Civil Liability Act 2003Reprint noteThis is the last reprint before expiry. Expired on 31 August 2025. See SIA s 56A and SIR s 5 sch 3.Civil Liability Regulation 20141Short titleThis regulation may be cited as the Civil Liability Regulation 2014.2CommencementThis regulation commences on 1 July 2014.3DefinitionsSchedule 8 defines particular words used in this regulation.4Prescribed entities providing services to enhance public safety—Act, s 26(1)(a)For section 26(1)(a) of the Act, each entity mentioned in schedule 1 is prescribed.5Prescribed entities providing services to enhance public safety—Act, s 27(1)For section 27(1) of the Act, each entity mentioned in schedule 2 is prescribed.6s 6 sub 2015 SL No. 47 s 4amd 2017 SL No. 110 s 4; 2018 SL No. 82 s 4; 2019 SL No. 113 s 4; 2020 SL No. 117 s 4; 2021 SL No. 52 s 4; 2022 SL No. 80 s 4; 2023 SL No. 50 s 4om 2024 SL No. 94 s 47Rules for assessing injury scale value—Act, s 61(1)(c)(i)(1)This section and schedules 3 to 6 provide the rules under which a court must assess the injury scale value for an injury.(2)Schedule 4 provides the ranges of injury scale values for particular injuries that the court is to consider in assessing the injury scale value for those injuries.(3)In assessing an injury scale value for an injury not mentioned in schedule 4, a court may have regard to the ranges prescribed in schedule 4 for other injuries.(4)Schedule 3 provides matters to which a court may or must have regard in applying schedule 4.(5)Schedule 6 provides the PIRS that may be used with schedule 4.(6)Schedule 5 provides—

(a)matters relevant to the application of schedule 6; and

(b)requirements with which a medical expert must comply in assessing a PIRS rating for a mental disorder of an injured person.

8s 8 sub 2015 SL No. 47 s 5om 2024 SL No. 94 s 59s 9 sub 2015 SL No. 47 s 5amd 2017 SL No. 110 s 5; 2018 SL No. 82 s 5; 2019 SL No. 113 s 5; 2020 SL No. 117 s 5; 2021 SL No. 52 s 5; 2022 SL No. 80 s 5; 2023 SL No. 50 s 5om 2024 SL No. 94 s 610RepealThe Civil Liability Regulation 2003, SL No. 229 is repealed.11Transitional provision(1)Subject to sections 6, 8 and 9, the repealed regulation continues, despite its repeal, to apply to injuries arising before the commencement.(2)In this section—commencement means the commencement of this section.repealed regulation means the Civil Liability Regulation 2003 as in force immediately before the commencement.Schedule 1Prescribed entities providing services to enhance public safety—Act, section 26(1)(a)section 4

Australian Helicopters Pty Ltd ABN 50 011 075 460 when providing aeromedical, air rescue and other emergency helicopter services under an agreement with the State

Brisbane City Council

Capricorn Helicopter Rescue Service Limited ABN 35 071 728 295

CareFlight Medical Services Limited ABN 83 101 511 719

CareFlight (Qld) Limited ABN 45 010 316 462

Central Queensland Helicopter Rescue Service Ltd ABN 73 415 515 751

The department administering the Disaster Management Act 2003

A local government or joint local government under the Local Government Act 2009

Marine Rescue Queensland under the Marine Rescue Queensland Act 2024

North Queensland Helicopter Rescue Service ABN 81 268 344 031

Queensland Ambulance Service established under the Ambulance Service Act 1991

Queensland Fire and Rescue established under the Fire Services Act 1990

The Queensland flotillas of The Australian Volunteer Coast Guard Association Inc. ABN 99 392 980 313

Royal Flying Doctor Service Queensland Section ABN 80 009 663 478

Royal Life Saving Society Queensland Incorporated and affiliated bodies providing services at or near the following places—

(a)Bulcock Beach, Caloundra;

(b)Tallebudgera Creek, Gold Coast;

(c)public swimming pools

Rural Fire Service Queensland established under the Fire Services Act 1990

the State Emergency Service under the State Emergency Service Act 2024

St John Ambulance Australia—Queensland

Sunshine Coast Helicopter Rescue Service Ltd ABN 34 010 104 560

Surf Life Saving Queensland ABN 27 360 485 381 and affiliated bodies

Volunteer Marine Rescue Association Queensland Inc. and affiliated bodies

sch 1 amd 2024 Act No. 18 s 39 sch 1; 2024 Act No. 22 s 92 sch 1Schedule 2Prescribed entities providing services to enhance public safety—Act, section 27(1)section 5

