For section 105O(3)(a) of the Act, the amount of total liability after a change in the self-insurer’s membership must be calculated under this division.

Subdivision 2 Actuarial calculations and reports

83Appointment of actuary

(1)The old insurer and WorkCover must each appoint an actuary to calculate the total liability amount.
(2)An actuary appointed by the old insurer must be approved by the non-scheme member.

84Parties to give actuaries information

The old insurer and WorkCover must give the appointed actuaries, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 86(3).

85Actuarial calculation

A calculation of a total liability amount must—
(a)be prepared under the actuarial standard; and
(b)apply a central estimate of the relevant liability; and
(c)apply the risk free rate of return; and
(d)include claims administration expenses of 7% of the outstanding liability; and
(e)not include a prudential margin; and
(f)be based, as far as practicable, on the claims experience of the employer or member of a group employer that is the subject of the transfer of liability; and
(g)be based on data as at the assessment day.

86Actuarial report

(1)For each calculation of a total liability amount each appointed actuary must prepare an actuarial report under the actuarial standard.
(2)The actuarial report must state the following—
(a)the amount;
(b)the key assumptions made for the calculation;
(c)how the key assumptions have been derived, including—
(i)the average amount of claims for compensation against the non-scheme member; and
(ii)the average amount of claims for damages against the non-scheme member; and
(iii)claims anticipated to have been incurred by the non-scheme member, for which no formal claim has been lodged; and
(iv)the frequency of claims for compensation against the non-scheme member; and
(v)the frequency of claims for damages against the non-scheme member; and
(vi)the net amount of the claims after allowing for future inflation (inflated value); and
(vii)the net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount; and
(viii)the rate of inflation used;
(d)the nature of the data used in the calculation;
(e)the actuary’s assessment of the data, including accuracy of the data;
(f)how the actuary interpreted the data;
(g)the actuarial model used in the calculation;
(h)the results of the calculation;
(i)the actuary’s confidence in the results of the calculation.
(3)Each appointed actuary must prepare an actuarial report within 35 days after the final day.

87Summary report

(1)The actuaries must jointly prepare a summary report that—
(a)includes the individual actuarial reports; and
(b)states how the individual reports agree or differ.
(2)The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the old insurer, within 2 months after the final day.

88Agreement on amount

The old insurer and WorkCover may agree on the liability amount having regard to the summary report.

89Reference to arbiter if no agreement on amount

(1)WorkCover or the old insurer may advise the Regulator that WorkCover and the old insurer do not agree on the liability amount.
(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the liability amount.

90Payment of amount

(1)For section 105O(3)(b) of the Act, the old insurer must pay the agreed amount or decided amount—
(a)within 3 months after the final day; or
(b)on a later day agreed to by the old insurer and WorkCover.
(2)The old insurer must pay WorkCover—
(a)the non-scheme member’s total liability amount (the agreed amount) agreed to by the old insurer and WorkCover; or
(b)if there is no agreement—the non-scheme member’s total liability amount (the decided amount) decided by the arbiter.
(3)The agreed amount or decided amount paid to WorkCover must be adjusted by the actuary of the old insurer to take into account—
(a)compensation and damages payments made between the assessment day and the final day; and
(b)claims lodged against the non-scheme member between the assessment day and the final day.
(4)The old insurer must advise the Regulator of the following no later than the day the total liability amount must be paid—
(a)the amount of the total liability;
(b)the day WorkCover assumes liability;
(c)details of the old insurer and the non-scheme member.

91Transfer of claims information

The old insurer must give WorkCover claims information in relation to the liability no later than the day the agreed or decided amount is paid.

Division 7 Actuarial arbiter

92Function of actuarial arbiter

The functions of the actuarial arbiter are—
(a)to consider the actuarial reports and the calculations of an amount for liability made under this part; and
(b)to decide on an amount for the liability.

93Selection and appointment of actuarial arbiter

(1)The arbiter is to be selected by a selection panel consisting of—
(a)2 individuals nominated by the Regulator; and
(b)2 individuals nominated by WorkCover; and
(c)2 individuals nominated by the Association of Self Insured Employers of Queensland.
(2)The arbiter must be a Fellow of the Institute of Actuaries or be an Accredited Member of the Institute.
(3)The Regulator must appoint the arbiter for a term of not more than 3 years.
(4)The arbiter’s conditions of appointment are to be set out in the contract made between the Regulator and the arbiter.

94Arbiter must decide amount

(1)After considering the actuarial reports and the calculations of an amount for the liability by the actuaries, the arbiter must decide on—
(a)the central estimate for the liability; and
(b)an amount for the liability.
(2)An amount for the liability decided by the arbiter must not be—
(a)more than the higher of the amounts calculated by the actuaries; and
(b)less than the lower of the amounts.
(3)The arbiter must give a written statement of the arbiter’s decision, and the reasons for the decision, within 21 days after the summary report is referred to the arbiter.

95Arbiter’s decision is final

The arbiter’s decision is final.

96Arbiter’s costs

The arbiter’s costs in deciding a liability amount are to be paid in equal amounts by the following—
(a)if the decision is for an amount of outstanding liability—WorkCover and the employer;
(b)if the decision is for an amount of the total liability—the relevant parties;
(c)if the decision is for an amount of liability after cancellation of the self-insurer’s licence—WorkCover and the former self-insurer;
(d)if the decision is for an amount of estimated claims liability—the Regulator and the self-insurer;
(e)if the decision is for an amount for non-scheme employer’s liability—WorkCover and the non-scheme employer;
(f)if the decision is for an amount for a recalculation of a non-scheme employer’s liability—WorkCover and the non-scheme employer;
(g)if the decision is for an amount for the total liability of a non-scheme member—WorkCover and the old insurer.

Part 4 Compensation

Division 1 Calculation of NWE

97Calculation of NWE—Act, s 106(3)

This division prescribes the way to calculate the NWE for section 106(3) of the Act.

98What amounts may be taken into account

(1)In calculating the NWE the following may be taken into account—
(a)amounts paid to the worker by way of overtime, higher duties, penalties and allowances that are of a regular nature, required by an employer;
(b)amounts that would have continued if not for the injury may be taken into account.
(2)However, amounts mentioned in the Act, schedule 6, definition wages, paragraphs (a) to (d) must not be taken into account in calculating the NWE.

99NWE if impracticable to calculate rate of worker’s remuneration

(1)This section applies if it is impracticable, at the date of injury to a worker, to calculate the rate of the worker’s remuneration because of—
(a)the period of time for which the worker has been employed; or
(b)the terms of the worker’s employment.
(2)In calculating the rate of the worker’s remuneration, regard must be had to—
(a)the NWE during the 12 months immediately before the date of injury of a person employed by the same employer who—
(i)is employed under the same or a comparable relevant industrial agreement or the same or comparable terms and conditions, the worker; and
(ii)performs the same or comparable work as the worker; or
(b)if paragraph (a) does not apply—the NWE during the 12 months immediately before the date of injury of a person employed by another employer who—
(i)is employed under the same or comparable relevant industrial agreement or the same or comparable terms and conditions as the worker; or
(ii)receives the same or comparable remuneration as the worker and performs the same or comparable work as the worker.

100NWE if worker worked for 2 or more employers

(1)This section applies if a worker has worked under concurrent contracts of service with 2 or more employers, under which the worker has worked at 1 time for 1 employer and at another time for another of the employers.
(2)The worker’s NWE is to be calculated as if earnings under all the contracts were earnings in the employment of the employer for whom the worker was working when the injury was sustained.

101NWE if insurer considers calculation unfair

(1)This section applies if an insurer considers that the calculation of NWE under this division would be unfair.
(2)The NWE may be calculated in a way the insurer considers to be fair, and the calculation under this subsection is taken to be the worker’s NWE.

Division 2 Compensation application and other procedures

102Application for compensation to include evidence or particulars—Act, s 132(3)(b)

(1)For section 132(3)(b) of the Act, the following evidence or particulars are prescribed—
(a)the injury and its cause;
(b)the nature, extent and duration of incapacity resulting from the injury;
(c)if the injury is, or results in, the death of a worker, proof of—
(i)the worker’s death; and
(ii)the identity of the worker; and
(iii)the relationship to the worker, and dependency, of persons claiming to be the worker’s dependants;
(d)if the injury is a latent onset injury that is a terminal condition and the worker has dependants—proof of the relationship to the worker of persons claiming to be the worker’s dependants.
(2)In this section—
dependant, of a worker, means a member of the worker’s family who is completely or partly dependent on the worker’s earnings.
member of the family, of a worker, means—
(a)the worker’s—
(i)spouse; or
(ii)parent, grandparent or step-parent; or
(iii)child, grandchild or stepchild; or
(iv)brother, sister, half-brother or half-sister; or
(b)if the worker stands in the place of a parent to another person—the other person; or
(c)if another person stands in the place of a parent to the worker—the other person.

103If dentist, doctor or nurse practitioner not available

(1)This section applies if—
(a)a person does not lodge a certificate in the approved form with an application made under section 132, 132A or 132B of the Act in relation to a worker; and
(b)the certificate can not be provided because the dentist, doctor or nurse practitioner required to give the certificate under the section was not available to attend the worker.
(2)The person must complete and lodge with the insurer a declaration in the approved form.
(3)For a non-fatal injury, the declaration—
(a)may be accepted by the insurer only once for injury to the worker in any 1 event; and
(b)is acceptable proof of incapacity of the worker for up to 3 days.
(4)The declaration is taken to be a certificate in the approved form for section 132(3)(a), 132A(3)(c)(i) or 132B(3)(c)(i) of the Act.

s 103 amd 2015 SL No. 135 s 4

104Certificate given by dentist, doctor or nurse practitioner

(1)This section applies if—
(a)a certificate in the approved form is not lodged with an application made under section 132, 132A or 132B of the Act in relation to a worker who sustains an injury; and
(b)the worker sustained the injury in another State or country.
(2)The insurer must accept a written certificate that is substantially to the effect of the approved form from the dentist, doctor or nurse practitioner who attended the worker.
(3)The certificate is taken to be a certificate in the approved form for section 132(3)(a), 132A(3)(c)(i) or 132B(3)(c)(i) of the Act.
(4)Also, on the insurer’s request, the dentist, doctor or nurse practitioner who attended the worker must give a detailed report on the worker’s condition to the insurer within 10 days after receiving the request.
(5)The fee payable to the dentist, doctor or nurse practitioner for the report is an amount that the insurer considers to be reasonable, having regard to the relevant table of costs.

s 104 amd 2015 SL No. 135 s 5

105Application for compensation for assessment of DPI—Act, s 132A(3)(c)(ii)

For section 132A(3)(c)(ii) of the Act, the following evidence or particulars are prescribed—
(a)proof of the injury and its cause;
(b)proof of the nature, extent and duration of incapacity resulting from the injury.

105AApplication for certificate of dependency—Act, s 132B(3)(c)(ii)

For section 132B(3)(c)(ii) of the Act, the following evidence is prescribed—
(a)proof of the injury and its cause;
(b)proof of the identity of the worker;
(c)proof of the worker’s death;
(d)proof of the relationship to the worker, and dependency, of the person claiming to be the worker’s dependant.

s 105A ins 2015 SL No. 135 s 6

106Request for examination of claimant or worker—Act, ss 135 and 510

(1)A request under sections 135 and 510 of the Act for a personal examination must be made in writing.
(2)The request must specify—
(a)the name of the doctor or other registered person, who is not employed by the insurer under a contract of service, engaged to make the examination; and
(b)if the doctor is a specialist—the field of specialty; and
(c)the day, time and place for the examination.
(3)A doctor or other registered person who examines a claimant or worker must, within 10 days after the examination, give the insurer—
(a)a written report on the examination; and
(b)an itemised account for the examination.
(4)Fees payable to a doctor or other registered person for the examination—
(a)are payable by the insurer; and
(b)are payable for—
(i)making the examination; and
(ii)giving a report to the insurer; and
(c)are the costs accepted by the insurer to be reasonable, having regard to the relevant table of costs.

Division 3 Entitlement to compensation for permanent impairment—generally

div hdg amd 2015 SL No. 135 s 7

107Additional lump sum compensation—workers with latent onset injuries that are terminal—Act, s 128B(2)(c)

For section 128B(2)(c) of the Act, the additional lump sum compensation, and graduated scale, set out in schedule 2 are prescribed.

108Calculating lump sum compensation—Act, s 180(1)

For section 180(1) of the Act, the lump sum compensation for a worker’s DPI is calculated by multiplying the maximum statutory compensation by the worker’s DPI.

Example—

A worker’s DPI is assessed as 10%. The maximum statutory compensation is $307,385. The lump sum compensation is $30,738.50.

109Additional lump sum compensation for workers with DPI of 30% or more—Act, s 192(2)

For section 192(2) of the Act, the additional lump sum compensation, and graduated scale, set out in schedule 3 are prescribed.

s 109 amd 2015 SL No. 135 s 8

110Additional lump sum compensation for gratuitous care (occupational therapist’s assessment)—Act, ss 193(4) and 224(3)

For sections 193(4) and 224(3) of the Act, the prescribed way of assessing the worker’s level of dependency is the way stated in the modified barthel index.

111Additional lump sum compensation for gratuitous care (occupational therapist’s report)—Act, ss 193(5)(b) and 224(4)(b)

For sections 193(5)(b) and 224(4)(b) of the Act, the following information, relating to the level of day to day care (the level of care) provided by a person at the worker’s home, is prescribed—
(a)whether the level of care was provided to the worker before the worker sustained the impairment;
(b)whether the level of care would ordinarily be provided in the worker’s home;
(c)if the level of care is likely to continue to be provided in the worker’s home;
(d)the number of hours of the level of care required by the worker.

112Additional lump sum compensation for gratuitous care—Act, s 193(6)

(1)For section 193(6) of the Act, the additional lump sum compensation, and graduated scale, set out in schedule 4 are prescribed.
(2)For section 193(6)(c) of the Act, the occupational therapist’s report is prescribed.
(3)In this section—
occupational therapist’s report means the report prepared by the occupational therapist under section 193(5) of the Act.

Division 3A Entitlement to additional compensation for permanent impairment—Act, s 193A

div hdg ins 2015 SL No. 135 s 9

Subdivision 1 Preliminary

sdiv hdg ins 2015 SL No. 135 s 9

112ADefinitions for div 3A

In this division—
injury means an injury mentioned in section 193A(1) of the Act.
panel means the panel established under section 112R.
qualifying condition means the condition prescribed by section 112D.
section 193A compensation, for an injury, means the additional lump sum compensation mentioned in section 193A(2) of the Act for the injury.
section 193A notice see section 112G(1).
specified worker means a worker to whom section 193A of the Act applies.

s 112A ins 2015 SL No. 135 s 9

112BOperation of div 3A

For section 193A of the Act, this division prescribes the following—
(a)the amount of section 193A compensation for an injury;
(b)the condition to which an entitlement to section 193A compensation is subject;
(c)the process for deciding whether the condition mentioned in paragraph (b) is satisfied for a specified worker;
(d)the establishment of a panel to review decisions made by insurers about section 193A compensation.

s 112B ins 2015 SL No. 135 s 9

Subdivision 2 Amount and condition of entitlement

sdiv hdg ins 2015 SL No. 135 s 9

112CAmount of compensation—Act, s 193A(2)(a)

For section 193A(2)(a) of the Act, the amount of section 193A compensation for an injury sustained by a specified worker in relation to whom the qualifying condition is satisfied is the amount provided for under schedule 4A.

s 112C ins 2015 SL No. 135 s 9

112DQualifying condition—Act, s 193A(2)(b)

(1)For section 193A(2)(b) of the Act, this section prescribes the condition applying to an entitlement to section 193A compensation for an injury sustained by a specified worker.
(2)The worker is entitled to section 193A compensation only if—
(a)the insurer is satisfied, on the balance of probabilities, the worker’s employer is, or would have been, liable to pay damages to the worker; but
(b)the worker can not seek damages because of the application of former section 237(1)(a)(i).
(3)In this section—
former section 237(1)(a)(i) means section 237(1)(a)(i) of the Act, as in force from 15 October 2013 until 31 January 2015.

s 112D ins 2015 SL No. 135 s 9

Subdivision 3 Process for deciding qualifying condition

sdiv hdg ins 2015 SL No. 135 s 9

112EApplication of sdiv 3

This subdivision applies if—
(a)a worker’s DPI has been decided; and
(b)the worker is a specified worker.