Australian Helicopters Pty Ltd ABN 50 011 075 460 when providing aeromedical, air rescue and other emergency helicopter services under an agreement with the State

Brisbane City Council

Capricorn Helicopter Rescue Service Limited ABN 35 071 728 295

CareFlight Medical Services Limited ABN 83 101 511 719

CareFlight (Qld) Limited ABN 45 010 316 462

Central Queensland Helicopter Rescue Service Ltd ABN 73 415 515 751

The department administering the Disaster Management Act 2003

A local government or joint local government under the Local Government Act 2009

Marine Rescue Queensland under the Marine Rescue Queensland Act 2024

North Queensland Helicopter Rescue Service ABN 81 268 344 031

Queensland Ambulance Service established under the Ambulance Service Act 1991

Queensland Fire and Rescue established under the Fire Services Act 1990

The Queensland flotillas of The Australian Volunteer Coast Guard Association Inc. ABN 99 392 980 313

Royal Flying Doctor Service Queensland Section ABN 80 009 663 478

Royal Life Saving Society Queensland Incorporated and affiliated bodies providing services at or near the following places—

(a)Bulcock Beach, Caloundra;

(b)Tallebudgera Creek, Gold Coast;

(c)public swimming pools

Rural Fire Service Queensland established under the Fire Services Act 1990

the State Emergency Service under the State Emergency Service Act 2024

St John Ambulance Australia—Queensland

Sunshine Coast Helicopter Rescue Service Ltd ABN 34 010 104 560

Surf Life Saving Queensland ABN 27 360 485 381 and affiliated bodies

Volunteer Marine Rescue Association Queensland Inc. and affiliated bodies

sch 2 amd 2024 Act No. 18 s 39sch 1; 2024 Act No. 22 s 92 sch 1Schedule 3Matters to which court may or must have regard in the application of schedule 4section 7(1)Part 1Objectives of schedule 4 (Ranges of ISVs)1Objectives of sch 4The objectives of schedule 4 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 person.

Note—For the assessment of an ISV by a court if general damages are to be awarded, see section 61 of the Act.Part 2How to use schedule 4Division 1Injury2Injury mentioned in sch 4(1)In assessing the ISV for an injury mentioned in the injury column of schedule 4, a court must consider the range of ISVs stated in schedule 4 for the injury.(2)The range of ISVs for the injury reflects the level of adverse impact of the injury on the injured person.3Multiple injuries(1)Subject to section 4, 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 person, 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.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 person 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; andNote—Under section 61(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 person 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 person is relevant under schedule 4.

(2)The PIRS rating for the mental disorder of the injured person 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 5 and 6; and

(b)provided to the court in a PIRS report as required under schedule 5, section 12.

7Aggravation of pre-existing condition(1)This section applies if an injured person 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 2Other matters8Court must have regard to particular provisions of sch 4(1)In addition to providing ranges of ISVs for particular injuries, schedule 4 sets out provisions relevant to using schedule 4 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 4 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 mattersIn 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 person’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 person

•difficulties in life likely to have emerged for the injured person whether or not the injury happened

•in assessing an ISV for multiple injuries, the range for, and other provisions of schedule 4 in relation to, an injury other than the dominant injury of the multiple injuries

10Whole person impairmentThe extent of whole person impairment is an important consideration, but not the only consideration affecting the assessment of an ISV.11Medical report stating whole person impairment percentageIf a medical report states a whole person impairment percentage, it must state how the percentage is calculated, including—

(a)the clinical findings; and

(b)how the impairment is calculated; and

(c)if the percentage 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 4 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 whole person impairment percentage based on the criteria for the assessment of whole person impairment provided under AMA 5 than to a medical assessment of a whole person impairment percentage not based on the criteria.13Greater weight to assessments of PIRS ratingIn assessing an ISV, a court must give greater weight to a PIRS report provided as required under schedule 5 than to another medical assessment of the permanent impairment caused by a mental disorder.14ISV must be a whole numberAn ISV assessed by a court must be a whole number.Note—Under section 61(1)(a) of the Act, an ISV is assessed on a scale running from 0 to 100.Schedule 4Ranges of ISVssection 7(1)Item no.InjuryOther provisionsRange of ISVsPart 1Central nervous system and head injuries1QuadriplegiaExamples of factors affecting ISV assessment75 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 complicationsComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate only if the injured person has assisted ventilation, full insight, extreme physical limitation and gross impairment of ability to communicate.2ParaplegiaExamples of factors affecting ISV assessment60 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 complications3Hemiplegia or severe paralysis of more than 1 limbComment for item 3Incomplete paralysis causing whole person impairment 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 3The same examples apply as for item 2.3.1Complete or nearly complete paralysis60 to 803.2Other paralysis, causing whole person impairment of at least 40%45 to 604MonoplegiaCommentSee items 5, 6 and 7 and part 6.5Extreme brain injuryCommentThe injury will involve major trauma to the brain with severe permanent impairment.5.1Substantial insight remaining71 to 100Comment 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 person 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 person 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 impairment5.2Substantially reduced insightComment for items 5.2.1 and 5.2.2•The injured person will have major trauma to the brain with severe permanent impairment.•The injured person’s insight of his or her condition may change.•Insight may be impaired in the degree, or continuity of, appreciation of the injured person’s condition.Examples of factors affecting ISV assessment for items 5.2.1 and 5.2.2The 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.5.2.1The injured person 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 705.2.2The injured person will have infrequent periods of partial insight and will show unreliable, rare or limited responses to physical or emotional stimuli.16 to 355.3Grossly reduced insight10 to 15Comment for item 5.3The injured person will be in a persistent vegetative state and have little or no insight.Comment about appropriate level of ISV for item 5.3If some minor awareness of loss remains, an ISV at or near the top of the range may be appropriate.6Serious brain injuryComment56 to 70The injured person will be very seriously disabled.Example of the injuryserious brain damage causing—(a)physical impairment, for example, limb paralysis; or(b)cognitive impairment with marked impairment of intellect and personalityExamples 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 complicationsComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate only if the injured person substantially depends on others and needs substantial professional and other care.7Moderate brain injuryComment21 to 55The injured person will be seriously disabled, but the degree of the injured person’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 complicationsComment 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 injuryComment6 to 20The injured person 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 change•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 complicationsComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if the injured person has—(a)an increased risk of epilepsy; and(b)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 part 3Comment0 to 5Brain damage, if any, is minimal.Examples of the injury•uncomplicated skull fracture•concussion with transitory loss of consciousness and no residual effectsExamples 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, headachesComment 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 person 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 2Mental disordersGeneral comment for items 10 to 13This part includes references to ratings on the psychiatric impairment rating scale set out in schedule 6 (PIRS ratings). A PIRS rating is capable of being accepted by a court only if it is assessed by a medical expert as required under schedules 5 and 6 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 reaction10Extreme mental disorderExample of the injury41 to 65a mental disorder with a PIRS rating between 31% and 100%Comment about appropriate level of ISVDespite a very high PIRS rating, an ISV at or near the bottom of the range may be appropriate if the injured person has reduced insight.11Serious mental disorderExample of the injury11 to 40a mental disorder with a PIRS rating between 11% and 30%12Moderate mental disorderComment2 to 10There is generally only moderate impairment.Example of the injurya mental disorder with a PIRS rating between 4% and 10%13Minor mental disorderComment0 to 1For many persons who have suffered the injury there will be little or no impact on their lives.Example of the injurya mental disorder with a PIRS rating between 0% and 3%Part 3Facial injuriesDivision 1Skeletal injuries of the facial areaExamples 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 repair14Extreme facial injuryComment26 to 45The 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 activitiesNote—Le Fort I fracture, Le Fort II fracture and Le Fort III fracture are defined in schedule 8 (Dictionary).Additional example of factor affecting ISV assessmentthe extent of any neurological impairment or effect on the airway15Serious facial