Notes—

1Section 193A of the Act applies only if a worker’s DPI has been decided—see section 191 of the Act.
2Also, see chapter 3, part 10 of the Act for provisions about—
assessing a worker’s injury to decide if the injury has resulted in a DPI; and
giving the worker a notice of assessment stating the DPI for the injury; and
an insurer making an offer of compensation to the worker.

s 112E ins 2015 SL No. 135 s 9

112FInsurer to consider qualifying condition

An insurer must decide—
(a)whether the insurer has enough information to decide whether the qualifying condition is satisfied for the worker; and
(b)if the insurer decides it has enough information—whether the qualifying condition is satisfied for the worker.

s 112F ins 2015 SL No. 135 s 9

112GNotification

(1)After deciding the matters mentioned in section 112F, the insurer must give the worker a notice (a section 193A notice in the approved form.
(2)If the insurer decides the qualifying condition is satisfied for the worker, the section 193A notice must state the amount of section 193A compensation to which the worker is entitled for the worker’s injury.
(3)If the insurer decides the qualifying condition is not satisfied for the worker, the section 193A notice must state—
(a)the insurer’s decision; and
(b)that the worker may ask the insurer for written reasons for the decision; and
(c)that the worker may apply to the panel for a review of the decision only if the worker has asked the insurer for the reasons for the decision.
(4)If the insurer decides it does not have enough information to decide whether the qualifying condition is satisfied for the worker, the section 193A notice must state—
(a)the insurer’s decision; and
(b)that the worker may, within 60 business days after receiving the notice, give the insurer information to enable the insurer to decide whether the qualifying condition is satisfied for the worker; and
(c)that, if the worker does not give the insurer the information within the period mentioned in paragraph (b)—
(i)the qualifying condition will be taken not to be satisfied for the worker; and
(ii)the worker will not be entitled to section 193A compensation; and
(iii)the worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii).

s 112G ins 2015 SL No. 135 s 9

112HWorker may request reasons

(1)This section applies if an insurer has given the worker a section 193A notice stating the insurer has decided the qualifying condition is not satisfied for the worker.
(2)The worker may, within 10 business days after receiving the notice, ask the insurer for written reasons for the decision.
(3)The insurer must give the worker the reasons for the decision within 10 business days after receiving the worker’s request.

s 112H ins 2015 SL No. 135 s 9

112IGiving information

(1)This section applies if the insurer has given the worker a section 193A notice stating the insurer does not have enough information to decide whether the qualifying condition is satisfied for the worker.
(2)The worker—
(a)may give the insurer information relevant to the decision within 60 business days after receiving the section 193A notice; and
(b)if the worker gives information to the insurer under paragraph (a)—must advise the insurer whether the worker has engaged a lawyer and incurred legal costs in giving the information.
(3)Despite subsection (2)(a), the insurer may, at the worker’s request, decide to allow the worker to give the insurer information after the period mentioned in the subsection has ended if the worker has a reasonable excuse for not giving the information during the period.
(4)The qualifying condition is taken not to be satisfied for the worker if the worker does not give the insurer information relevant to the decision during the period—
(a)mentioned in subsection (2)(a); or
(b)decided by the insurer under subsection (3).

s 112I ins 2015 SL No. 135 s 9

112JDecision based on worker’s information

(1)This section applies if the worker has given the insurer information under section 112I.
(2)The insurer must consider the information and decide whether the qualifying condition is satisfied for the worker.
(3)The insurer must make the decision within the later of the following periods to end—
(a)60 business days after receiving the information from the worker;
(b)if the insurer meets with the worker under section 112K—10 business days after the day of the meeting.
(4)If the insurer decides the qualifying condition is satisfied for the worker, the insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.
(5)If the insurer decides the qualifying condition is not satisfied for the worker, the insurer must give the worker written reasons for the decision.
(6)If the insurer does not make a decision within the period mentioned in subsection (3), the insurer is taken to have decided the qualifying condition is not satisfied for the worker.

s 112J ins 2015 SL No. 135 s 9

112KMeeting before decision made

(1)This section applies if—
(a)the worker has given the insurer information under section 112I; and
(b)the insurer proposes to decide the qualifying condition is not satisfied for the worker.
(2)Before making the decision, the insurer must—
(a)give the worker an opportunity to meet with the insurer to discuss the proposed decision; and
(b)if the worker agrees to meet with the insurer—give the worker any relevant information the insurer holds at least 10 business days before the meeting.
(3)The insurer is not required to give the worker more than 1 opportunity to meet with the insurer.
(4)In this section—
relevant information, in relation to a worker, means information, other than information given to the insurer by the worker, that the insurer intends to consider for making the proposed decision.

s 112K ins 2015 SL No. 135 s 9

Subdivision 4 Review of insurer’s decision

sdiv hdg ins 2015 SL No. 135 s 9

112LDefinition for sdiv 4

In this subdivision—
decision, of an insurer, includes a decision taken to have been made by the insurer under section 112J(6).

s 112L ins 2015 SL No. 135 s 9

112MApplication of sdiv 4

This subdivision applies to a worker—
(a)who, under subdivision 3, has received written reasons for an insurer’s decision that the qualifying condition is not satisfied for the worker; or
(b)in relation to whom an insurer is taken to have decided that the qualifying condition is not satisfied under section 112J(6).

s 112M ins 2015 SL No. 135 s 9

112NApplication for review

(1)The worker may apply to the panel for a review of the decision within 20 business days after—
(a)the worker receives written reasons for the decision; or
(b)the day on which the worker becomes aware the insurer has failed to decide whether the qualifying condition is satisfied for the worker within the period mentioned in section 112J(3).
(2)The application must include the following—
(a)the worker’s reasons for asking for a review of the decision;
(b)if the worker has received written reasons for the decision—the reasons;
(c)if the worker has not already had an opportunity to give the insurer information about whether the qualifying condition is satisfied for the worker—any information the worker wants the panel to consider in support of the worker’s application;
(d)if the worker has engaged a lawyer and incurred legal costs in relation to the application—a statutory declaration verifying the worker has engaged the lawyer and incurred legal costs.
(3)The worker must give the insurer a copy of the application.

s 112N ins 2015 SL No. 135 s 9

112OInsurer to give information to panel

As soon as practicable after receiving a copy of the worker’s application under section 112N, the insurer must give the panel and the worker any information the insurer has considered in deciding whether the qualifying condition is satisfied for the worker.

s 112O ins 2015 SL No. 135 s 9

112PReview by panel

(1)After considering the application and reviewing the insurer’s decision, the panel must decide to—
(a)confirm the decision; or
(b)cancel the decision and substitute a new decision.
(2)The panel must give the worker and the insurer written notice of its decision and the reasons for its decision.
(3)The panel’s decision—
(a)is final; and
(b)if the decision is to substitute a new decision—is taken to be the insurer’s decision that the qualifying condition is satisfied for the worker.
(4)To remove any doubt, it is declared that the panel may review the insurer’s decision without receiving oral submissions.

s 112P ins 2015 SL No. 135 s 9

112QInsurer must notify amount of entitlement

(1)This section applies if the insurer is notified by the panel that the insurer’s decision is substituted with a new decision that the qualifying condition is satisfied for the worker.
(2)The insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.

s 112Q ins 2015 SL No. 135 s 9

Subdivision 5 Establishment of panel

sdiv hdg ins 2015 SL No. 135 s 9

112RPanel—Act, s 193A(3)

(1)For section 193A(3) of the Act, there is to be a panel made up of 1 chairperson and 2 other members.
(2)The function of the panel is to meet, as required, to review decisions under subdivision 4.

s 112R ins 2015 SL No. 135 s 9

112SAppointment to panel

(1)The Minister must appoint a chairperson and 2 other members to the panel, on terms decided by the Minister.
(2)The Minister must ensure that each person appointed to the panel—
(a)is qualified, or eligible to qualify, as a lawyer; and
(b)has demonstrated significant experience relevant to the laws of personal injury and negligence.

s 112S ins 2015 SL No. 135 s 9

112TAdministrative matters

The Regulator may decide administrative matters about the panel that are not provided for under this subdivision, including, for example, the way in which the panel members must meet.

s 112T ins 2015 SL No. 135 s 9

Subdivision 6 Miscellaneous

sdiv hdg ins 2015 SL No. 135 s 9

112ULiability not affected

To remove any doubt, it is declared that a decision made by an insurer or the panel under this division does not impose liability on, or otherwise affect the liability of, the insurer or an employer for any other purpose or proceeding.

s 112U ins 2015 SL No. 135 s 9

Division 3AA Entitlement to compensation for pneumoconiosis

div hdg ins 2017 Act No. 27 s 35

112V Working out pneumoconiosis score—Act, s 36F

For section 36F(b) of the Act, the way set out in schedule 4B is prescribed.

s 112V ins 2017 Act No. 27 s 35

112W Lump sum compensation for workers with pneumoconiosis—Act, s 128G

(1)For section 128G(2) of the Act, the lump sum compensation, and graduated scale, set out in schedule 4C are prescribed.
(2)For section 128G(3) of the Act, the pneumoconiosis bands set out in schedule 4C are prescribed.

s 112W ins 2017 Act No. 27 s 35

Division 4 Liability for caring allowance

113Payment of caring allowance—Act, s 225(a)

(1)For section 225(a) of the Act, if an insurer pays a caring allowance, the prescribed way of payment is for the insurer to—
(a)decide the number of hours of the level of care required by the worker having regard to the occupational therapist’s report, and the graduated scale set out in schedule 5; and
(b)decide the allowance having regard to the information in the occupational therapist’s report; and
(c)pay the allowance at an hourly rate equal to the carer pension rate divided by 35.
(2)In this section—
carer pension rate means the weekly amount of the maximum single carer pension rate payable from time to time under a Commonwealth law, but does not include an amount for allowances such as rent assistance or family payment.
occupational therapist’s report means the report prepared by the occupational therapist under section 224(3) of the Act.

Part 5 Rehabilitation

Division 1 Rehabilitation and return to work coordinators

114Functions of rehabilitation and return to work coordinator—Act, s 41(b)

For section 41(b) of the Act, the following functions are prescribed—
(a)initiate early communication with an injured worker in order to clarify the nature and severity of the worker’s injury;
(b)provide overall coordination of the worker’s return to work;
(c)if a rehabilitation and return to work plan is required—
(i)consult with the worker and the worker’s employer to develop the suitable duties program component of the plan; and
(ii)ensure the program is consistent with the current medical certificate or report for the worker’s injury;
(d)liaise with—
(i)any person engaged by the employer to help in the worker’s rehabilitation and return to work; and
(ii)the insurer about the worker’s progress and indicate, as early as possible, if there is a need for the insurer to assist or intervene.

115Criteria for employer to appoint rehabilitation and return to work coordinator—Act, s 226(1)

(1)For section 226(1) of the Act, the following criteria is prescribed—
(a)for an employer who employs workers at a workplace in a high risk industry—the wages of the employer in Queensland for the preceding financial year were more than 2,600 times QOTE;
(b)otherwise—the wages of the employer in Queensland for the preceding financial year were more than 5,200 times QOTE.
(2)For the purpose of section 226(3)(a) of the Act, an employer is taken to have established a workplace, or started to employ workers at the workplace, when the employer first meets the criteria.
(3)An employer may appoint a person as the rehabilitation and return to work coordinator for more than 1 workplace if the person can reasonably perform the person’s functions as a rehabilitation and return to work coordinator for each workplace.
(4)In this section—
high risk industry means an industry specified by the Regulator by gazette notice.

Division 2 Guidelines for standard for rehabilitation

116Standard for rehabilitation—Act, s 228(2)

For section 228(2) of the Act, the standard for the rehabilitation that the employer must provide is contained in the guidelines made by the Regulator for the purpose of this section.

117Availability of guidelines

(1)The Regulator must keep a copy of each guideline, as in force from time to time, available for inspection, free of charge at—
(a)the department’s head office; and
(b)other places the Regulator considers appropriate.
(2)Also, the Regulator must publish each guideline, as in force from time to time, on the department’s website.

Part 5A Treatment, care and support payments

pt hdg ins 2016 Act No. 44 s 50

Division 1 Assessing entitlement

div hdg ins 2016 Act No. 44 s 50

Subdivision 1 Preliminary

sdiv hdg ins 2016 Act No. 44 s 50

117A Definitions for division

In this division—
childrens functional independence measure instrument means the functional independence measure instrument adapted for paediatrics and described on the department’s website.
functional independence measure instrument means a clinical tool used to assess the functional ability of a person by scoring motor and cognitive items against a scale and described on the department’s website.

s 117A ins 2016 Act No. 44 s 50

Subdivision 2 Eligibility criteria

sdiv hdg ins 2016 Act No. 44 s 50

117B Purpose of subdivision

For section 232M(2)(a) of the Act, this subdivision prescribes the eligibility criteria for particular serious personal injuries.

s 117B ins 2016 Act No. 44 s 50

117C Eligibility criteria for permanent spinal cord injury

(1)The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit are—
(a)the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and
(b)the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.
(2)In this section—
ASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association.
ISAFSCI means the document called ‘International standards to document remaining autonomic function after spinal cord injury’, published by the American Spinal Injury Association.
ISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.

s 117C ins 2016 Act No. 44 s 50

117D Eligibility criteria for traumatic brain injury

(1)The eligibility criteria for a traumatic brain injury resulting in a permanent impairment are—
(a)any or all of the following apply—
(i)the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;
(ii)the worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;
(iii)brain imaging shows a significant brain abnormality as a result of the injury; and
(b)the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—
(i)for an adult—the functional independence measure instrument; or
(ii)for a child—the childrens functional independence measure instrument.
(2)In this section—
approved scale, for assessing post-traumatic amnesia, means—
(a)the Westmead PTA scale; or
(b)a clinically accepted scale similar to the Westmead PTA scale approved by the Regulator for this definition.
Westmead PTA scale means the clinical tool, known as the Westmead Post-traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.

s 117D ins 2016 Act No. 44 s 50

117E Eligibility criterion for the amputation of a leg through or above the femur

(1)The eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.
(2)For subsection (1), the percentage of the length of the femur lost must be worked out by—
(a)comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or
(b)if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.
(3)To remove any doubt, it is declared that the eligibility criterion in subsection (1) may be satisfied even if the worker suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.

s 117E ins 2016 Act No. 44 s 50

117F Eligibility criteria for the amputation of more than 1 limb or parts of different limbs

(1)The eligibility criteria for the amputation of more than 1 limb or parts of different limbs are—
(a)the amputations involve the loss of 50% or more of the length of each of the worker’s tibias; or
(b)both of the worker’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or
(c)the amputations involve—
(i)the loss of 50% or more of the length of 1 of the worker’s tibias; and
(ii)1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.
(2)For subsection (1), the percentage of the length of the tibia lost must be worked out by—
(a)comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or
(b)if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or
(c)if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.

s 117F ins 2016 Act No. 44 s 50

117G Eligibility criteria for a full thickness burn to all or part of the body

The eligibility criteria for a full thickness burn to all or part of the body are—
(a)the full thickness burn is to—
(i)for a worker younger than 16 years—more than 30% of the total body surface area; or
(ii)for a worker 16 years or older—more than 40% of the total body surface area; or
(iii)both hands; or
(iv)the face; or
(v)the genital area; and
(b)the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—
(i)for an adult—the functional independence measure instrument; or
(ii)for a child—the childrens functional independence measure instrument.

s 117G ins 2016 Act No. 44 s 50

117H Eligibility criterion for an inhalation burn resulting in a permanent respiratory impairment

The eligibility criterion for an inhalation burn resulting in a permanent respiratory impairment is that the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—
(a)for an adult—the functional independence measure instrument; or
(b)for a child—the childrens functional independence measure instrument.

s 117H ins 2016 Act No. 44 s 50

117I Eligibility criterion for permanent blindness caused by trauma

(1)The eligibility criterion for permanent blindness caused by trauma is that the injured person has a visual defect, or a combination of visual defects, that result in visual loss that is, or is equivalent to—
(a)visual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or
(b)the constriction of the worker’s field of vision to 10 degrees or less of the arc around central fixation in the worker’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).
(2)In this section—
Snellen scale means the scale for measuring visual acuity using rows of letters printed in decreasing sizes.

s 117I ins 2016 Act No. 44 s 50

Subdivision 3 Assessing eligibility criteria

sdiv hdg ins 2016 Act No. 44 s 50

117J Requirements for using functional independence measure instrument or childrens functional independence measure instrument to assess injuries

An assessment using the functional independence measure instrument or childrens functional independence measure instrument may be used for deciding whether a serious personal injury meets the eligibility criteria for the injury only if the assessment is carried out by a person who is—
(a)accredited by the Australasian Rehabilitation Outcomes Centre to carry out the assessment; and
(b)approved by the insurer to carry out the assessment.

s 117J ins 2016 Act No. 44 s 50

Division 2 Assessing worker’s needs

div hdg ins 2016 Act No. 44 s 50

Subdivision 1 Assessment process

sdiv hdg ins 2016 Act No. 44 s 50

117K Assessment generally

(1)For section 232O(2)(a) of the Act, this section prescribes requirements about assessing a matter mentioned in section 232O(1)(a) of the Act.
(2)In carrying out the assessment, the insurer must, to the extent practicable, consult with the worker about the following matters—
(a)the treatment, care and support needs resulting from the serious personal injury the worker considers are necessary and reasonable;
(b)the treatment, care or support needed by the worker for any other injury resulting from the same event as the serious personal injury;
(c)the worker’s abilities and limitations;
(d)the worker’s individual goals.
(3)The insurer may also consult with any other person the insurer considers appropriate.

s 117K ins 2016 Act No. 44 s 50

117L Intervals for carrying out assessments

For section 232O(2)(a) of the Act, an assessment under section 232O(1)(a) of the Act for an eligible worker must be carried out—
(a)as soon as practicable after the insurer decides the worker is entitled to treatment, care and support payments; and
(b)if an assessment has been previously carried out for the worker—within 1 year after the last assessment was carried out.

s 117L ins 2016 Act No. 44 s 50

Subdivision 2 Matters for deciding necessary and reasonable treatment, care and support needs

sdiv hdg ins 2016 Act No. 44 s 50

117M Purpose of subdivision

(1)For section 232N(b) of the Act, this subdivision prescribes matters the insurer must consider in deciding whether an eligible worker’s treatment, care and support needs resulting from the worker’s serious personal injury are necessary and reasonable in the circumstances.
(2)This subdivision does not limit the matters the insurer may consider in making a decision mentioned in subsection (1).

s 117M ins 2016 Act No. 44 s 50

117N Benefit to worker

(1)The insurer must consider whether providing treatment, care or support for, or relating to, the worker’s treatment, care and support needs—
(a)is likely to maximise the worker’s independence, participation in the community and employment; and
(b)will assist the worker in managing the injury.
(2)In considering the matters mentioned in subsection (1), the insurer must also have regard to the following matters—
(a)whether the treatment, care or support relates directly to the worker’s individual goals;
(b)whether the treatment, care or support will improve or maintain the worker’s ability to conduct daily activities or participate in the community or employment;
(c)whether the treatment, care or support has been provided to the worker previously, resulting in an improvement to, or assistance in managing, the worker’s injury;
(d)whether the treatment, care or support has a measurable outcome;
(e)whether the worker has agreed or is likely to agree that the treatment, care or support will benefit the worker in the ways mentioned in subsection (1);
(f)any associated risks of the treatment, care or support to the worker, weighed against the expected benefit of the treatment, care or support to the worker.

s 117N ins 2016 Act No. 44 s 50

117O Appropriateness of service

(1)The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs—
(a)is consistent with other treatment, care or support being received by the worker; and
(b)is consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.
(2)In considering the matters mentioned in subsection (1), the insurer must also have regard to the following matters—
(a)whether the treatment, care or support will be consistent with the worker’s future treatment, care or support needs;
(b)whether the treatment, care or support relates directly to the worker’s individual goals;
(c)whether the treatment, care or support could be harmful to the worker;
(d)whether similar treatment, care or support is already being, or is to be, provided to the worker for the injury;
(e)whether there is evidence that supports the effectiveness of the treatment, care or support.

Examples of evidence—

peer-reviewed journal articles
inclusion of the treatment in clinical guidelines and frameworks
successful clinical trials
inclusion in the medical benefits schedule administered by the Commonwealth

s 117O ins 2016 Act No. 44 s 50

117P Appropriateness of provider

(1)The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs is provided by an appropriate provider.
(2)In considering the matter mentioned in subsection (1), the insurer must also have regard to the following matters—
(a)whether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support;
(b)whether the provider is appropriate having regard to, for example, the worker’s location, age, culture and ethnicity;
(c)whether the provider is acceptable to the worker;
(d)whether the provider has or may have a conflict of interest in providing the treatment, care or support to the worker;
(e)whether the provider’s fee is reasonable;
(f)if, under section 232K(2) of the Act, the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.

s 117P ins 2016 Act No. 44 s 50

117Q Cost-effectiveness

(1)The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs is cost-effective.
(2)In considering the matter mentioned in subsection (1), the insurer must also have regard to the following matters—
(a)the likely benefit to the worker of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the worker;
(b)the cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers;
(c)whether there is a more cost-effective way to provide the treatment, care or support;

Examples—

considering whether leasing equipment would be more cost-effective than purchasing new equipment
considering whether the treatment, care or support can be more appropriately funded under another scheme
(d)whether the cost of the treatment, care or support is reasonable having regard to the period for which it is required;
(e)whether the cost of the treatment, care or support exceeds an amount prescribed for the treatment, care or support under section 232R(4) of the Act.

s 117Q ins 2016 Act No. 44 s 50

Subdivision 3 Other matters relating to assessing needs

sdiv hdg ins 2016 Act No. 44 s 50

117R Additional requirement about assessing particular treatment, care or support

(1)This section applies if the insurer is assessing a worker’s needs for, or relating to—
(a)home modification; or
(b)transport modification; or
(c)workplace modification; or
(d)attendant care and support services that are personal assistance services or services to assist a person to participate in the community.
(2)In carrying out the assessment, the insurer must obtain and consider information about the needs mentioned in subsection (1) from a person who is appropriately qualified to give advice about the needs.