injuryComment14 to 25The 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 faceAdditional examples of factors affecting ISV assessment•any neurological impairment or effect on the airway•permanent cosmetic deformityComment 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 injuryExamples of the injury6 to 13•a simple cheekbone fracture, requiring minor reconstructive surgery, from which the injured person 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 person 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 paraesthesia17Minor facial injuryExamples of the injury0 to 5•a simple cheekbone fracture, for which surgery is not required and from which the injured person will recover fully•a simple jaw fracture, requiring immobilisation and from which the injured person 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 person will fully recover•a severed sensory nerve of the face, with good repair causing minimal or no paraesthesia18Injury to teeth or gumsCommentThere 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 eatingComment about appropriate level of ISVIf protracted dentistry causes the injury, the ISV may be higher than the ISV for the same injury caused by something else.18.1Loss of or serious damage to more than 3 teeth, serious gum injury or serious gum infection6 to 1018.2Loss of or serious damage to 2 or 3 teeth, moderate gum injury or moderate gum infection3 to 518.3Loss of or serious damage to 1 tooth, minor gum injury or minor gum infection0 to 2Division 2Scarring to the faceGeneral comment for items 19 to 22This division will usually apply to an injury involving skeletal damage only if the skeletal damage is minor.19Extreme facial scarringExamples of the injury21 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 ticComment about appropriate level of ISV•An ISV in the upper half of the range may be appropriate if the injured person 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 scarringExamples of the injury11 to 20•substantial disfigurement and significant adverse psychological reaction•severe linear scarring•discoloured hypertrophic (keloid) scarring•atrophic scarring•serious contour defects21Moderate facial scarringComment6 to 10Any 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 severity22Minor facial scarringExamples of the injury0 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 elevationPart 4Injuries affecting the sensesDivision 1General commentGeneral comment for items 23 to 33Injuries mentioned in this part are commonly symptoms of brain or nervous system injury.Division 2Injuries affecting the eyes23Total sight and hearing impairmentComment90 to 100The injury ranks with the most devastating injuries.Examples of factors affecting ISV assessment•degree of insight•age and life expectancy24Total sight impairmentExamples of factors affecting ISV assessment50 to 80•degree of insight•age and life expectancy25Complete sight impairment in 1 eye with reduced vision in the other eyeComment about appropriate level of ISV25 to 50An 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 eyeExamples of factors affecting ISV assessment26 to 30•the extent to which the injured person’s activities are adversely affected by the impairment or loss•associated scarring or cosmetic damageComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is a minor risk of sympathetic ophthalmia.27Serious eye injuryExamples of the injury11 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 intermittent28Moderate eye injuryExample of the injury6 to 10minor but permanent impairment of vision in one eye, including if there is double vision that is minor and intermittent29Minor eye injuryExamples of the injury0 to 5a 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 person will fully recover within a relatively short timeDivision 3Injuries affecting the earsComment for items 30 to 33The 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 person 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 tinnitus30Extreme ear injuryDefinition of injury36 to 55The 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 lossComment about appropriate level of ISVAn 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 injuryDefinition of injury26 to 35The 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 injuryDefinition of injury11 to 25The 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 ISVAn 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 injuryDefinition of injuryThe 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.33.1Moderate tinnitus or hearing loss, or both6 to 1033.2Mild tinnitus with some hearing loss4 to 533.3Slight or occasional tinnitus with slight hearing loss or an occasional vestibular disturbance, or both0 to 3Division 4Impairment of taste or smell34Total loss of taste or smell, or bothComment about appropriate level of ISV6 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 smell or taste, or bothComment about appropriate level of ISV0 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 5Injuries to internal organsDivision 1Chest injuriesExample of factor affecting ISV assessment for items 36 to 39the level of any reduction in the capacity for employment and enjoyment of life36Extreme chest injuryComment46 to 65The 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 ISVAn 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 injuryComment21 to 45The 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 dayExample of factors affecting ISV assessmentthe need for a permanent tracheostomyComment about appropriate level of ISVAn 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)whole person impairment for the injury of, or of nearly, 40%.38Moderate chest injuryExample of the injury11 to 20the injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing moderate disability and ongoing medical problemsExamples of factors affecting ISV assessment•duration and intensity of pain and suffering•the degree of permanent impairment of lung or cardiac function, as evidenced by objective test results•the need for a temporary tracheostomy for short-term airway managementComment 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 injuryExamples 