Example of appropriately qualified persons—

an occupational therapist specialising in home or workplace modifications

s 117R ins 2016 Act No. 44 s 50

117S Treatment, care or support that must be provided by a registered provider

For section 232K(2)(b) of the Act, the following treatment, care or support is prescribed—
(a)a home modification;
(b)workplace modification;
(c)a service for the coordination of treatment, care or support.

Example for paragraph (c)—

a case manager engaged to coordinate a worker’s treatment, care and support

s 117S ins 2016 Act No. 44 s 50

Subdivision 4 Support plans and service requests

sdiv hdg ins 2016 Act No. 44 s 50

117T Support plans

(1)For section 232O(3) of the Act, this section prescribes requirements about an eligible worker’s support plan.
(2)The support plan must state—
(a)the name of the worker; and
(b)the outcomes of the assessment under section 232O(1)(a) of the Act; and
(c)the matters stated in section 117K(2), if known by the insurer; and
(d)any treatment, care and support needs resulting from the worker’s serious personal injury the insurer considers are necessary and reasonable in the circumstances; and
(e)any treatment, care or support resulting from any other injury resulting from the same event as the serious personal injury that the insurer considers is necessary and reasonable in the circumstances; and
(f)any other treatment, care or support for the serious personal injury, or any other injury resulting from the same event as the serious personal injury, the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act, having regard to the following matters—
(i)whether the treatment, care or support is needed by the worker as a result of the injury;
(ii)whether it would be fair and reasonable in the circumstances for the insurer to pay for the treatment, care or support, wholly or partly;
(iii)whether providing the treatment, care or support will, or is likely to, reduce the worker’s treatment, care and support needs for the injury;
(iv)whether the insurer considers, wholly or partly, paying for the treatment, care or support is more practical or cost-effective than the insurer paying for the worker’s treatment, care and support needs for the injury, without compromising the level of treatment, care or support received by the worker under chapter 4A of the Act;
(v)whether the treatment, care or support is excluded treatment, care or support;
(vi)where the treatment, care or support is to be provided, including, for example, whether the treatment, care or support is to be provided outside Australia; and
(g)the intervals at which an assessment under section 232O(1)(a) of the Act will be carried out for the worker.
(3)The support plan must be consistent with an existing decision on a service request relating to the worker.
(4)However, subsection (3) applies only to the extent the support plan relates to the period covered by the existing decision.

s 117T ins 2016 Act No. 44 s 50

117U Amending support plans

(1)For section 232O(5) of the Act, this section prescribes requirements about amending an eligible worker’s support plan under section 232O(4)(a) of the Act.
(2)An amendment of the support plan must be consistent with an existing decision on a service request relating to the worker.
(3)However, subsection (2) applies only to the extent the support plan relates to the period covered by the existing decision.

s 117U ins 2016 Act No. 44 s 50

117V Deciding service request

(1)For section 232P(4) of the Act, this section prescribes the matters an insurer must consider in deciding a service request relating to an eligible worker.
(2)The insurer must consider the following matters—
(a)whether or not the requested service relates to—
(i)the worker’s treatment, care and support needs resulting from the worker’s serious personal injury; or
(ii)the worker’s need for treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury;
(b)if the requested service relates to the treatment, care and support needs mentioned in paragraph (a)(i)—whether or not the needs are necessary and reasonable in the circumstances;
(c)if the requested service relates to the treatment, care or support mentioned in paragraph (a)(ii)—whether or not the treatment, care or support is necessary and reasonable in the circumstances;
(d)if the requested service does not relate to treatment, care and support needs or treatment, care or support mentioned in paragraph (a), or the insurer does not consider the needs or the treatment, care or support mentioned in the paragraph are necessary and reasonable in the circumstances—whether or not the insurer considers the insurer should, wholly or partly, pay for the requested service under chapter 4A of the Act, having regard to the matters mentioned in section 117T(2)(f).

s 117V ins 2016 Act No. 44 s 50

Division 3 Payment options

div hdg ins 2016 Act No. 44 s 50

117W Circumstances in which payment request may be made

(1)For section 232Q(3)(b) of the Act, this section prescribes the circumstances for making a payment request for an expense for the treatment, care or support of an eligible worker.
(2)A payment request may not be made for the expense if—
(a)the person has entered into a funding agreement with the insurer for the treatment, care or support; and
(b)the expense was incurred in the period covered by the funding agreement.
(3)A payment request must be made within 6 months after the expense is incurred.
(4)However, the insurer may accept a later payment request if the insurer considers it is fair and reasonable in the circumstances to accept the request.

s 117W ins 2016 Act No. 44 s 50

117X Deciding payment request

(1)For section 232R(2) of the Act, this section prescribes matters about an insurer deciding a payment request for an expense for the treatment, care or support of an eligible worker.
(2)If the insurer makes an information request and the person of whom it is made does not provide the information requested by the stated day or a later day agreed between the insurer and the person—
(a)the payment request lapses; and
(b)the insurer is not required to approve or refuse the request.
(3)The insurer must approve the payment request if—
(a)the expense is incurred in the eligibility period for the worker; and
(b)the treatment, care or support the request relates to is an approved service for the worker.
(4)To remove any doubt, it is declared that the insurer may approve the payment request even though the treatment, care or support the request relates to is not an approved service for the worker.
(5)In this section—
approved service does not include treatment, care or support that is excluded treatment, care or support, unless—
(a)if a support plan has been made for the eligible worker—the excluded treatment, care or support is specifically stated in the support plan to be—
(i)treatment, care or support for, or relating to, the worker’s treatment, care and support needs resulting from the worker’s serious personal injury the insurer considers is necessary and reasonable in the circumstances; or
(ii)treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury the insurer considers is necessary and reasonable in the circumstances; or
(iii)treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act; or
(b)if a support plan has not been made for the eligible worker—the excluded treatment, care or support is specifically approved under an approval of a service request relating to the worker.
information request, for a payment request, means a written request made by the insurer—
(a)asking a relevant person for further information about the payment request by a stated day of at least 10 business days after the insurer makes the request; and
(b)stating that, if the requested information is not given to the insurer by the stated day, the payment request will lapse.
relevant person, for an information request, means—
(a)the person who made the payment request; or
(b)if the person who made the payment request is not the eligible worker—the eligible worker.

s 117X ins 2016 Act No. 44 s 50

117Y Limit on amount payable under payment request

For section 232R(4) of the Act, the amount prescribed is—
(a)for medical treatment or rehabilitation—the amount stated in the relevant table of costs; or
(b)for hospitalisation of the worker as an in-patient at a private hospital—the amount stated in section 217(3) of the Act; or
(c)for hospitalisation of the worker as an in-patient at a public hospital—the amount stated in section 218A(3) of the Act.

s 117Y ins 2016 Act No. 44 s 50

Division 4 Review of entitlement

div hdg ins 2016 Act No. 44 s 50

117ZReview of worker’s entitlement

(1)This section prescribes matters for a review of a worker’s entitlement to treatment, care and support payments under section 232S of the Act.
(2)The insurer must give the worker written notice of the review at least 20 business days before carrying out the review.
(3)In carrying out the review, the insurer may ask the worker to give the insurer information needed to make a decision about the worker’s entitlement at the end of the review.

s 117Z ins 2016 Act No. 44 s 50

Part 6 Damages

Division 1 Particulars in notice of claim

118Notice of claim for damages—Act, s 275

For section 275(3) of the Act, the particulars contained in this division are prescribed.

119Particulars of claimant and worker

(1)A notice of claim must include—
(a)the worker’s—
(i)full name and any other known names; and
(ii)residential address; and
(iii)date of birth; and
(iv)gender; and
(v)usual occupation and, if that differs from the nature of employment at the time the worker was injured, the nature of the employment at that time; and
(b)the name and address of every employer of the worker at the time the worker was injured.
(2)Also, if the claimant is not the worker, the notice of claim must include the claimant’s—
(a)full name and any other known names; and
(b)residential address; and
(c)date of birth; and
(d)gender.

120Particulars of event

A notice of claim must include the following—
(a)the date, time and place of the event;
(b)the claimant’s description of the facts of the circumstances surrounding the worker’s injury;
(c)the names and addresses of all witnesses to the injury, and their relationship, if any, to the worker;
(d)the name and address of any person on behalf of the claimant’s employer to whom the claimant reported the injury and the details of their employment;
(e)the full particulars of the negligence alleged against the claimant’s employer and any other party on which the claim is based;
(f)if a party other than the claimant’s employer is involved—
(i)the liability expressed as a percentage that the claimant holds the other party responsible; and
(ii)details of the notice of claim given to the party.

121Injury particulars

(1)A notice of claim must include, full particulars of the nature and extent of—
(a)all injuries alleged to have been sustained by the claimant or worker because of the event resulting in the injury; and
(b)the degree of permanent impairment that the claimant alleges has resulted from the injuries; and
(c)the amount of damages sought under each head of damage claimed by the claimant and the method of calculating each amount; and
(d)how the claimant or worker is currently affected by the injuries.
(2)Also, the notice of claim must include all personal injuries, illnesses and impairments of a medical, psychiatric or psychological nature sustained by the claimant or worker, either before or after the event—
(a)that may affect—
(i)the extent of the permanent impairment resulting from the injury to which the claim relates: or
(ii)the amount of damages in another way; and
(b)for which the claimant has claimed damages, compensation or benefits—
(i)the name and address of any person against whom a claim for damages or compensation was made; and
(ii)if an insurer or other insurance provider was involved in that claim—the name and address of that entity.

122Particulars of hospital, treatment and rehabilitation

(1)A notice of claim must include the name and address of each of the following—
(a)each hospital at which the claimant or worker has been treated for the injury;
(b)each doctor who treated the claimant or worker for the injury;
(c)each provider of treatment or rehabilitation services assessed, treated, or provided treatment or rehabilitation services for, permanent impairment arising from the injury.
(2)Also, if section 121(2) applies, the notice of claim must include the name and address of—
(a)each hospital at which the claimant or worker has been treated for an injury, illness or impairment; and
(b)each doctor who treated the claimant for the injury, illness or impairment.

123Particulars if claim for diminished income earning capacity

If the claimant claims damages for diminished income earning capacity, a notice of claim must include the following particulars of the claimant’s employment for the 3 year period immediately before the event, and the period since the event—
(a)the name and address of each of the claimant’s employers;
(b)the period of employment by each employer;
(c)the capacity in which the claimant was employed by each employer;
(d)the claimant’s gross and net (after tax) earnings for each period of employment;
(e)the periods during which the claimant was receiving payments from Centrelink on behalf of the department in which the Social Security Act 1991 (Cwlth) is administered;
(f)the periods during which the claimant received no income, and the reasons why the claimant was not receiving any income.

Note—

See also section 276 of the Act.

124Particulars if injury causes death

(1)A notice of claim relating to an injury causing death must include the following additional particulars—
(a)if the claimant is the spouse of the deceased worker—
(i)the relevant date; and
(ii)the relevant place; and
(iii)the claimant’s net (after tax) weekly income immediately before and after the worker’s death; and
(iv)the age to which the claimant intended to work and the basis of the claimant’s future employment, that is, whether full-time or part-time; and
(v)details of any health problems that the claimant currently has; and
(vi)the amount of average weekly financial benefit derived by the claimant from the deceased worker before the worker’s death and the method of calculating the amount; and
(vii)the expected date of birth of a posthumous child of the relationship; and
(viii)details of any remarriage or start of a marriage-like relationship; or
(b)if the claimant is not the spouse of the deceased worker—
(i)the claimant’s relationship to the deceased worker; and
(ii)the claimant’s net (after tax) weekly earnings; and
(iii)the age to which the claimant would have been dependent on the deceased worker and the basis of the dependency; and
(iv)details of any health problems that the claimant currently has; and
(v)the amount of average weekly financial benefit derived by the claimant from the deceased worker immediately before the worker’s death and the method of calculating the amount.
(2)In this section—
relevant date means—
(a)the date of marriage; or
(b)the date the civil partnership had effect; or
(c)the date on which the de facto relationship started.
relevant place means—
(a)the place of the marriage; or
(b)the place of registration of the civil partnership; or
(c)the residential address where the de facto relationship started.

s 124 amd 2016 SL No. 15 s 22 sch 1

125Particulars of mitigation

A notice of claim must include all steps taken by the worker or claimant to mitigate their loss.

Division 2 General provisions

126Time for adding another person as contributor—Act, s 278A(1)

For section 278A(1) of the Act, the prescribed time is the later of the following—
(a)30 business days after the insurer receives the notice of claim;
(b)5 business days after the insurer identifies someone else as a contributor.

127Contribution notice to contain particular information—Act, s 278B(1)(a)

For section 278B(1)(a) of the Act, the following information is prescribed—
(a)the contributor’s full name;
(b)the contributor’s business address;
(c)the contributor’s postal address;
(d)the name and contact details of the contributor’s legal representatives, if appointed;
(e)the contributor’s ABN, if any;
(f)if the contributor is a corporation—
(i)the corporation’s ACN; and
(ii)the corporation’s registered office.

Part 7 Assessment of damages

128Prescribed amount of damages for loss of consortium or loss of servitium—Act, s 306M(1)(b)

For an injury sustained during a period stated in an item of the following table, the amount stated in the item is prescribed.

Item

Period (dates inclusive)

Amount

1

1 July 2010 to 30 June 2011

$35,340

2

1 July 2011 to 30 June 2012

$36,350

3

1 July 2012 to 30 June 2013

$38,290

4

1 July 2013 to 30 June 2014

$39,430

5

1 July 2014 to 30 June 2015

$40,920

6

1 July 2015 to 30 June 2017

$41,920

7

1 July 2017 to 30 June 2018

$42,650

8

1 July 2018 to 30 June 2019

$43,960

9

1 July 2019 and after

$45,290

s 128 sub 2015 SL No. 47 s 12

amd 2017 SL No. 110 s 12; 2018 SL No. 82 s 10; 2019 SL No. 113 s 10

129Rules for assessing injury scale value—Act, s 306O(1)(c)(i)

For section 306O(1)(c)(i) of the Act, a court must have regard to the following—
(a)for assessment of the ranges of injury scale value—the ranges mentioned in schedule 9;
(b)for matters to which a court is to have regard in the application of schedule 9—the rules mentioned in schedule 8;
(c)for the PIRS that must be used with schedule 9—the scales mentioned in schedule 11;
(d)for matters relevant to the application of schedule 11 and requirements with which a medical expert must comply in assessing a PIRS rating—the matters mentioned in schedule 10.

130General damages calculation provisions—Act, s 306P(2), definition general damages calculation provisions

(1)For each period stated in a table in schedule 12, this section and that table are the general damages calculation provisions for the period.
(2)For an injury within the injury scale value stated in an item of a table, the general damages are the sum of—
(a)the base amount for the item (if any); and
(b)the variable amount for the item.
(3)In this section—
variable amount means the amount worked out in the way stated in the column of a table with the heading ‘variable amount’.

s 130 sub 2015 SL No. 47 s 13

131Prescribed amount of award for future loss—Act, s 306R(2)

For an injury sustained during a period stated in an item of the following table, the amount stated in the item is prescribed.

Item

Period (dates inclusive)

Amount

1

1 July 2010 to 30 June 2011

$117,800

2

1 July 2011 to 30 June 2012

$121,160

3

1 July 2012 to 30 June 2013

$127,620

4

1 July 2013 to 30 June 2014

$131,420

5

1 July 2014 to 30 June 2015

$136,400

6

1 July 2015 to 30 June 2017

$139,740

7

1 July 2017 to 30 June 2018

$142,160

8

1 July 2018 to 30 June 2019

$146,540

9

1 July 2019 and after

$150,970

s 131 sub 2015 SL No. 47 s 13

amd 2017 SL No. 110 s 13; 2018 SL No. 82 s 11; 2019 SL No. 113 s 11

Part 8 Costs

Division 1 Proceeding before industrial magistrate or industrial commission

132Costs—proceeding before industrial magistrate or industrial commission

(1)A decision to award costs of a proceeding heard by an industrial magistrate or the industrial commission is at the discretion of the magistrate or commission.
(2)If the magistrate or commission awards costs—
(a)costs in relation to counsel’s or solicitor’s fees are as under the Uniform Civil Procedure Rules 1999, schedule 2, part 2, scale C; and
(b)costs in relation to witnesses’ fees and expenses are as under the Uniform Civil Procedure (Fees) Regulation 2019, part 3; and
(c)costs in relation to bailiff’s fees are as under the Uniform Civil Procedure (Fees) Regulation 2019, schedule 2, part 2.
(3)The magistrate or commission may allow costs up to 1.5 times the amounts provided for under subsection (2)(a), in total or in relation to any item, if the magistrate or commission is satisfied the amounts are inadequate having regard to—
(a)the work involved; or
(b)the importance, difficulty or complexity of the matter to which the proceeding relates.

s 132 amd 2018 SL No. 127 s 77; 2019 SL No. 168 s 37 sch 5

133Payment of additional amount for costs

(1)This section applies if—
(a)the Regulator or an insurer is required to pay costs in a proceeding in relation to a witness who—
(i)is a medical practitioner; or
(ii)gives evidence of a professional nature; and
(b)the amount of fees and expenses payable in relation to the witness by the party that called the witness is more than the amount of costs allowed by the industrial magistrate or the industrial commission.
(2)The Regulator or the insurer may, on the application of the party that called the witness, pay an additional amount for costs that the Regulator or the insurer is satisfied are reasonable, having regard to the subject matter of the proceeding.

Division 2 Claim for damages

134Who this division applies to

This division applies to a claimant who is—
(a)a worker whose DPI is 20% or more; or
(b)a worker who has a terminal condition; or
(c)a dependant.

135Costs before proceeding started

(1)This section prescribes the legal professional costs of a claim before a proceeding is started.
(2)If a claimant recovers at least $150,000 net damages, the costs are—
(a)if the claim is settled—
(i)without holding a compulsory conference—120% of the amount in schedule 6, column A; or
(ii)after a compulsory conference is held—the amounts in schedule 6, columns A and B; and
(b)for investigation of liability by an expert—the amount in schedule 6, column C; and
(c)for an application to the court—the amount in schedule 6, column D.
(3)If a claimant recovers net damages of $50,000 or more but less than $150,000, the costs are 85% of the amount calculated under subsection (2).
(4)If a claimant recovers less than $50,000 net damages, the costs are 85% of the amount calculated under subsection (2) multiplied by the proportion that the net damages bear to $50,000.

Example of subsection (4)—

If the net damages recovered are $30,000, the costs are (85% of the amount calculated under subsection (2)) x 3/5.
(5)However, if a court in the proceeding awards the payment of legal costs, the costs recoverable under subsections (2), (3) and (4) are multiplied by 120%.
(6)In this section—
net damages means the damages recovered less the compensation paid by an insurer.

136Costs after proceeding started

(1)This section prescribes the legal professional costs of a claim after a proceeding is started.
(2)The costs are chargeable under the relevant scales of costs for work done for or in a proceeding in the court.
(3)However, the costs do not include—
(a)the cost of work performed before the proceeding is started; or
(b)the cost of work performed before the proceeding is started that is performed again after the proceeding is started.

137Outlays

(1)In addition to legal costs, the following outlays incurred by the claimant are allowed—
(a)1 hospital report fee for each hospital that treated the worker’s injury;
(b)1 report fee for each doctor in general practice who treated the worker’s injury;
(c)1 medical specialist’s report fee for each medical discipline reasonably relevant and necessary for the understanding of the worker’s injury;
(d)1 report fee of an expert investigating liability, of not more than $1,000, less any proportion of the fee agreed to be paid by the insurer;
(e)Australian Taxation Office or tax agents’ fees for supplying copies of income tax returns;
(f)fees charged by the claimant’s previous employers for giving information necessary for the claimant to complete the notice of claim, but not more than $50 for each employer;
(g)fees charged by a mediator of an amount previously agreed to by the insurer;
(h)filing fees or other necessary charges incurred in relation to an application to the court before a proceeding is started;
(i)reasonable fees for sundry items properly incurred, other than photocopying costs.
(2)The fees—
(a)are allowable only for reports mentioned in subsection (1)(a) to (d) disclosed before the start of proceedings; and
(b)for subsection (1)(a) to (c)—are payable according to the recommended Australian Medical Association scale of fees.

Part 9 Medical assessment tribunals

138Medical assessment tribunals—Act, s 492

For section 492 of the Act each of the following is prescribed—
(a)the General Medical Assessment Tribunal;
(b)specialty medical tribunals, including the following—
(i)the Cardiac Assessment Tribunal;
(ii)the Orthopaedic Assessment Tribunal;
(iii)the Dermatology Assessment Tribunal;
(iv)the Ear, Nose and Throat Assessment Tribunal;
(v)the Neurology/Neurosurgical Assessment Tribunal;
(vi)the Ophthalmology Assessment Tribunal;
(vii)the Disfigurement Assessment Tribunal;
(c)the Composite Medical Assessment Tribunal.

139Constitution of General Medical Assessment Tribunal

(1)For deciding a matter referred to the General Medical Assessment Tribunal, the tribunal is constituted by—
(a)if the chairperson is a specialist—
(i)the chairperson; and
(ii)2 appointees to the panel of doctors for the tribunal chosen by the chairperson; or
(b)if the chairperson is not a specialist and there is at least 1 deputy chairperson who is a specialist—
(i)a deputy chairperson who is a specialist chosen by the Regulator; and
(ii)2 appointees to the panel of doctors for the tribunal chosen by the deputy chairperson; or
(c)otherwise—
(i)the chairperson; and
(ii)2 appointees to the panel of doctors for the tribunal designated by the chairperson.
(2)When choosing a member of the panel for the tribunal under subsection (1)(a)(ii), (b)(ii) or (c)(ii), the chairperson or deputy chairperson must consider the medical specialty that is relevant to the matters referred to the tribunal.
(3)In this section—
specialist means a specialist in the medical specialty relevant to the matters referred to the tribunal.

140Chairperson and deputy chairperson of General Medical Assessment Tribunal

(1)A chairperson must preside over meetings of the General Medical Assessment Tribunal.
(2)However, if a deputy chairperson is designated under section 139(1)(b)(i) for deciding a matter referred to the General Medical Assessment Tribunal, the deputy chairperson must act as chairperson and preside over the meetings of the tribunal for deciding the matter.
(3)Also, if the chairperson is not available to attend to the business of the General Medical Assessment Tribunal, other than deciding a matter mentioned in subsection (2), a deputy chairperson must act as chairperson.
(4)A deputy chairperson may act as a member of the General Medical Assessment Tribunal only if the deputy chairperson has been chosen for the purpose—
(a)under section 139; or
(b)by the chairperson.

141Constitution of a specialty medical tribunal

(1)For deciding a matter referred to a specialty medical tribunal, the tribunal is constituted by—
(a)its chairperson; and
(b)2 appointees to the panel of doctors for the tribunal, including persons appointed to the panel as deputy chairpersons, chosen by the chairperson.
(2)When choosing a member of the panel for a specialty medical tribunal, the chairperson must consider the medical specialty that is relevant to the matters referred to the tribunal for decision.

142Chairperson and deputy chairperson of a specialty medical tribunal

(1)The chairperson must preside over meetings of a specialty medical tribunal.
(2)If the chairperson is not available to attend to the business of a specialty medical tribunal—
(a)if there is only 1 deputy chairperson of the tribunal—the deputy chairperson must act as chairperson; or
(b)if there is more than 1 deputy chairperson of the tribunal—a deputy chairperson designated by the chairperson must act as chairperson.

143Constitution of Composite Medical Tribunal

(1)The constitution of a Composite Medical Tribunal is to be decided by—
(a)the chairperson of the tribunal; and
(b)if the chairperson of the tribunal is not the chairperson of the General Medical Assessment Tribunal—the chairperson of the General Medical Assessment Tribunal; and
(c)the chairperson of each specialty medical assessment tribunal relevant to the matters to be decided.
(2)The chairpersons must consult with the secretary of a Composite Medical Tribunal about the constitution of the tribunal.
(3)When deciding the constitution of a Composite Medical Tribunal, the chairpersons must consider the medical specialty that is relevant to the matter referred to the tribunal for decision.
(4)For deciding a matter referred to a Composite Medical Tribunal, the tribunal is constituted by—
(a)a chairperson; and
(b)at least 2 but not more than 4 appointees to the panel of doctors for the composite tribunal chosen by the chairperson.
(5)For a serious personal injury matter, the chairperson is the chairperson of the General Medical Assessment Tribunal.
(6)The composite tribunal must consist of at least 1 specialist for each type of injury that is a subject of the reference to the tribunal.
(7)However, the number of specialists for each type of injury must be equal.

Example—

A worker has a post-traumatic stress disorder and a fractured arm, leg, and ribs. The tribunal would consist of—
(a)1 psychiatrist and 1 orthopaedic surgeon; or
(b)2 psychiatrists and 2 orthopaedic surgeons.
(8)If, because of subsection (6), there would be an even number of members on the composite tribunal, the chairperson must also designate a physician to be a member of the tribunal.

Example—

A worker has 3 different types of injuries. The tribunal would consist of the chairperson and 3 specialists. A physician is also to be a member of the tribunal.
(9)In this section—
serious personal injury matter means a matter referred to the tribunal under—
(a)section 500(1)(fa), (fb) or (fc) of the Act; or
(b)the National Injury Insurance Scheme (Queensland) Act 2016, section 113.

s 143 amd 2016 Act No. 44 s 51

144Chairperson and deputy chairperson of Composite Medical Tribunal

(1)The chairperson must preside over meetings of a Composite Medical Tribunal.
(2)If the chairperson is not available to attend to the business of a Composite Medical Tribunal—
(a)if there is only 1 deputy chairperson of the tribunal—the deputy chairperson must act as chairperson; or
(b)if there is more than 1 deputy chairperson of the tribunal—a deputy chairperson designated by the chairperson must act as chairperson.

Part 10 Miscellaneous

145Declaration of designated courts—Act, s 114(4), definition designated court

(1)This section is made for section 114(4) of the Act, definition designated court, paragraph (b).
(2)Each court, tribunal or decision-making body mentioned in schedule 7, column 2, set out opposite the name of a State in schedule 7, column 1, is declared.

146Declaration of provisions—Act, s 322(2), definition a State’s legislation about damages for a work related injury

(1)This section is made for section 322(2) of the Act, definition a State’s legislation about damages for a work related injury, paragraph (b).
(2)Each provision mentioned in schedule 7, column 3, set out opposite the name of a State in schedule 7, column 1, is declared.

147Documents and particulars to be kept—Act, s 532D(1) and (2)

(1)For section 532D(1) and (2) of the Act, the following are prescribed—
(a)if the employer must keep a time and wages record for the employee under the Industrial Relations Act 1999, section 366—the time and wages record; or
(b)if the employer must keep an employee’s records under the Fair Work Act 2009 (Cwlth), section 535—the employee record; or
(c)documents, or accurate and complete copies of documents, required to be kept under a law of the Commonwealth for payments made to the employer’s workers or contractors for the performance of work, including, for example—
(i)group certificates; and
(ii)group employer’s reconciliation statements; and
(iii)tax invoices to claim a GST credit; and
(iv)invoices from a contractor received for work; or
(d)the person’s profit and loss account, to the extent the account relates to amounts paid for wages for workers, or to contractors.
(2)However, a document mentioned in subsection (1)(c) or (d) need not contain information an employer or contractor reasonably believes is—
(a)confidential; and
(b)not necessary to enable the Regulator or WorkCover to calculate the person’s actual expenditure on wages or for contracts for the period to which the document relates.

Examples—

income and profit lines
tax file numbers
(3)An employer or contractor need not comply with subsection (1) if—
(a)the Regulator or WorkCover has given the employer or contractor notice that a document need not be kept, and the notice remains in force; or
(b)the employer or contractor was a corporation and has been wound up.
(4)In this section—
employee record see Fair Work Act 2009 (Cwlth), section 12.
time and wages record see Industrial Relations Act 1999, section 363.
worker does not include a household worker.

148Reasons for decisions must address certain matters—Act, ss 540(4) and 546(3AA)

(1)For sections 540(4) and 546(3AA) of the Act, the following matters are prescribed—
(a)citation of the provision of the Act under which the decision is made; and
(b)a statement of—
(i)the evidence considered for the decision; and
(ii)the evidence that was accepted or rejected for the decision and why the evidence was accepted or rejected; and
(iii)the conclusions drawn from the evidence; and
(iv)the link between the evidence, the conclusions and the relevant provision of the Act; and
(v)the decision made.
(2)Each reason for a decision must be written in plain English.

Part 11 Savings and transitional provision for Workers’ Compensation and Rehabilitation Amendment Regulation (No. 1) 2015

pt hdg ins 2015 SL No. 135 s 10

149Decision about qualifying condition if DPI decided before commencement

(1)This section applies if—
(a)before the commencement—a worker’s DPI was decided; and
(b)on the commencement—the worker is a specified worker.
(2)The insurer must, as soon as practicable after the commencement, decide the matters mentioned in section 112F for the worker.

s 149 ins 2015 SL No. 135 s 10

Schedule 1 Additional premium

section 8

Time of lodgement of declaration of wages

 

Additional premium

on or after 1 September and not later than 31 October in 1 calendar year

 

the greater of—

(a)  5% of assessed premium for the period of insurance to which the declaration relates; or
(b)  $5

on or after 1 November and not later than 30 November in 1 calendar year

 

the greater of—

(a)  10% of assessed premium for the period of insurance to which the declaration relates; or
(b)  $10

on or after 1 December and not later than 31 December in 1 calendar year

 

the greater of—

(a)  15% of assessed premium for the period of insurance to which the declaration relates; or
(b)  $15

on or after 1 January in the next calendar year

 

the greater of—

(a)  20% of assessed premium for the period of insurance to which the declaration relates; or
(b)  $20

Schedule 2 Graduated scale for additional compensation for workers with terminal latent onset injuries

section 107

1Graduated scale

(1)This schedule contains the graduated scale for additional compensation for a worker who has a terminal condition that is a latent onset injury.
(2)The maximum amount of lump sum compensation payable under this schedule is $307,385.

2How to use the graduated scale

The worker’s additional lump sum compensation entitlement is the amount shown in column 2 that corresponds to the age of the worker when the worker lodges the worker’s application for compensation as shown in column 1.Graduated scale

Column 1

Worker’s age

Column 2

Additional lump sum compensation

 

$

70 years or under

307,385

71 years

276,647

72 years

245,908

73 years

215,170

74 years

184,431

75 years

153,693

76 years

122,954

77 years

92,216

78 years

61,477

79 years

30,739

80 years or over

nil

Schedule 3 Graduated scale of additional compensation for workers with DPI of 30% or more

section 109

1Graduated scale

(1)This schedule contains the graduated scale for additional compensation for a worker who sustains an injury that results in a DPI of 30% or more.
(2)The maximum amount of lump sum compensation payable under this schedule is $307,385.

2How to use the graduated scale

A worker who sustains a DPI shown in column 1 is entitled to additional lump sum compensation in the amount shown for the corresponding entry in column 2.Graduated scale

Column 1

DPI

Column 2

Additional lump sum compensation

%

$

30

11,565

31

18,138

32

24,712

33

31,286

34

37,860

35

44,433

36

51,007

37

57,581

38

64,155

39

70,728

40

77,302

41

83,876

42

90,451

43

97,023

44

103,597

45

110,172

46

116,744

47

123,319

48

129,893

49

136,467

50

143,040

51

149,614

52

156,188

53

162,762

54

169,335

55

175,909

56

182,483

57

189,057

58

195,630

59

202,204

60

208,778

61

215,352

62

221,925

63

228,499

64

235,074

65

241,648

66

248,220

67

254,795

68

261,369

69

267,943

70

274,516

71

281,090

72

287,664

73

294,238

74

300,811

75–100

307,385

sch 3 amd 2015 SL No. 135 s 11

Schedule 4 Graduated scale for additional compensation for gratuitous care

section 112

1Graduated scale

(1)This schedule contains the graduated scale for additional compensation for gratuitous care.
(2)The maximum amount of lump sum compensation payable under this schedule is $348,210.

2How to use the graduated scale

(1)The DPI is shown in column 1.
(2)The range of dependency assessed under the modified barthel index is shown in column 2.
(3)In column 2—
(a)moderate is a modified barthel index total score of 50–74; and
(b)severe is a modified barthel index total score of 25–49; and
(c)total is a modified barthel index total score of 0–24.
(4)The worker’s additional lump sum compensation entitlement is shown for the corresponding entry in column 3.
Graduated scale

Column 1

DPI

Column 2

Range of dependency (modified barthel index)

Column 3

Additional lump sum compensation

%

 

$

15–39

moderate

severe

total

2,820

5,633

8,438

40–49

moderate

severe

total

5,249

10,682

15,923

50–59

moderate

severe

total

23,239

46,455

69,671

60–69

moderate

severe

total

58,075

104,491

139,312

70–79

moderate

severe

total

81,268

150,924

208,944

80–89

moderate

severe

total

92,872

187,711

278,577

90–94

moderate

severe

total

104,491

208,944

324,994

95–100

moderate

severe

total

116,080

232,191

348,210

Schedule 4A Section 193A compensation for specified workers

section 112C

sch hdg ins 2015 SL No. 135 s 12

1Amount of section 193A compensation

Section 193A compensation consists of the following amounts for an injury sustained by a specified worker in relation to whom the qualifying condition is satisfied—
(a)an amount of compensation (the DPI amount)—
(i)payable under the graduated scale in section 2 of this schedule; and
(ii)applied to multiple injuries in the way provided for under section 3 of this schedule;
(b)an amount of compensation (the legal cost amount) payable towards legal costs if the worker engages a lawyer and incurs legal costs for particular things done under part 4, division 3A.

s 1 ins 2015 SL No. 135 s 12

2DPI amount generally

A worker who sustains a DPI shown in column 1 is entitled to the amount shown in column 2 opposite the DPI.
Graduated scale

Column 1

DPI

Column 2

DPI amount

%

$

1

6,298

2

12,596

3

18,894

4

25,192

5

31,490

s 2 ins 2015 SL No. 135 s 12

3DPI amount for multiple injuries

(1)This section prescribes the DPI amount if the worker—
(a)has sustained multiple injuries from 1 event; and
(b)receives a notice of assessment for the worker’s physical injury and another notice of assessment for the worker’s psychological injury.
(2)The worker is only entitled to 1 payment for the DPI amount, being the amount shown in section 2, column 2 opposite the DPI—
(a)shown in section 2, column 1; and
(b)that is the higher of the DPI percentages stated in the notices.
(3)However, subsection (4) applies if—
(a)a worker is paid the DPI amount based on a notice of assessment for an injury; and
(b)the worker later receives a second notice of assessment for a different type of injury; and
(c)the second notice of assessment states a DPI that is higher than the DPI stated in the first notice of assessment but is not more than 5%.
(4)The worker is entitled to another payment for the DPI amount, being the amount shown in section 2, column 2 opposite the DPI—
(a)shown in section 2, column 1; and
(b)that is equal to the difference between the DPI percentages stated in the notices.

Example of DPI amount if subsection (4) applies—

A worker with a DPI of 3% is paid a DPI amount of $18,894 for a physical injury. The worker later receives a notice of assessment stating a DPI of 5% for a psychological injury. The worker is entitled to be paid an additional DPI amount of $12,596 for the difference of 2% between the DPI percentages.

s 3 ins 2015 SL No. 135 s 12

4Legal cost amount

(1)This section applies if a worker has engaged a lawyer and incurs legal costs for doing 1 or more things mentioned in column 1.
(2)The worker is entitled to the amount shown in column 2 opposite each thing for which legal costs were incurred.