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 suffering39.1Complicated or significant fracture, or internal organ injury, that substantially resolves5 to 10CommentThe 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 functionComment 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.39.2Soft tissue injury, minor fracture or minor internal organ injury0 to 4Comment•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 disabilityComment 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 person 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 person will fully recover.Division 2Lung injury other than asthmaGeneral comment for items 40 to 43The 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 ISV40Extreme lung injuryExamples of the injury46 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 bothAdditional examples of factors affecting ISV assessment•age•likelihood of progressive worsening•duration and intensity of pain and suffering41Serious lung injury41.1Serious lung injury if progressive worsening of lung function25 to 45Example of item 41.1lung 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 lifeAdditional 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 therapy41.2Serious lung injury if no progressive worsening of lung function11 to 24Examples 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 pulmonale42Moderate lung injuryExamples of the injury6 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 endarterectomy43Minor lung injuryExamples of the injury0 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 yearComment about appropriate level of ISVAn 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 3Asthma44Extreme asthmaComment31 to 55The most serious cases may confine a person to the home and destroy capacity for employment.Example of the injurysevere 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 employment45Severe asthmaExample of the injury11 to 30chronic asthma, with a poor prognosis, causing—•breathing difficulties•the need to frequently use an inhaler•significantly reduced capacity for employment46Moderate asthmaExample of the injury6 to 10asthma, with symptoms that include bronchitis and wheezing, affecting employment or social life47Minor asthmaExample of the injury0 to 5asthma with minor symptoms that has no effect on employment or social lifeComment about appropriate level of ISVAn 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 4Injuries to male reproductive systemGeneral 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 life48Impotence and sterilityAdditional examples of factors affecting ISV assessment5 to 37•age•whether the injured person has children•whether the injured person intended to have children or more childrenComment 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 person 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 person 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 person with children has sterility and permanent impotence.•An ISV at or near the top of the range will be appropriate if a young injured person has total impotence and loss of sexual function and sterility.49Loss of part or all of penisAdditional examples of factors affecting ISV assessment5 to 25•extent of the penis remaining•availability of a prosthesis•extent to which sexual activity will be possible50Loss of both testiclesCommentSee item 48 because sterility results.Additional example of factor affecting ISV assessmentlevel of any pain or residual scarring51Loss of 1 testicleAdditional example of factors affecting ISV assessment2 to 10age, cosmetic damage or scarringComment about appropriate level of ISVAn ISV at or near the bottom of the range will be appropriate if the injury does not reduce reproductive capacity.Division 5Injuries to female reproductive systemGeneral comment for items 52 to 54•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).Examples of factors affecting ISV assessment for items 52 to 54•extent of any physical trauma•whether the injured person has children•whether the injured person intended to have children or more children•age•scarring•depression or adverse psychological reaction•effect on social and domestic life52Infertility52.1Infertility causing severe effects16 to 35Example of item 52.1infertility with severe depression, anxiety and pain52.2Infertility causing moderate effects9 to 15Example of item 52.2infertility without any medical complication if the injured person has a child or childrenComment about appropriate level of ISV for item 52.2An ISV at or near the top of the range will be appropriate if there is significant adverse psychological reaction.52.3Infertility causing minor effects0 to 8Example of item 52.3infertility if—(a)the injured person was unlikely to have had children, for example, because of age; and(b)there is little or no adverse psychological reaction53Any other injury to the female reproductive system53.1Post-menopausal hysterectomy5 to 1553.2Female impotence5 to 15Comment for item 53.2The injury may be correctable by surgery.Additional example of factors affecting ISV assessment for item 53.2the level of sexual function or the extent of any corrective surgery53.3An injury causing an inability to give birth by normal vaginal delivery, for example, because of pelvic ring disruption or deformity4 to 15Comment for item 53.3The injury may be correctable by surgery.53.4Injury to female genitalia or reproductive organs, or both3 to 25Comment 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.53.5Reduced fertility, caused by, for example, trauma to ovaries or fallopian tubes3 to 8Comment about appropriate level of ISV for item 53.5An 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.54Failed sterilisation leading to unwanted pregnancy54.1If no child is born and there is no serious adverse psychological reaction3 to 10Comment for item 54.1For a mental disorder, see part 2 (Mental disorders).54.2If a child is born15 to 25Comment about appropriate level of ISV for item 54.2An ISV at or near the top of the range will be appropriate if there is a difficult pregnancy or birth, or both, followed by medical problems, for example, post-natal depression.Division 6Injuries to digestive systemSubdivision 1Injury caused by trauma55Extreme injury to the digestive system caused by traumaExamples of the injury19 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 8 (Dictionary).