Column 1

Circumstance

Column 2

Legal cost amount

$

Giving information to an insurer under section 112I within the period mentioned in the section

1,700

The worker and the worker’s lawyer attending a meeting mentioned in section 112K

2,000

The worker, under section 112N, applying to the panel to review an insurer’s decision

1,000

The worker giving information to the panel under section 112N(2)(c)

1,700

Example of when a legal cost amount is included in section 193A compensation—

A worker with a DPI of 5% who has engaged a lawyer to give information to an insurer, attended a meeting with the lawyer and the insurer, and had the insurer’s decision reviewed successfully, is entitled to section 193A compensation totalling $36,190, being $31,490 for the DPI amount and $4,700 for the legal cost amount.

s 4 ins 2015 SL No. 135 s 12

Schedule 4B Pneumoconiosis score

section 112V

sch hdg ins 2017 Act No. 27 s 36

1Definitions for schedule

In this schedule—
category see section 2(1)(b).
consecutive categories see section 3.
corresponding score, for a category, means the score in section 2(1), table 1, column 2 that corresponds to the category.
reading, of a chest x-ray, see section 2.

s 1 ins 2017 Act No. 27 s 36

2Meaning of reading of chest x-ray

(1)A reading, of a chest x-ray, is a process in which a qualified reader—
(a)assesses the x-ray for the appearance of opacities; and
(b)decides, in accordance with the ILO classification guidelines, the category in table 1, column 1 (the category) that applies to the appearance of opacities in the x-ray; and
(c)records the category decided under paragraph (b).
Table 1

Column 1

Category

Column 2

Score

0/-

0

0/0

0

0/1

0

1/0

15

1/1

20

1/2

25

2/1

50

2/2

55

2/3

60

3/2

75

3/3

80

3/+

85

Category A

90

Category B

95

Category C

100

(2)In this section—
opacity means—
(a)a small opacity within the meaning of the ILO classification guidelines; or
(b)a large opacity within the meaning of the ILO classification guidelines.
qualified reader means a doctor who is qualified and competent to categorise, in accordance with the ILO classification guidelines, the appearance of opacities in a chest x-ray.

Example—

a doctor approved as a B Reader by the National Institute for Occupational Safety and Health

s 2 ins 2017 Act No. 27 s 36

3Meaning of consecutive categories

Two categories are consecutive categories if the categories—
(a)start with the same digit, other than 0; and
(b)appear in consecutive rows in section 2(1), table 1.

Examples of categories that are consecutive categories—

2/1 and 2/2
3/3 and 3/+

Examples of categories that are not consecutive categories—

0/0 and 0/1
1/2 and 2/1
category B and category C

s 3 ins 2017 Act No. 27 s 36

4Requirement for 2 readings

(1)A worker’s pneumoconiosis score is worked out by using 2 readings of the same chest x-ray of the worker in the way provided under subsection (2) or (3).
(2)If each reading records the same category, the worker’s pneumoconiosis score is the corresponding score for that category.
(3)If each reading records a different category, the worker’s pneumoconiosis score is—
(a)if the 2 categories are any combination of 0/-, 0/0 or 0/1—0; or
(b)if the 2 categories are consecutive categories—the higher of the corresponding scores for the consecutive categories; or

Example for paragraph (b)—

One reading records the category as 2/2, which has a corresponding score of 55. The other reading records the category as 2/3, which has a corresponding score of 60. The worker’s pneumoconiosis score is 60, being the higher of the corresponding scores for the consecutive categories.
(c)if the 2 categories are any combination of category A, category B or category C—the higher of the corresponding scores for the 2 categories.

Example for paragraph (c)—

One reading records the category as category A, which has a corresponding score of 90. The other reading records the category as category C, which has a corresponding score of 100. The worker’s pneumoconiosis score is 100, being the higher of the corresponding scores for the 2 categories.

s 4 ins 2017 Act No. 27 s 36

5Requirement for third reading

(1)This section applies if the worker’s pneumoconiosis score can not be worked out under section 4.
(2)The worker’s pneumoconiosis score is worked out by—
(a)obtaining a third reading of the same chest x-ray; and
(b)using that reading, with the first 2 readings, in the way provided under subsection (3) or (4).
(3)If the third reading records the same category as either of the first 2 readings, the worker’s pneumoconiosis score is the corresponding score for that category.
(4)If the third reading records a different category from both of the first 2 readings, the worker’s pneumoconiosis score is—
(a)if 2 of the 3 categories are consecutive categories—the higher of the corresponding scores for the consecutive categories; or

Example for paragraph (a)—

The first 2 readings record the categories as 1/2 and 2/1. The third reading records the category as 2/2. Because the categories of 2/1 and 2/2 are consecutive categories, the worker’s pneumoconiosis score is 55, being the higher of the corresponding scores for the consecutive categories.
(b)if 2 of the 3 categories are any combination of category A, category B or category C—the higher of the corresponding scores for the 2 categories.

Example for paragraph (b)—

The first 2 readings record the categories as 3/+ and category A. The third reading records the category as category B. The worker’s pneumoconiosis score is 95, being the higher of the corresponding scores for category A and category B.

s 5 ins 2017 Act No. 27 s 36

6Requirement for fourth and fifth readings

(1)This section applies if the worker’s pneumoconiosis score can not be worked out under section 4 or 5.
(2)The worker’s pneumoconiosis score is worked out by—
(a)obtaining a fourth and fifth reading of the same chest x-ray; and
(b)using those readings, with the other 3 readings, in the way provided under subsection (3).
(3)The worker’s pneumoconiosis score is the corresponding score for the median category of the categories recorded in each of the 5 readings.

Example—

The first 3 readings record the categories as 1/2, 2/1 and 2/3. The fourth and fifth readings record the categories as 1/2 and 2/1. The 5 categories, in ascending order, are 1/2, 1/2, 2/1, 2/1 and 2/3. The median category is 2/1, and the worker’s pneumoconiosis score is 50.

s 6 ins 2017 Act No. 27 s 36

Schedule 4C Lump sum compensation for workers with pneumoconiosis

section 112W

sch hdg ins 2017 Act No. 27 s 36

1Graduated scale

(1)This schedule contains the graduated scale for lump sum compensation for a worker to whom chapter 3, part 3, division 5 of the Act applies.
(2)The maximum amount of lump sum compensation payable under chapter 3, part 3, division 5 of the Act is $120,000.

s 1 ins 2017 Act No. 27 s 36

2How to use the graduated scale

(1)A pneumoconiosis band shown in column 1 comprises the pneumoconiosis scores in the corresponding entry in column 2.
(2)A worker who has a pneumoconiosis score shown in column 2 is entitled to lump sum compensation in the amount shown for the corresponding entry in column 3.
(3)However, the amount of the lump sum compensation under subsection (2) is subject to any reduction required under section 3.

Graduated scale

Column 1
Pneumoconiosis band

Column 2
Pneumoconiosis scores

Column 3
Lump sum compensation

$

1

0

0

2

15
20
25

18,000
24,000
30,000

3

50
55
60

60,000
66,000
72,000

4

75
80

90,000
96,000

5

85

102,000

6

90

108,000

7

95

114,000

8

100

120,000

s 2 ins 2017 Act No. 27 s 36

3Effect of worker’s lodgement age

(1)This section applies if the worker’s lodgement age is 71 years or more.
(2)For each whole year by which the worker’s lodgement age is more than 70 years, the amount (the prescribed amount) to which the worker would otherwise be entitled under section 2(2) must be reduced by an amount equal to 5% of the prescribed amount.

Example—

A worker with a pneumoconiosis score of 100 has a lodgement age of 72 years. The worker is entitled under section 2(2) to the amount of $120,000. However, that amount must be reduced under this subsection by $6,000 for each of the 2 years by which the worker’s lodgement age is more than 70 years. The amount of the worker’s entitlement under this schedule is therefore $108,000.
(3)However, the maximum reduction that may be made under subsection (2) is an amount equal to 50% of the prescribed amount.

s 3 ins 2017 Act No. 27 s 36

Schedule 5 Graduated scale of care required for payment of caring allowance

section 113(1)(a)

1Graduated scale

This schedule contains the graduated scale for the payment of caring allowance.

2How to use the graduated scale

(1)The range of dependency assessed under the modified barthel index is shown in column 1.
(2)In column 1—
(a)minimal is a modified barthel index total score of 91–99; and
(b)mild is a modified barthel index total score of 75–90; and
(c)moderate is a modified barthel index total score of 50–74; and
(d)severe is a modified barthel index total score of 25–49; and
(e)total is a modified barthel index total score of 0–24.
(3)The maximum number of hours of care required in a week is shown for the corresponding entry in column 2.

Graduated scale

Column 1

Range of dependency

(modified barthel index)

Column 2

Maximum hours of care required in a week

minimal

<10

mild

13.0

moderate

20.0

severe

23.5

total

27.0

Schedule 6 Legal professional costs

section 135(2)

Column A

Pre-proceeding notification and negotiation

Column B

Compulsory conference

Column C

Investigation by expert

Column D

Pre-proceedings court applications

$2,000

$135 for the first hour or part of an hour

$105 for each additional hour or part of an hour

$270

$400

Schedule 7 Designated courts and provisions that are a State’s legislation about damages for work related injury

sections 145(2) and 146(2)

Column 1

State

Column 2

Designated court

Column 3

Provisions that are that State’s legislation about damages for work related injury

Australian Capital Territory

Magistrates Court

the provisions of the Workers Compensation Act 1951 (ACT)

New South Wales

District Court of New South Wales

Workers Compensation Commission of New South Wales

the provisions of the Workers Compensation Act 1987 (NSW) and the Workplace Injury Management and Workers Compensation Act 1998 (NSW)

Northern Territory

Work Health Court

the provisions of the Workers Rehabilitation and Compensation Act (NT)

South Australia

Workers Compensation Tribunal

the provisions of the Workers Rehabilitation and Compensation Act 1986 (SA)

Tasmania

Workers Rehabilitation and Compensation Tribunal

the provisions of the Workers Rehabilitation and Compensation Act 1988 (Tas)

Victoria

County Court

Magistrates Court of Victoria

the provisions of the Accident Compensation Act 1985 (Vic) and the Accident Compensation (WorkCover Insurance) Act 1993 (Vic)

Western Australia

District Court of Western Australia

the provisions of the Workers’ Compensation and Injury Management Act 1981 (WA)

Schedule 8 Matters to which court is to have regard in the application of sch 9

section 129(b)

Part 1 Objectives of sch 9 (Ranges of injury scale values)

1Objectives of sch 9

The objectives of schedule 9 include promoting—
(a)consistency between assessments of general damages awarded by courts for similar injuries; and
(b)similar assessments of general damages awarded by courts for different types of injury that have a similar level of adverse impact on an injured worker.

Notes—

Under section 306O(1) of the Act, if general damages are to be awarded by a court in relation to an injury sustained on or after 1 July 2010, the court must assess an injury scale value as follows—
the injured worker’s total general damages must be assigned a numerical value (injury scale value) on a scale running from 0 to 100—the Act, section 306O(1)(a);
the scale reflects 100 equal graduations of general damages, from a case in which an injury is not severe enough to justify any award of general damages to a case in which an injury is of the gravest conceivable kind—the Act, section 306O(1)(b);
in assessing the injury scale value, the court must—
assess the injury scale value under any rules provided under a regulation; and
have regard to the injury scale values given to similar injuries in previous proceedings—the Act, section 306O(1)(c).
Under section 306O(2) of the Act, if a court assesses an injury scale value for a particular injury to be more or less than any injury scale value prescribed for or attributed to similar particular injuries under section 306O(1)(c) of the Act, the court must state the factors on which the assessment is based that justify the assessed injury scale value.

Part 2 How to use sch 9

Division 1 Injury

2Injury mentioned in sch 9

(1)In assessing the injury scale value (ISV) for an injury mentioned in the injury column of schedule 9, a court must consider the range of injury scale values stated in schedule 9 for the injury.
(2)The range of ISVs for the injury reflects the level of adverse impact of the injury on the injured worker.

3Multiple injuries

(1)Subject to section 9, in assessing the ISV for multiple injuries, a court must consider the range of ISVs for the dominant injury of the multiple injuries.
(2)To reflect the level of adverse impact of multiple injuries on an injured worker, the court may assess the ISV for the multiple injuries as being higher in the range of ISVs for the dominant injury of the multiple injuries than the ISV the court would assess for the dominant injury only.

Note—

This section acknowledges that—
the effects of multiple injuries commonly overlap, with each injury contributing to the overall level of adverse impact on the injured worker; and
if each of the multiple injuries were assigned an individual ISV and these ISVs were added together, the total ISV would generally be too high.

4Multiple injuries and maximum dominant ISV inadequate

(1)This section applies if a court considers the level of adverse impact of multiple injuries on an injured worker is so severe that the maximum dominant ISV is inadequate to reflect the level of impact.
(2)To reflect the level of impact, the court may make an assessment of the ISV for the multiple injuries that is higher than the maximum dominant ISV.
(3)However, the ISV for the multiple injuries—
(a)must not be more than 100; and

Note—

Under section 306O(1)(a) of the Act, an ISV is assessed on a scale running from 0 to 100.
(b)should rarely be more than 25% higher than the maximum dominant ISV.
(4)If the increase is more than 25% of the maximum dominant ISV, the court must give detailed written reasons for the increase.
(5)In this section—
maximum dominant ISV, in relation to multiple injuries, means the maximum ISV in the range for the dominant injury of the multiple injuries.

5Adverse psychological reaction

(1)This section applies if a court is assessing an ISV where an injured worker has an adverse psychological reaction to a physical injury.
(2)The court must treat the adverse psychological reaction merely as a feature of the injury.

6Mental disorder

(1)This section applies if—
(a)a court is assessing an ISV; and
(b)a PIRS rating for a mental disorder of an injured worker is relevant under schedule 9.
(2)The PIRS rating for the mental disorder of the injured worker is the PIRS rating accepted by the court.
(3)A PIRS rating is capable of being accepted by the court only if it is—
(a)assessed by a medical expert as required under schedules 10 and 11; and
(b)provided to the court in a PIRS report as required under schedule 10, section 12.

7Aggravation of pre-existing condition

(1)This section applies if an injured worker has a pre-existing condition that is aggravated by an injury for which a court is assessing an ISV.
(2)In considering the impact of the aggravation of the pre-existing condition, the court may have regard only to the extent to which the pre-existing condition has been made worse by the injury.

Division 2 Other matters

8Court must have regard to particular provisions of sch 9

(1)In addition to providing ranges of ISVs for particular injuries, schedule 9 sets out provisions relevant to using schedule 9 to assess an ISV for particular injuries.

Examples of relevant provisions—

examples of the injury
examples of factors affecting ISV assessment
comments about appropriate level of ISV
(2)In assessing an ISV, a court must have regard to those provisions to the extent they are relevant in a particular case.
(3)The fact that schedule 9 provides examples of factors affecting an ISV assessment is not intended to discourage a court from having regard to other factors it considers are relevant in a particular case.

9Court may have regard to other matters

In assessing an ISV, a court may have regard to other matters to the extent they are relevant in a particular case.

Examples of other matters—

the injured worker’s age, degree of insight, life expectancy, pain, suffering and loss of amenities of life
the effects of a pre-existing condition of the injured worker
difficulties in life likely to have emerged for the injured worker whether or not the injury happened
in assessing an ISV for multiple injuries, the range for, and other provisions of schedule 9 in relation to, an injury other than the dominant injury of the multiple injuries

10DPI

The extent of DPI is an important consideration, but not the only consideration affecting the assessment of an ISV.

11Medical report stating DPI

If a medical report states a DPI, it must state how the DPI is decided, including—
(a)the clinical findings; and
(b)how the impairment is calculated; and
(c)if the DPI is based on criteria provided under AMA 5—
(i)the provisions of AMA 5 setting out the criteria; and
(ii)if a range of percentages is available under AMA 5 for an injury of the type being assessed—the reason for assessing the injury at the selected point in the range.

Notes—

1It is not a function of a doctor to identify—
(a)the item in schedule 9 to which an injury belongs; or
(b)the appropriate ISV for an injury.
2A medical report tendered in evidence in a proceeding for a claim for personal injury damages must comply with the Uniform Civil Procedure Rules 1999, chapter 11, part 5.

12Greater weight to assessments based on AMA 5

(1)This section does not apply to a medical assessment of scarring or of a mental disorder.
(2)In assessing an ISV, a court must give greater weight to a medical assessment of a DPI based on the criteria for the assessment of a DPI provided under AMA 5 than to a medical assessment of a DPI not based on the criteria.

13Greater weight to assessments of PIRS rating

In assessing an ISV, a court must give greater weight to a PIRS report provided as required under schedule 10 than to another medical assessment of the permanent impairment caused by a mental disorder.

14ISV must be a whole number

An ISV assessed by a court must be a whole number.

Note—

Under section 306O(1)(a) of the Act, an ISV is assessed on a scale running from 0 to 100.

Schedule 9 Ranges of injury scale values

section 129(a)

Item no.

Injury

Other provisions

Range of injury scale values (ISVs)

Part 1 Central nervous system and head injuries

1Quadriplegia

  

Examples of factors affecting ISV assessment

75 to 100

  

•  Presence and extent of pain
 
  

•  Extent of any residual movement
 
  

•  Degree of insight
 
  

•  Adverse psychological reaction
 
  

•  Level of function and pre-existing function
 
  

•  Degree of independence
 
  

•  Ability to participate in daily activities, including employment
 
  

•  Presence and extent of secondary medical complications
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate only if the injured worker has assisted ventilation, full insight, extreme physical limitation and gross impairment of ability to communicate.

 

2Paraplegia

  

Examples of factors affecting ISV assessment

60 to 80

  

•  Presence and extent of pain
 
  

•  Extent of any residual movement
 
  

•  Adverse psychological reaction
 
  

•  Level of function and pre-existing function
 
  

•  Degree of independence
 
  

•  Ability to participate in daily activities, including employment
 
  

•  Loss of reproductive or sexual function
 
  

•  Bowel or bladder incontinence
 
  

•  Presence and extent of secondary medical complications
 

3Hemiplegia or severe paralysis of more than 1 limb

  

Comment

 
  

Incomplete paralysis causing a DPI of less than 40% must be assessed under part 6 if it is the only injury or the dominant injury of multiple injuries.

 
  

Examples of factors affecting ISV assessment for item 3

 
  

The same examples apply as for item 2.

 

4Monoplegia

  

Comment

 
  

See items 5, 6 and 7 and part 6.

 

5Extreme brain injury

  

Comment

 
  

The injury will involve major trauma to the brain with severe permanent impairment.

 

5.1

 

Substantial insight remaining

71 to 100

  

Comment about appropriate level of ISV for item 5.1

 
  

•  An ISV at or near the top of the range will be appropriate only if the injured worker needs full-time nursing care and has the following—
 
  

•  substantial insight despite gross disturbance of brain function
 
  

•  significant physical limitation and destruction of pre-existing lifestyle
 
  

•  epileptic seizures
 
  

•  double incontinence
 
  

•  little or no language function
 
  

•  little or no meaningful response to environment.
 
  

•  An injured worker with an injury for which an ISV at or near the top of the range is appropriate may have some ability to follow basic commands, recovery of eye opening, return of postural reflex movement and return to pre-existing sleep patterns.
 
  

Examples of factors affecting ISV assessment for item 5.1

 
  

•  Degree of insight
 
  

•  Life expectancy
 
  

•  Extent of bodily impairment
 

5.2

 

Substantially reduced insight

 
  

Comment for items 5.2.1 and 5.2.2

 
  

•  The injured worker will have major trauma to the brain with severe permanent impairment.
 
  

•  The injured worker’s insight of his or her condition may change.
 
  

•  Insight may be impaired in the degree, or continuity of, appreciation of the injured worker’s condition.
 
  

Examples of factors affecting ISV assessment for items 5.2.1 and 5.2.2

 
  

The same examples apply as for an item 5.1 injury, but reducing levels of insight progressively reduce the level of suffering and the appropriate level of ISV.

 

5.2.1

 

The injured worker will have partial or complete insight (as evidenced by appropriate responses to physical or emotional stimuli) for not more than half of the person’s waking hours.

36 to 70

5.2.2

 

The injured worker will have infrequent periods of partial insight and will show unreliable, rare or limited responses to physical or emotional stimuli.

16 to 35

5.3

 

Grossly reduced insight

10 to 15

  

Comment for item 5.3

 
  

The injured worker will be in a persistent vegetative state and have little or no insight.

 
  

Comment about appropriate level of ISV for item 5.3

 
  

If some minor awareness of loss remains, an ISV at or near the top of the range may be appropriate.

 

6Serious brain injury

  

Comment

56 to 70

  

The injured worker will be very seriously disabled.

 
  

Example of the injury

 
  

Serious brain damage causing—

 
  

(a)  physical impairment, for example, limb paralysis; or
 
  

(b)  cognitive impairment with marked impairment of intellect and personality
 
  

Examples of factors affecting ISV assessment

 
  

•  Degree of insight
 
  

•  Life expectancy
 
  

•  Extent of physical limitations
 
  

•  Extent of cognitive limitations
 
  

•  Extent of sensory limitation, for example, limitation of hearing or sense of taste or smell
 
  

•  Level of function and pre-existing function
 
  

•  Degree of independence
 
  

•  Ability to communicate
 
  

•  Behavioural or psychological changes
 
  

•  Epilepsy or a high risk of epilepsy
 
  

•  Presence of and extent of secondary medical complications
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate only if the injured worker substantially depends on others and needs substantial professional and other care.

 

7Moderate brain injury

  

Comment

21 to 55

  

The injured worker will be seriously disabled, but the degree of the injured worker’s dependence on others, although still present, is lower than for an item 6 injury.

 
  

Examples of factors affecting ISV assessment

 
  

•  Degree of insight
 
  

•  Life expectancy
 
  

•  Extent of physical limitations
 
  

•  Extent of cognitive limitations
 
  

•  Extent of sensory limitation, for example, limitation of hearing or sense of taste or smell
 
  

•  Level of function and pre-existing function
 
  

•  Degree of independence
 
  

•  Ability to communicate
 
  

•  Behavioural or psychological changes
 
  

•  Epilepsy or a high risk of epilepsy
 
  

•  Presence of, and extent of, secondary medical complications
 
  

Comment about appropriate level of ISV

 
  

•  An ISV of 21 to 25 will be appropriate if there is reduced concentration and memory, or reduced mood control, and either or both—
 
  

•  reduced capacity for employment
 
  

•  a noticeable interference with lifestyle and leisure.
 
  

•  An ISV of 26 to 40 will be appropriate if there is an increased risk of epilepsy and either or both—
 
  

•  a moderate cognitive impairment
 
  

•  loss of, or greatly reduced capacity for, employment.
 
  

•  An ISV of 41 to 55 will be appropriate if there is no capacity for employment, and 1 or more of the following—
 
  

•  moderate to severe cognitive impairment
 
  

•  marked personality change
 
  

•  dramatic effect on speech, sight or other senses
 
  

•  epilepsy or a high risk of epilepsy.
 

8Minor brain injury

  

Comment

6 to 20

  

The injured worker will make a good recovery and be able to take part in normal social life and to return to work. There may be minor problems persisting that prevent a restoration of normal function.

 
  

Examples of factors affecting ISV assessment

 
  

•  Severity of any physical injury causing the brain damage, having regard to—
 
  

(a)  any medical assessment made immediately after the injury was caused, for example, CT or MRI scans, an ambulance officer’s assessment or hospital emergency unit assessment; and
 
  

(b)  any post-traumatic amnesia.
 
  

•  Extent of any ongoing, and possibly permanent, disability
 
  

•  Extent of any personality changer
 
  

•  Depression
 
  

•  Degree of insight
 
  

•  Life expectancy
 
  

•  Extent of physical limitations
 
  

•  Extent of cognitive limitations
 
  

•  Extent of sensory limitation, for example, limitation of hearing or sense of taste or smell
 
  

•  Level of function and pre-existing function
 
  

•  Degree of independence
 
  

•  Ability to communicate
 
  

•  Behavioural or psychological changes
 
  

•  Epilepsy or a high risk of epilepsy
 
  

•  Presence of, and extent of, secondary medical complications
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if the injured worker has—

 
  

•  an increased risk of epilepsy; and
 
  

•  ongoing reduced concentration and memory, or reduced mood control, that does not significantly interfere with the person’s ability to take part in normal social life or return to work.
 

9Minor head injury, other than an injury mentioned in pt 3

  

Comment

0 to 5

  

Brain damage, if any, is minimal.

 
  

Examples of the injury

 
  

•  Uncomplicated skull fracture
 
  

•  Concussion with transitory loss of consciousness and no residual effect
 
  

Examples of factors affecting ISV assessment

 
  

•  Severity of any physical injury causing brain damage
 
  

•  Length of time to recover from any symptoms
 
  

•  Extent of ongoing symptoms
 
  

•  Presence of, or absence of, headaches
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate for an injury from which the injured worker fully recovers within a few weeks.
 
  

•  An ISV at or near the top of the range will be appropriate if there is an uncomplicated skull fracture and there are associated concussive symptoms of dizziness, headache and memory loss persisting for less than 6 months.
 

Part 2 Mental disorders

  

General comment for items 10 to 13

 
  

This part includes references to ratings (PIRS ratings) on the psychiatric impairment rating scale set out in schedule 11. A PIRS rating is capable of being accepted by a court only if it is assessed by a medical expert as required under schedules 10 and 11 and provided to the court in a PIRS report.

 
  

Examples of factors affecting ISV assessment for items 10 to 13

 
  

•  PIRS rating
 
  

•  Degree of insight
 
  

•  Age and life expectancy
 
  

•  Pain and suffering
 
  

•  Loss of amenities of life
 
  

•  Likelihood difficulties would have emerged in any event
 
  

•  If there is extreme psychological trauma, for example, intense helplessness or horror, the immediate adverse psychological reaction
 

10Extreme mental disorder

  

Example of the injury

41 to 65

  

A mental disorder with a PIRS rating between 31% and 100%

 
  

Comment about appropriate level of ISV

 
  

Despite a very high PIRS rating, an ISV at or near the bottom of the range may be appropriate if the injured worker has reduced insight.

 

11Serious mental disorder

  

Example of the injury

11 to 40

  

A mental disorder with a PIRS rating between 11% and 30%

 

12Moderate mental disorder

  

Comment

2 to 10

  

There is generally only moderate impairment.

 
  

Example of the injury

 
  

A mental disorder with a PIRS rating between 4% and 10%

 

13Minor mental disorder

  

Comment

0 to 1

  

For many persons who have suffered the injury there will be little or no impact on their lives.

 
  

Example of the injury

 
  

A mental disorder with a PIRS rating between 0% and 3%

 

Part 3 Facial injuries

Division 1 Skeletal injuries of the facial area

  

Examples of factors affecting ISV assessment for items 14 to 22

 
  

•  Extent of skeletal or functional damage
 
  

•  Degree of cosmetic damage or disfigurement
 
  

•  Adverse psychological reaction
 
  

•  Availability of cosmetic repair
 

14Extreme facial injury

  

Comment

26 to 45

  

The injury will involve severe traumatic injury to the face requiring substantial reconstructive surgery.

 
  

Examples of the injury

 
  

•  A Le Fort I fracture or Le Fort II fracture if the degree of incapacity and disfigurement after reconstructive surgery will be very severe
 
  

•  A Le Fort III fracture causing incapacity in daily activities
 
  

Additional example of factor affecting ISV assessment

 
  

The extent of any neurological impairment or effect on the airway

 
  

Note—

Le Fort I fracture, Le Fort II fracture and Le Fort III fracture are defined in schedule 13.

 

15Serious facial injury

  

Comment

14 to 25

  

The injury will involve serious traumatic injury to the face requiring reconstructive surgery that is not substantial.

 
  

Examples of the injury

 
  

•  A Le Fort I fracture or Le Fort II fracture if the degree of incapacity and disfigurement after reconstructive surgery will not be very severe
 
  

•  A Le Fort III fracture if no serious deformity will remain after reconstructive surgery
 
  

•  A serious or multiple fracture of the nasal complex either or both—
 
  

(a)  requiring more than 1 operation; and
 
  

(b)  causing 1 or more of the following—
 
  

•  permanent damage to the airway
 
  

•  permanent damage to nerves or tear ducts
 
  

•  facial deformity.
 
  

•  A serious cheekbone fracture that will require surgery and cause serious disfigurement and permanent effects despite reconstructive surgery, for example, hyperaesthesia or paraesthesia
 
  

•  A very serious multiple jaw fracture that will—
 
  

(a)  require prolonged treatment; and
 
  

(b)  despite reconstructive surgery, cause permanent effects, for example, severe pain, restriction in eating, paraesthesia or a risk of arthritis in the joints.
 
  

•  A severed trunk of the facial nerve (7th cranial nerve), causing total paralysis of facial muscles on 1 side of the face
 
  

Additional examples of factors affecting ISV assessment

 
  

•  Any neurological impairment or effect on the airway
 
  

•  Permanent cosmetic deformity
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if the injury causes permanent cosmetic deformity, asymmetry of 1 side of the face and limited adverse psychological reaction.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury causes serious bilateral deformity and significant adverse psychological reaction.
 

16Moderate facial injury

  

Examples of the injury

6 to 13

  

•  A simple cheekbone fracture, requiring minor reconstructive surgery, from which the injured worker will fully recover with little or no cosmetic damage
 
  

•  A fracture of the jaw causing—
 
  

(a)  permanent effects, for example, difficulty in opening the mouth or in eating; or
 
  

(b)  hyperaesthesia or paraesthesia in the area of the fracture.
 
  

•  A displaced fracture of the nasal complex from which the injured worker will almost fully recover after surgery
 
  

•  Severed branches of the facial nerve (7th cranial nerve) with paralysis of some of the facial muscles
 
  

•  A severed sensory nerve of the face with minor permanent paraesthesia
 

17Minor facial injury

  

Examples of the injury

0 to 5

  

•  A simple cheekbone fracture, for which surgery is not required and from which the injured worker will recover fully
 
  

•  A simple jaw fracture, requiring immobilisation and from which the injured worker will fully recover
 
  

•  A stable fracture of the joint process of the jaw
 
  

•  A displaced fracture of the nasal complex requiring only manipulation
 
  

•  A simple undisplaced fracture of the nasal complex, from which the injured worker will fully recover
 
  

•  A severed sensory nerve of the face, with good repair causing minimal or no paraesthesia
 

18Injury to teeth or gums

  

Comment

 
  

There will generally have been a course of treatment as a result of the injury.

 
  

Additional examples of factors affecting ISV assessment

 
  

•  Extent and degree of discomfort during treatment
 
  

•  Difficulty with eating
 
  

Comment about appropriate level of ISV

 
  

If protracted dentistry causes the injury, the ISV may be higher than the ISV for the same injury caused by something else.

 

18.1

 

Loss of or serious damage to more than 3 teeth, serious gum injury or serious gum infection

6 to 10

18.2

 

Loss of or serious damage to 2 or 3 teeth, moderate gum injury or moderate gum infection

3 to 5

18.3

 

Loss of or serious damage to 1 tooth, minor gum injury or minor gum infection

0 to 2

Division 2 Scarring to the face

  

General comment for items 19 to 22

 
  

This division will usually apply to an injury involving skeletal damage only if the skeletal damage is minor.

 

19Extreme facial scarring

  

Examples of the injury

21 to 45

  

•  Widespread area scarring, for example, over the side of the face or another whole area
 
  

•  Severe contour deformity
 
  

•  Significant deformity of the mouth or eyelids with muscle paralysis or tic
 
  

Comment about appropriate level of ISV

 
  

•  An ISV in the upper half of the range may be appropriate if the injured worker is relatively young, the cosmetic damage is very disfiguring and the adverse psychological reaction is severe.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury is caused by burns that resulted in loss of the entire nose, eyelids or ears.
 

20Serious facial scarring

  

Examples of the injury

11 to 20

  

•  Substantial disfigurement and significant adverse psychological reaction
 
  

•  Severe linear scarring
 
  

•  Discoloured hypertrophic (keloid) scarring
 
  

•  Atrophic scarring
 
  

•  Serious contour defects
 

21Moderate facial scarring

  

Comment

6 to 10

  

Any adverse psychological reaction is small, or having been considerable at the outset, has greatly diminished.

 
  

Examples of the injury

 
  

•  Scarring, the worst effects of which will be reduced by plastic surgery that will leave minor cosmetic damage
 
  

•  Scars crossing lines of election with discoloured, indurated, hypertrophic or atrophic scarring, of moderate severity
 

22Minor facial scarring

  

Examples of the injury

0 to 5

  

•  A single scar able to be camouflaged
 
  

•  More than 1 very small scar if the overall effect of the scars is to mar, but not to markedly affect, appearance and adverse psychological reaction is minor
 
  

•  Almost invisible linear scarring, in lines of election, with normal texture and elevation
 

Part 4 Injuries affecting the senses

Division 1 General comment

 

General comment for items 23 to 33

 
  

Injuries mentioned in this part are commonly symptoms of brain or nervous system injury.

 

Division 2 Injuries affecting the eyes

23Total sight and hearing impairment

  

Comment

90 to 100

  

The injury ranks with the most devastating injuries.

 
  

Examples of factors affecting ISV assessment

 
  

•  Degree of insight
 
  

•  Age and life expectancy
 

24Total sight impairment

  

Examples of factors affecting ISV assessment

50 to 80

  

•  Degree of insight
 
  

•  Age and life expectancy
 

25Complete sight impairment in 1 eye with reduced vision in the other eye

  

Comment about appropriate level of ISV

25 to 50

  

An ISV at or near the top of the range will be appropriate if there is serious risk of further significant deterioration in the remaining eye.

 

26Complete sight impairment in 1 eye or total loss of 1 eye

  

Examples of factors affecting ISV assessment

26 to 30

  

•  The extent to which the injured worker’s activities are adversely affected by the impairment or loss
 
  

•  Associated scarring or cosmetic damage
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if there is a minor risk of sympathetic ophthalmia.

 

27Serious eye injury

  

Examples of the injury

11 to 25

  

•  A serious but incomplete loss of vision in 1 eye without significant risk of loss or reduction of vision in the other eye
 
  

•  An injury causing double vision that is not minor and intermittent
 

28Moderate eye injury

  

Example of the injury

6 to 10

  

Minor but permanent impairment of vision in one eye, including if there is double vision that is minor and intermittent

 

29Minor eye injury

  

Example of the injury

0 to 5

  

A minor injury, for example, from being struck in the eye, exposed to smoke or other fumes or being splashed by liquids—

 
  

(a)  causing initial pain and temporary interference with vision; and
 
  

(b)  from which the injured worker will fully recover within a relatively short time
 

Division 3 Injuries affecting the ears

  

Comment for items 30 to 33

 
  

The injuries commonly, but not always, involve hearing loss. If the injury is to a single ear, the binaural loss must be assessed.

 
  

Examples of factors affecting ISV assessment for item 30 to 33 injuries

 
  

•  Whether the injury has an immediate effect, allowing the injured worker no opportunity to adapt, or whether it occurred over a period of time, for example, from exposure to noise
 
  

•  Whether the injury was suffered at an early age so that it has affected or will affect speech
 
  

•  Whether the injury will affect balance
 
  

•  The extent to which former activities will be affected
 
  

•  Presence of tinnitus
 

30Extreme ear injury

  

Definition of injury

36 to 55

  

The injury involves a binaural hearing loss of at least 80%.

 
  

Additional examples of factors affecting ISV assessment

 
  

•  Associated problems, for example, severe tinnitus, moderate vertigo, a moderate vestibular disturbance or headaches
 
  

•  Availability of hearing aids or other devices that may reduce the hearing loss
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if the injury happened at an early age so as to prevent or to seriously affect the development of normal speech.

 

31Serious ear injury

  

Definition of injury

26 to 35

  

The injury involves—

 
  

(a)  a binaural hearing loss of at least 50% but less than 80%; or
 
  

(b)  severe permanent vestibular disturbance.
 
  

Comment about appropriate level of ISV

 
  

An ISV in the lower half of the range will be appropriate if there is no speech impairment or tinnitus.

 
  

An ISV in the upper half of the range will be appropriate if there is speech impairment and tinnitus.

 

32Moderate ear injury

  

Definition of injury

11 to 25

  

The injury involves—

 
  

(a)  a binaural hearing loss of at least 20% but less than 50%; or
 
  

(b)  significant permanent vestibular disturbance.
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if there are problems associated with the injury, for example, severe tinnitus, moderate vertigo, a moderate vestibular disturbance or headaches.

 

33Minor ear injury

  

Definition of injury

 
  

The injury involves a binaural hearing loss of less than 20%.

 
  

Comment

 
  

•  This item covers the bulk of hearing impairment cases.
 
  

•  The injury is not to be judged simply by the degree of hearing loss.
 
  

•  There will often be a degree of tinnitus present.
 
  

•  There may also be minor vertigo or a minor vestibular disturbance causing loss of balance.
 
  

•  A vestibular disturbance may increase the level of ISV.
 

33.1

 

Moderate tinnitus or hearing loss, or both

6 to 10

33.2

 

Mild tinnitus with some hearing loss

4 to 5

33.3

 

Slight or occasional tinnitus with slight hearing loss or an occasional vestibular disturbance, or both

0 to 3

Division 4 Impairment of taste or smell

34Total loss of taste or smell, or both

  

Comment about appropriate level of ISV

6 to 9

  

•  An ISV at or near the bottom of the range will be appropriate if there will be a total loss of either taste or smell
 
  

•  An ISV at or near the top of the range will be appropriate if there will be a total loss of both taste and smell.
 

35Partial loss of taste or smell, or both

  

Comment about appropriate level of ISV

0 to 5

  

•  An ISV at or near the bottom of the range will be appropriate if there will be a partial loss of either taste or smell.
 
  

•  An ISV at or near the top of the range will be appropriate if there will be a partial loss of both taste and smell.
 

Part 5 Injuries to internal organs

Division 1 Chest injuries

  

Example of factor affecting ISV assessment for items 36 to 39

 
  

The level of any reduction in the capacity for employment and enjoyment of life

 

36Extreme chest injury

  

Comment

46 to 65

  

The injury will involve severe traumatic injury to the chest, or a large majority of the organs in the chest cavity, causing a high level of disability and ongoing medical problems.

 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if there will be total removal of 1 lung or serious heart damage, or both, with serious and prolonged pain and suffering and significant permanent scarring.

 

37Serious chest injury

  

Comment

21 to 45

  

The injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing serious disability and ongoing medical problems.

 
  

Examples of the injury

 
  

•  A trauma to 1 or more of the following, causing permanent damage, physical disability and impairment of function—
 
  

•  the chest
 
  

•  the heart
 
  

•  1 or both of the lungs
 
  

•  the diaphragm.
 
  

•  An injury that causes the need for oxygen therapy for about 16 to 18 hours a day
 
  

Example of factors affecting ISV assessment

 
  

The need for a permanent tracheostomy

 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if, after recovery, there are both of the following—

 
  

(a)  serious impairment to cardio-pulmonary function;
 
  

(b)  a DPI for the injury of, or of nearly, 40%.
 

38Moderate chest injury

  

Example of the injury

11 to 20

  

The injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing moderate disability and ongoing medical problems

 
  

Examples of factors affecting ISV assessment

 
  

•  Duration and intensity of pain and suffering
 
  

•  The DPI of lung or cardiac function, as evidenced by objective test results
 
  

•  The need for a temporary tracheostomy for short-term airway management
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the bottom of the range will be appropriate if there will be the loss of a breast without significant adverse psychological reaction.

 
  

An ISV in the lower half of the range will be appropriate if there was a pneumothorax, or haemothorax, requiring intercostal catheter insertion.

 
  

An ISV at or near the top of the range will be appropriate if there are multiple rib fractures causing—

 
  

(a)  a flail segment (flail chest) requiring mechanical ventilation in the acute stage; and
 
  

(b)  moderate permanent impairment of cardio-pulmonary function.
 

39Minor chest injury

  

Examples of factors affecting ISV assessment for items 39.1 and 39.2

 
  

•  complexity of any fractures
 
  

•  extent of injury to underlying organs
 
  

•  extent of any disability
 
  

•  duration and intensity of pain and suffering
 

39.1

 

Complicated or significant fracture, or internal organ injury, that substantially resolves

5 to 10

  

Comment

 
  

The injury will involve significant or complicated fractures, or internal injuries, that cause some tissue damage but no significant long-term effect on organ function.

 
  

Examples of the injury

 
  

•  Multiple fractures of the ribs or sternum, or both, that may cause cardio-pulmonary contusion
 
  

•  Internal injuries that cause some tissue damage but no significant long-term effect on organ function
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is a fractured sternum that substantially resolves, and there is some ongoing pain and activity restriction.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury causes significant persisting pain and significant activity restriction.
 

39.2

 

Soft tissue injury, minor fracture or minor internal organ injury

0 to 4

  

Comment

 
  

•  The injury will involve a soft tissue injury, minor fracture, or minor and non-permanent injury to internal organs.
 
  

•  There may be persistent pain from the chest, for example, from the chest wall or sternocostal or costochondral joints.
 
  

Examples of the injury

 
  

•  A single penetrating wound, causing some tissue damage but no long-term effect on lung function
 
  

•  An injury to the lungs caused by the inhalation of toxic fumes or smoke that will not permanently interfere with lung function
 
  

•  A soft tissue injury to the chest wall, for example, a laceration or serious seatbelt bruising
 
  

•  Fractured ribs or a minor fracture of the sternum causing serious pain and disability for weeks, without internal organ damage or permanent disability
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is a soft tissue injury from which the injured worker will fully recover.
 
  

•  An ISV at or near the top of the range will be appropriate if there is an injury causing a small pneumothorax that does not require intercostal catheter insertion, and from which the injured worker will fully recover.
 

Division 2 Lung injuries other than asthma

  

General comment for items 40 to 43

 
  

The level of an ISV for lung disease often reflects the fact that the disease is worsening and there is a risk of the development of secondary medical consequences.

 
  

Examples of factors affecting ISV assessment for items 40 to 43

 
  

•  A history of smoking tobacco will reduce the level of ISV
 
  

•  Adverse psychological reaction may increase the level of ISV
 

40Extreme lung injury

  

Examples of the injury

46 to 65

  

•  Diagnosed lung cancer
 
  

•  Lung disease involving serious disability causing severe pain and dramatic impairment of function and quality of life
 
  

•  A recurrent pulmonary embolism resulting in failure of the right side of the heart requiring a lung transplant, heart transplant or both
 
  

Additional examples of factors affecting ISV assessment

 
  

•  Age
 
  

•  Likelihood of progressive worsening
 
  

•  Duration and intensity of pain and suffering
 

41Serious lung injury

41.1

 

Serious lung injury if progressive worsening of lung function

25 to 45

  

Example of item 41.1

 
  

Lung disease, for example, emphysema, causing—

 
  

•  significantly reduced and worsening lung function
 
  

•  prolonged and frequent coughing
 
  

•  disturbance of sleep
 
  

•  restriction of physical activity, employment and enjoyment of life.
 
  

Additional examples of factors affecting ISV assessment for item 41.1

 
  

•  The possibility of lung cancer developing may increase the level of ISV
 
  

•  The need for continuous oxygen therapy
 

41.2

 

Serious lung injury if no progressive worsening of lung function

11 to 24

  

Examples of item 41.2

 
  

•  Lung disease causing breathing difficulties, short of disabling breathlessness, requiring frequent use of an inhaler
 
  

•  Lung disease causing a significant effect on employment and social life, including inability to tolerate a smoky environment, with an uncertain prognosis
 
  

•  A recurrent pulmonary embolism causing pulmonary hypertension and cor pulmonale
 

42Moderate lung injury

  

Examples of the injury

6 to 10

  

•  Bronchitis that does not cause serious symptoms, with little or no serious or permanent effect on employment or social life
 
  

•  A pulmonary embolism requiring anticoagulant therapy for at least 1 year or pulmonary endarterectomy
 

43Minor lung injury

  

Examples of the injury

0 to 5

  

•  Lung disease causing slight breathlessness, with—
 
  

(a)  no effect on employment; and
 
  

(b)  the likelihood of substantial and permanent recovery within a few years after the injury is caused
 
  

•  A pulmonary embolism requiring anticoagulant therapy for less than 1 year
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the bottom of the range will be appropriate if there is lung disease causing temporary aggravation of bronchitis, or other chest problems, that will resolve within a few months.

 

Division 3 Asthma

44Extreme asthma

  

Comment

31 to 55

  

The most serious cases may confine a person to the home and destroy capacity for employment.

 
  

Example of the injury

 
  

Severe and permanent disabling asthma causing—

 
  

•  prolonged and frequent coughing
 
  

•  disturbance of sleep
 
  

•  severe restriction of physical activity and enjoyment of life
 
  

•  gross reduction of capacity for employment
 

45Severe asthma

  

Example of the injury

11 to 30

  

Chronic asthma, with a poor prognosis, causing—

 
  

•  breathing difficulties
 
  

•  the need to frequently use an inhaler
 
  

•  significantly reduced capacity for employment.
 

46Moderate asthma

  

Example of the injury

6 to 10

  

Asthma, with symptoms that include bronchitis and wheezing, affecting employment or social life

 

47Minor asthma

  

Example of the injury

0 to 5

  

Asthma with minor symptoms that has no effect on employment or social life

 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the bottom of the range will be appropriate if there is asthma treated by a general practitioner that will resolve within 1 year after the injury is caused.

 

Division 4 Injuries to male reproductive system

  

General comment for items 48 to 51

 
  

•  This division applies to injuries caused by physical trauma rather than as a secondary result of a mental disorder
 
  

•  For a mental disorder that causes loss of reproductive system function, see part 2 (Mental disorders).
 
  

•  Sterility is usually either—
 
  

(a)  caused by surgery, chemicals or disease; or
 
  

(b)  caused by a traumatic injury that is often aggravated by scarring.
 
  

Examples of factors affecting ISV assessment for items 48 to 51

 
  

•  Adverse psychological reaction
 
  

•  Effect on social and domestic life
 

48Impotence and sterility

  

Additional examples of factors affecting ISV assessment

5 to 37

  

•  Age
 
  

•  Whether the injured worker has children
 
  

•  Whether the injured worker intended to have children or more children
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if the sterility has little impact.
 
  

•  An ISV in the lower half of the range will be appropriate if an injured worker with children may have intended to have more children and has uncomplicated sterility, without impotence or any aggravating features.
 
  

•  An ISV in the upper half of the range will be appropriate if a young injured worker without children has uncomplicated sterility, without impotence or any aggravating features.
 
  

•  An ISV at or near the middle of the range will be appropriate if a middle-aged injured worker with children has sterility and permanent impotence.
 
  

•  An ISV at or near the top of the range will be appropriate if a young injured worker has total impotence and loss of sexual function and sterility.
 

49Loss of part or all of penis

  

Additional examples of factors affecting ISV assessment

5 to 25

  

•  Extent of the penis remaining
 
  

•  Availability of a prosthesis
 
  

•  Extent to which sexual activity will be possible
 

50Loss of both testicles

  

Comment

 
  

See item 48 because sterility results.

 
  

Additional example of factor affecting ISV assessment

 
  

Level of any pain or residual scarring

 

51Loss of 1 testicle

  

Additional example of factors affecting ISV assessment

2 to 10

  

Age, cosmetic damage or scarring

 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the bottom of the range will be appropriate if the injury does not reduce reproductive capacity.

 

Division 5 Injuries to female reproductive system

  

General comment for items 52 to 53.5

 
  

•  This division applies to injuries caused by physical trauma rather than as a secondary result of a mental disorder.
 
  

•  For a mental disorder that causes loss of reproductive system function, see part 2.
 
  

Examples of factors affecting ISV assessment for items 52 to 53.5

 
  

•  Extent of any physical trauma
 
  

•  Whether the injured worker has children
 
  

•  Whether the injured worker intended to have children or more children
 
  

•  Age
 
  

•  Scarring
 
  

•  Depression or adverse psychological reaction
 
  

•  Effect on social and domestic life
 

52Infertility

52.1

 

Infertility causing severe effects

16 to 35

  

Example of item 52.1

 
  

Infertility with severe depression, anxiety and pain

 

52.2

 

Infertility causing moderate effects

9 to 15

  

Example of item 52.2

 
  

Infertility without any medical complication if the injured worker has a child or children

 
  

Comment about appropriate level of ISV for item 52.2

 
  

An ISV at or near the top of the range will be appropriate if there is significant adverse psychological reaction.

 

52.3

 

Infertility causing minor effects

0 to 8

  

Example of item 52.3

 
  

Infertility if—

 
  

(a)  the injured worker was unlikely to have had children, for example, because of age; and
 
  

(b)  there is little or no adverse psychological reaction
 

53Any other injury to the female reproductive system

53.1

 

Post-menopausal hysterectomy

5 to 15

53.2

 

Female impotence

5 to 15

  

Comment for item 53.2

 
  

The injury may be correctable by surgery.

 
  

Additional examples of factors affecting ISV assessment for item 53.2

 
  

The level of sexual function or the extent of any corrective surgery

 

53.3

 

An injury causing an inability to give birth by normal vaginal delivery, for example, because of pelvic ring disruption or deformity

4 to 15

  

Comment for item 53.3

 
  

The injury may be correctable by surgery.

 

53.4

 

Injury to female genitalia or reproductive organs, or both

3 to 25

  

Comment about appropriate level of ISV for item 53.4

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is a laceration or tear with good repair.
 
  

•  An ISV at or near the middle of the range will be appropriate if the injury causes development of a prolapse or fistula.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury causes the early onset of menopause or irregular hormonal activity.
 

53.5

 

Reduced fertility, caused by, for example, trauma to ovaries or fallopian tubes

3 to 8

  

Comment about appropriate level of ISV for item 53.5

 
  

An ISV in the lower half of the range will be appropriate if the injury is caused by a delay in diagnosis of an ectopic pregnancy.

 

Division 6 Injuries to digestive system

Subdivision 1 Injuries caused by trauma

54Extreme injury to the digestive system caused by trauma

  

Examples of the injury

19 to 40

  

Severe permanent damage to the digestive system, with ongoing debilitating pain and discomfort, diarrhoea, nausea and vomiting that—

 
  

(a)  are not controllable by drugs; and
 
  

(b)  cause weight loss of at least 20%.
 
  

Note—

Digestive system is defined in schedule 13.

 
  

•  An injury to the throat requiring a permanent gastrostomy
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is an injury to the throat requiring a temporary gastrostomy for more than 1 year and permanent dietary changes, for example, a requirement for a soft food diet.
 
  

•  An ISV at or near the top of the range will be appropriate if there is an injury to the throat requiring a permanent gastrostomy, with significant ongoing symptoms.
 
  

Examples of factors affecting ISV assessment

 
  

•  the extent of any voice or speech impairment
 
  

•  need for ongoing endoscopic procedures
 

55Serious injury to the digestive system caused by trauma

  

Examples of the injury

11 to 18

  

•  A serious injury causing long-term complications aggravated by physical strain
 
  

•  An injury requiring a feeding tube for between 3 and 12 months
 
  

Examples of factors affecting ISV assessment

 
  

•  The extent of any ongoing voice or speech impairment
 
  

•  Whether a feeding tube was required, and if so, for how long it was required
 

56Moderate injury to the digestive system caused by trauma

  

Examples of the injury

6 to 10

  

•  A simple penetrating stab wound, causing some permanent tissue damage, but with no significant long-term effect on digestive function
 
  

•  An injury requiring a feeding tube for less than 3 months
 
  

Example of factors affecting ISV assessment

 
  

•  Whether a feeding tube was required, and if so, for how long it was required
 
  

•  Whether dietary changes are required to reduce the risk of aspiration because of impaired swallowing
 

57Minor injury to the digestive system caused by trauma

  

Examples of the injury

0 to 5

  

•  A soft tissue injury to the abdomen wall, for example, a laceration or serious seatbelt bruising to the abdomen or flank, or both
 
  

•  A minor injury to the throat or tongue causing temporary difficulties with swallowing or speech
 
  

•  A laceration of the tongue requiring suturing
 

Subdivision 2 Injuries not caused by trauma

  

General comment for items 58 to 61

 
  

There is a marked difference between those comparatively rare cases having a long-term or even permanent effect on quality of life and cases in which the only ongoing symptom is an allergy, for example, to specific foods, that may cause short-term illness.

 

58Extreme injury to the digestive system not caused by trauma

  

Examples of the injury

13 to 35

  

Severe toxicosis—

 
  

(a)  causing serious acute pain, vomiting, diarrhoea and fever, requiring hospitalisation for days or weeks; and
 
  

(b)  also causing 1 or more of the following—
 
  

•  ongoing incontinence
 
  

•  haemorrhoids
 
  

•  irritable bowel syndrome; and
 
  

(c)  having a significant impact on the capacity for employment and enjoyment of life
 
  

Comment about appropriate level of ISV

 
  

An ISV in the lower half of the range will be appropriate if the injury causes a chronic infection, that requires prolonged hospitalisation, that will not resolve after antibiotic treatment for 1 year.

 

59Serious injury to the digestive system not caused by trauma

  

Examples of the injury

6 to 12

  

•  Serious but short-term food poisoning causing diarrhoea and vomiting—
 
  

(a)  that requires admission to an intensive care unit; and
 
  

(b)  with some remaining discomfort and disturbance of bowel function and impact on sex life and enjoyment of food, over a few years
 
  

•  Constant abdominal pain, causing significant discomfort, for up to 18 months caused by a delay in diagnosis of an injury to the digestive system
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the top of the range will be appropriate if there is an adverse response to the administration of a drug that—
 
  

(a)  requires admission to an intensive care unit; and
 
  

(b)  does not cause any permanent impairment; and
 
  

(c)  causes the need for ongoing drug therapy for life.
 
  

•  An ISV in the upper half of the range will be appropriate if a chronic infection—
 
  

(a)  requires prolonged hospitalisation and additional treatment; and
 
  

(b)  will be resolved by antibiotic treatment within 1 year.
 
  

•  An ISV at or near the bottom of the range will be appropriate if there is an adverse response to the administration of a drug that—
 
  

(a)  requires admission to an intensive care unit; and
 
  

(b)  does not cause any permanent impairment; and
 
  

(c)  does not cause the need for ongoing drug therapy for life.
 

60Moderate injury to the digestive system not caused by trauma

  

Examples of the injury

3 to 5

  

•  Food poisoning—
 
  

(a)  causing significant discomfort, stomach cramps, change of bowel function and fatigue; and
 
  

(b)  requiring hospitalisation for days; and
 
  

(c)  with symptoms lasting a few weeks; and
 
  

(d)  from which the injured worker will fully recover within 1 or 2 years
 
  

•  An infection that is resolved by antibiotic treatment, with or without additional treatment in hospital, within 3 months after the injury is caused
 
  

•  An adverse response to the administration of a drug, causing any of the following continuing over a period of more than 7 days, and requiring hospitalisation—
 
  

(a)  vomiting;
 
  

(b)  shortness of breath;
 
  

(c)  hypertension;
 
  

(d)  skin irritation
 

61Minor injury to the digestive system not caused by trauma

  

Examples of the injury

0 to 2

  

•  Disabling pain, cramps and diarrhoea, ongoing for days or weeks
 
  

•  A localised infection, requiring antibiotic treatment, that heals within 6 weeks after the start of treatment
 
  

•  An adverse response to the administration of a drug, causing any of the following continuing over a period of not more than 7 days, and not requiring hospitalisation—
 
  

(a)  vomiting;
 
  

(b)  shortness of breath;
 
  

(c)  hypertension;
 
  

(d)  skin irritation
 
  

•  Intermittent abdominal pain for up to 6 months caused by a delay in diagnosis of an injury to the digestive system
 

Division 7 Kidney or ureter injuries

  

General comment for items 62 to 65

 
  

An injury to a ureter or the ureters alone, without loss of, or serious damage to, a kidney will generally be assessed under item 64 or 65.

 
  

Examples of factor affecting ISV assessment for items 62 to 65

 
  

•  Age
 
  

•  Risk of ongoing kidney or ureter problems, complications or symptoms
 
  

•  Need for future medical procedures
 

62Extreme injury to kidneys or ureters

62.1

 

Loss of both kidneys causing loss of renal function and requiring permanent dialysis or transplant

56 to 75

62.2

 

Serious damage to both kidneys, requiring temporary or intermittent dialysis

31 to 55

  

Examples of factors affecting ISV assessment

 
  

•  The effect of dialysis and loss of kidney function on activities of daily living
 
  

•  The length of time for which dialysis was required or the frequency of intermittent dialysis
 
  

•  Ongoing requirement for medication, for example, to control blood pressure
 
  

•  Whether the injury caused the need for dietary changes, and if so, for how long
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if dialysis was required for an initial 3-month period, with intermittent dialysis required after that.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury required dialysis for about 1 year and ongoing dietary changes and medication.
 

63Serious injury to kidneys or ureters

  

Comment

19 to 30

  

The injury may require temporary dialysis for less than 3 months.

 
  

Example of the injury

 
  

Loss of 1 kidney if there is severe damage to, and a risk of loss of function of, the other kidney

 
  

Comment about appropriate level of ISV

 
  

The higher the risk of loss of function of the other kidney, the higher the ISV.

 

64Moderate injury to kidneys or ureters

  

Examples of the injury

11 to 18

  

•  Loss of 1 kidney, with no damage to the other kidney
 
  

•  An injury to a ureter or the ureters that requires surgery or placement of stents
 

65Minor injury to kidneys or ureters

  

Examples of the injury

0 to 10

  

A laceration or contusion to 1 or both of the kidneys

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is an injury to a kidney causing a contusion.
 
  

•  An ISV at or near the top of the range will be appropriate if a partial removal of a kidney is required.
 

Division 8 Liver, gall bladder or biliary tract injuries

  

Examples of factors affecting ISV assessment for items 66 to 69

 
  

•  Whether there are recurrent episodes of infection or obstruction
 
  

•  Whether there is a risk of developing biliary cirrhosis
 

66Extreme injury to liver, gall bladder or biliary tract

  

Examples of the injury

51 to 70

  

Loss, or injury causing effective loss, of liver function, requiring constant substitutional therapy

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there are recurrent episodes of liver failure that require hospital admission and medical management but do not require liver transplantation.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury requires liver transplantation.
 

67Serious injury to liver, gall bladder or biliary tract

  

Examples of the injury

36 to 50

  

Serious damage causing loss of over 30% of the tissue of the liver, but with some functional capacity of the liver remaining

 

68Moderate injury to liver, gall bladder or biliary tract

  

Examples of the injury

16 to 35

  

A laceration or contusion to the liver, with a moderate effect on liver function

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if the injury causes impaired liver function with symptoms of intermittent nausea and vomiting.
 
  

•  An ISV at or near the bottom of the range will also be appropriate if there is a gall bladder injury with recurrent infection or symptomatic stone disease, the symptoms of which may include, for example, pain or jaundice.
 
  

•  An ISV at or near the middle of the range will be appropriate if the injury involves removal of the gall bladder causing a bile duct injury.
 
  

•  An ISV at or near the top of the range will be appropriate if—
 
  

(a)  surgery is required to remove not more than 30% of the liver; or
 
  

(b)  bile ducts require repair, for example, placement of stents.
 
  

•  An ISV at or near the top of the range will also be appropriate if there is an injury to the gall bladder, that despite biliary surgery, causes ongoing symptoms, infection or the need for further endoscopic surgery.
 

69Minor injury to liver, gall bladder or biliary tract

  

Comment

3 to 15

  

An injury within this item should not require surgery to the liver.

 
  

Example of the injury

 
  

A laceration or contusion to the liver, with a minor effect on liver function

 
  

Comment about appropriate level of ISV

 
  

An ISV in the lower half of the range will be appropriate if there is an uncomplicated removal of the gall bladder with no ongoing symptoms.

 

Division 9 Bowel injuries

  

Examples of factors affecting ISV assessment for items 70 to 73

 
  

•  Age
 
  

•  Risk of ongoing bowel problems, complications or symptoms
 
  

•  Need for future surgery
 
  

•  The degree to which dietary changes are required to manage chronic pain or diarrhoea caused by the injury
 

70Extreme bowel injury

  

Example of the injury

41 to 60

  

An injury causing a total loss of natural bowel function and dependence on colostomy

 

71Serious bowel injury

  

Example of the injury

19 to 40

  

A serious abdominal injury causing either or both of the following—

 
  

(a)  impairment of bowel function (which often requires permanent or long-term colostomy, leaving disfiguring scars);
 
  

(b)  restrictions on employment and diet
 

72Moderate bowel injury

  

Comment about appropriate level of ISV

7 to 18

  

•  An ISV at or near the bottom of the range will be appropriate if—
 
  

(a)  the injury requires an ileostomy or colostomy for less than 3 months; and
 
  

(b)  bowel function returns to normal; and
 
  

(c)  there are no ongoing symptoms.
 
  

•  An ISV at or near the top of the range will be appropriate if—
 
  

(a)  the injury requires temporary surgical diversion of the bowel, for example, an ileostomy or colostomy; and
 
  

(b)  there is ongoing intermittent abnormal bowel function requiring medication.
 

73Minor bowel injury

  

Example of the injury

3 to 6

  

An injury causing tears to the bowel, with minimal ongoing bowel problems

 

Division 10 Bladder, prostate or urethra injuries

  

Examples of factors affecting ISV assessment for items 74 to 77

 
  

•  Age
 
  

•  Risk of ongoing bladder, prostate or urethra problems, complications or symptoms
 
  

•  Need for future surgery
 

74Extreme bladder, prostate or urethra injury

  

Example of the injury

40 to 60

  

An injury causing a complete loss of bladder function and control, with permanent dependence on urostomy

 

75Serious bladder, prostate or urethra injury

  

Example of the injury

19 to 39

  

An injury causing serious impairment of bladder control, with some incontinence

 
  

Comment about appropriate level of ISV

 
  

An ISV in the upper half of the range will be appropriate if there is serious ongoing pain.

 

76Moderate bladder, prostate or urethra injury

  

Example of the injury

7 to 18

  

An injury causing continued impairment of bladder control, with minimal incontinence and minimal pain

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is a laceration of the urethra, that required surgical repair and caused intermittent infection or bladder dysfunction.
 
  

•  An ISV at or near the top of the range will be appropriate if there is—
 
  

(a)  increased urinary frequency of more than once every 2 hours throughout the day and more than 3 times at night that is unresponsive to treatment; or
 
  

(b)  an ongoing requirement for minor surgery, for example, cystoscopy or urethral dilation.
 

77Minor bladder, prostate or urethra injury

  

Example of the injury

3 to 6

  

A bladder injury, from which the injured worker will fully recover, with some relatively long-term interference with natural bladder function

 

Division 11 Pancreas and spleen injuries

78Injury to the pancreas

  

Comment about appropriate level of ISV

10 to 35

  

•  An ISV at or near the bottom of the range will be appropriate if there is a contusion to the pancreas that heals.
 
  

•  An ISV at or near the middle of the range will be appropriate if there are chronic symptoms, for example, pain or diarrhoea.
 
  

•  An ISV at or near the top of the range will be appropriate if—
 
  

(a)  there are chronic symptoms with significant weight loss of between 10% and 20% of body weight, and pancreatic enzyme replacement is required; or
 
  

(b)  an injury to the pancreas causes diabetes.
 
  

Examples of factors affecting ISV assessment

 
  

•  The extent of any ongoing risk of internal infection and disorders, for example, diabetes
 
  

•  The need for, and outcome of, further surgery, for example, surgery to manage pain caused by stone disease, infection or an expanding pseudocyst
 

79Loss of spleen (complicated)

  

Example of the injury

8 to 20

  

Loss of spleen if there will be a risk, that is not minor, of ongoing internal infection and disorders caused by the loss

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if the injury leads to a splenectomy, with intermittent symptoms of pain, nausea and vomiting that settle.
 
  

•  An ISV at or near the middle of the range will be appropriate if—
 
  

(a)  the injury leads to a splenectomy, with serious infection after the splenectomy; and
 
  

(b)  the infection requires surgical or radiological intervention.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury leads to a splenectomy, with portal vein thrombosis after the splenectomy.
 

80Injury to the spleen or uncomplicated loss of spleen

  

Example of the injury

0 to 7

  

Laceration or contusion to the spleen that—

 
  

(a)  has been radiologically confirmed; and
 
  

(b)  has no ongoing bleeding; and
 
  

(c)  is managed conservatively; and
 
  

(d)  resolves fully.
 
  

Comment about appropriate level of ISV

 
  

An ISV at or near the top of the range will be appropriate if there has been removal of the spleen (splenectomy), with little or no risk of ongoing infections and disorders caused by the loss of the spleen.

 

Division 12 Hernia injuries

81Severe hernia

  

Example of the injury

11 to 20

  

A hernia if after repair there is either or both—

 
  

(a)  ongoing pain; or
 
  

(b)  a restriction on physical activities, sport or employment
 

82Moderate hernia

  

Example of the injury

6 to 10

  

A hernia that after repair has some real risk of recurring in the short-term

 

83Minor hernia

  

Example of the injury

0 to 5

  

An uncomplicated inguinal hernia, whether or not repaired

 

Part 6 Orthopaedic injuries

Division 1 Cervical spine injuries

  

General comment for items 84 to 88

 
  

•  This division does not apply to the following injuries (that are dealt with in items 1 to 3)—
 
  

•  quadriplegia
 
  

•  paraplegia
 
  

•  hemiplegia or severe paralysis of more than 1 limb.
 
  

•  Cervical spine injuries, other than those dealt with in items 1 to 3, range from cases of very severe disability to cases of a minor strain, with no time off work and symptoms only suffered for 2 or 3 weeks.
 
  

•  Symptoms associated with nerve root compression or damage can not be taken into account in assessing an ISV under item 84, 85 or 86 unless objective signs are present of nerve root compression or damage, for example—
 
  

•  CT or MRI scans or other radiological evidence
 
  

•  muscle wasting
 
  

•  clinical findings of deep tendon reflex loss, motor weakness and loss of sensation.
 

84Extreme cervical spine injury

  

Comment

41 to 75

  

These are extremely severe injuries that cause gross limitation of movement and serious interference with performance of daily activities.

 
  

The injury will involve significant upper or lower extremity impairment and may require the use of an adaptive device or prosthesis.

 
  

Examples of the injury

 
  

•  A total neurological loss at a single level
 
  

•  Severe multilevel neurological dysfunction
 
  

•  Structural compromise of the spinal canal with extreme upper or lower extremity motor and sensory impairments
 
  

•  Fractures involving more than 50% compression of a vertebral body with neural compromise
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is a DPI of about 29%.
 
  

•  An ISV at or near the top of the range will be appropriate if there is a cervical spine injury causing monoplegia of the dominant upper limb and a DPI of at least 60%.
 

85Serious cervical spine injury

  

Comment

16 to 40

  

•  The injury will cause serious upper extremity impairment or serious permanent impairment of the cervical spine.
 
  

•  The injury may involve—
 
  

(a)  a change of motion segment integrity; or
 
  

(b)  bilateral or multilevel nerve root compression or damage.
 
  

Examples of the injury

 
  

•  Loss of motion in a motion segment because of a surgical or post-traumatic fusion
 
  

•  A fracture involving more than 25% compression of 1 vertebral body
 
  

•  An injury showing objective signs of nerve root damage after surgery
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if—
 
  

(a)  the injured worker has had surgery and symptoms persist; or
 
  

(b)  there is a fracture involving 25% compression of 1 vertebral body.
 
  

•  An ISV in the middle of the range will be appropriate if there is a fracture involving about 50% compression of a vertebral body, with ongoing pain.
 
  

•  An ISV at or near the top of the range will be appropriate if—
 
  

(a)  the injured worker has had a fusion of vertebral bodies that has failed, leaving objective signs of significant residual nerve root damage and ongoing pain, affecting 1 side of the body; and
 
  

(b)  there is a DPI of about 28%.
 

86Moderate cervical spine injury—fracture, disc prolapse or nerve root compression or damage

  

Comment about appropriate level of ISV

5 to 15

  

•  An ISV at or near the top of the range will be appropriate if—
 
  

(a)  there is a disc prolapse for which there is radiological evidence at an anatomically correct level; and
 
  

(b)  there are symptoms of pain and 3 or more of the following objective signs that are anatomically localised to an appropriate spinal nerve root distribution—
 
  

(i)  sensory loss;
 
  

(ii)  loss of muscle strength;
 
  

(iii)  loss of reflexes;
 
  

(iv)  unilateral atrophy; and
 
  

(c)  the impairment has not improved after non-operative treatment.
 
  

•  An ISV of about 10 will be appropriate if there is a fracture of a vertebral body with up to 25% compression, and ongoing pain.
 
  

•  An ISV at or near the bottom of the range will be appropriate for an uncomplicated fracture of a posterior element of 1 or more of the vertebral segments, for example, spinous or transverse processes, without neurological impairment.
 

87Moderate cervical spine injury—soft tissue injury

  

Comment

5 to 10

  

The injury will cause moderate permanent impairment, for which there is objective evidence, of the cervical spine.

 
  

Comment about appropriate level of ISV

 
  

An ISV of not more than 10 will be appropriate if there is a DPI of 8% caused by a soft tissue injury for which there is no radiological evidence.

 

88Minor cervical spine injury

  

Comment

0 to 4

  

•  Injuries within this item include a whiplash injury with no ongoing symptoms, other than symptoms that are merely a nuisance, remaining more than 18 months after the injury is caused.
 
  

•  There will be no objective signs of neurological impairment
 
  

Example of the injury

 
  

A soft tissue or whiplash injury if symptoms are minor and the injured worker recovers, or is expected to recover, from the injury to a level where the injury is merely a nuisance within 18 months after the injury is caused

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if the injury will resolve without any ongoing symptoms within months after the injury is caused.
 
  

•  An ISV at or near the top of the range will be appropriate if the injury, despite improvement, causes headaches and some ongoing pain.
 

Division 2 Thoracic or lumbar spine injuries

  

General comment for items 89 to 93

 
  

•  This division does not apply to the following injuries (that are dealt with in items 1 to 3)—
 
  

•  quadriplegia
 
  

•  paraplegia
 
  

•  hemiplegia or severe paralysis of more than 1 limb.
 
  

•  Thoracic or lumbar spine injuries, other than those dealt with in items 1 to 3, range from cases of very severe disability to cases of a minor strain, with no time off work and symptoms suffered only for 2 or 3 weeks.
 
  

•  Symptoms associated with nerve root compression or damage can not be taken into account in assessing an ISV under item 89, 90 or 91 unless objective signs are present of nerve root compression or damage, for example—
 
  

•  CT or MRI scans or other radiological evidence
 
  

•  muscle wasting
 
  

•  clinical findings of deep tendon reflex loss, motor weakness and loss of sensation.
 

89Extreme thoracic or lumbar spine injury

  

Comment

36 to 60

  

These are extremely severe injuries causing gross limitation of movement and serious interference with performance of daily activities. There may be some motor or sensory loss, and some impairment of bladder, ano-rectal or sexual function.

 
  

Example of the injury

 
  

A fracture involving compression of a thoracic or lumbar vertebral body of more than 50%, with neurological impairment

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 25%.
 
  

•  An ISV at or near the top of the range will be appropriate if there is a DPI for the injury of at least 45%.
 

90Serious thoracic or lumbar spine injury

  

Comment

16 to 35

  

•  The injury will cause serious permanent impairment in the thoracic or lumbar spine.
 
  

•  The injury may involve—
 
  

(a)  bilateral or multilevel nerve root damage; or
 
  

(b)  a change in motion segment integrity, for example, because of surgery.
 
  

Example of the injury

 
  

A fracture involving at least 25% compression of 1 thoracic or lumbar vertebral body

 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the bottom of the range will be appropriate if—
 
  

(a)  the injured worker has had surgery and symptoms persist; or
 
  

(b)  there is a fracture involving 25% compression of 1 vertebral body.
 
  

•  An ISV in the middle of the range will be appropriate if there is a fracture involving 50% compression of a vertebral body, with ongoing pain.
 
  

•  An ISV at or near the top of the range will be appropriate if the injured worker has had a fusion of vertebral bodies that has failed—
 
  

(a)  leaving objective signs of significant residual nerve root damage and ongoing pain, affecting 1 side of the body; and
 
  

(b)  causing a DPI of 24%.
 

91Moderate thoracic or lumbar spine injury—fracture, disc prolapse or nerve root compression or damage

  

Comment about appropriate level of ISV

5 to 15

  

•  An ISV at or near the top of the range will be appropriate if—
 
  

(a)  there is a disc prolapse for which there is radiological evidence at an anatomically correct level; and
 
  

(b)  there are symptoms of pain and 3 or more of the following objective signs, that are anatomically localised to an appropriate spinal nerve root distribution—
 
  

(i)  sensory loss;
 
  

(ii)  loss of muscle strength;
 
  

(iii)  loss of reflexes;
 
  

(iv)  unilateral atrophy; and
 
  

(c)  the impairment has not improved after non-operative treatment.
 
  

•  An ISV of about 10 will be appropriate if there is a fracture of a vertebral body with up to 25% compression, and ongoing pain.
 
  

•  An ISV at or near the bottom of the range will be appropriate for an uncomplicated fracture of a posterior element of 1 or more of the vertebral segments, for example spinous or transverse processes, without neurological impairment.
 

92Moderate thoracic or lumbar spine injury—soft tissue injury

  

Comment

5 to 10

  

The injury will cause moderate permanent impairment, for which there is objective evidence, of the thoracic or lumbar spine.

 
  

Comment about appropriate level of ISV

 
  

An ISV of not more than 10 will be appropriate if there is a DPI of 8% caused by a soft tissue injury for which there is no radiological evidence.

 

93Minor thoracic or lumbar spine injury

  

Example of the injury

0 to 4

  

A soft tissue injury of the thoracic or lumbar spine with no—

 
  

•  significant clinical findings
 
  

•  fractures
 
  

•  documented neurological impairment
 
  

•  significant loss of motion segment integrity
 
  

•  other objective signs of impairment relating to the injury
 
  

Comment about appropriate level of ISV

 
  

•  An ISV at or near the top of the range will be appropriate, whether or not the injured worker continues to suffer some ongoing pain, if the injury will substantially reach maximum medical improvement, with only minor symptoms, within about 18 months after the injury is caused.
 
  

•  An ISV at or near the bottom of the range will be appropriate if the injury will resolve without any ongoing symptoms within months after the injury is caused.
 

Division 3 Shoulder injuries

  

General comment for items 94 to 97

 
  

•  Injuries under items 94 to 97 include subluxations or dislocations of the sternoclavicular joint, acromioclavicular joint or glenohumeral joint.
 
  

•  Soft tissue injuries may involve the musculoligamentous supporting structures of the joints.
 
  

•  Fractures may involve the clavicle, the scapula (shoulder blade) and the humerus.
 
  

Comment about appropriate level of ISV for items 94 to 97

 
  

An ISV at or near the top of the range will generally only be appropriate if the injury is to the shoulder of the dominant upper limb.

 

94Extreme shoulder injury

  

Comment

31 to 50

  

These are the most severe traumatic injuries causing gross permanent impairment.

 
  

Examples of the injury

 
  

•  A severe fracture or dislocation, with secondary medical complications
 
  

•  Joint disruption with poor outcome after surgery
 
  

•  Degloving
 
  

•  Permanent nerve palsies
 
  

Additional comment about appropriate level of ISV