•an injury to the throat requiring a permanent gastrostomyComment 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 procedures56Serious injury to the digestive system caused by traumaExamples of the injury11 to 18•a serious injury causing long-term complications aggravated by physical strain•an injury requiring a feeding tube for between 3 and 12 monthsExamples 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 required57Moderate injury to the digestive system caused by traumaExamples of the injury6 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 monthsExamples 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 swallowing58Minor injury to the digestive system caused by traumaExamples of the injury0 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 suturingSubdivision 2Injury not caused by traumaGeneral comment for items 59 to 62There 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.59Extreme injury to the digestive system not caused by traumaExample of the injury13 to 35severe 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 lifeComment about appropriate level of ISVAn 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.60Serious injury to the digestive system not caused by traumaExamples of the injury6 to 12•serious but short-term food poisoning causing diarrhoea and vomiting—(a)diminishing over 2 to 4 weeks; 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 systemComment 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.61Moderate injury to the digestive system not caused by traumaExamples of the injury3 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 person 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 irritation62Minor injury to the digestive system not caused by traumaExamples of the injury0 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 systemDivision 7Kidney or ureter injuriesGeneral comment for items 63 to 66An injury to a ureter or the ureters alone, without loss of, or serious damage to, a kidney will generally be assessed under item 65 or 66.Examples of factors affecting ISV assessment for items 63 to 66•age•risk of ongoing kidney or ureter problems, complications or symptoms•need for future medical procedures63Extreme injury to kidneys or ureters63.1Loss of both kidneys causing loss of renal function and requiring permanent dialysis or transplant56 to 7563.2Serious damage to both kidneys, requiring temporary or intermittent dialysis31 to 55Examples 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 longComment 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.64Serious injury to kidneys or uretersComment19 to 30The injury may require temporary dialysis for less than 3 months.Example of the injuryloss of 1 kidney if there is severe damage to, and a risk of loss of function of, the other kidneyComment about appropriate level of ISVThe higher the risk of loss of function of the other kidney, the higher the ISV.65Moderate injury to kidneys or uretersExamples of the injury11 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 stents66Minor injury to kidneys or uretersExample of the injury0 to 10a laceration or contusion to 1 or both of the kidneysComment 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 8Liver, gall bladder or biliary tract injuriesExamples of factors affecting ISV assessment for items 67 to 70•whether there are recurrent episodes of infection or obstruction•whether there is a risk of developing biliary cirrhosis67Extreme injury to liver, gall bladder or biliary tractExample of the injury51 to 70loss, or injury causing effective loss, of liver function, requiring constant substitutional therapyComment 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.68Serious injury to liver, gall bladder or biliary tractExample of the injury36 to 50serious damage causing loss of over 30% of the tissue of the liver, but with some functional capacity of the liver remaining69Moderate injury to liver, gall bladder or biliary tractExample of the injury16 to 35a laceration or contusion to the liver, with a moderate effect on liver functionComment 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.70Minor injury to liver, gall bladder or biliary ductComment3 to 15An injury within this item should not require surgery to the liver.Example of the injurya laceration or contusion to the liver, with a minor effect on liver functionComment about appropriate level of ISVAn 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 9Bowel injuriesExamples of factors affecting ISV assessment for items 71 to 74•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 injury71Extreme bowel injuryExample of the injury41 to 60an injury causing a total loss of natural bowel function and dependence on colostomy72Serious bowel injuryExample of the injury19 to 40a 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 diet73Moderate bowel injuryComment about appropriate level of ISV7 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.74Minor bowel injuryExample of the injury3 to 6an injury causing tears to the bowel, with minimal ongoing bowel problemsDivision 10Bladder, prostate or urethra injuriesExamples of factors affecting ISV assessment for items 75 to 78•age•risk of ongoing bladder, prostate or urethra problems, complications or symptoms•need for future surgery75Extreme bladder, prostate or urethra injuryExample of the injury40 to 60an injury causing a complete loss of bladder function and control, with permanent dependence on urostomy76Serious bladder, prostate or urethra injuryExample of the injury19 to 39an injury causing serious impairment of bladder control, with some incontinenceComment about appropriate level of ISVAn ISV in the upper half of the range will be appropriate if there is serious ongoing pain.77Moderate bladder, prostate or urethra injuryExample of the injury7 to 18an injury causing continued impairment of bladder control, with minimal incontinence and minimal painComment 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.78Minor bladder, prostate or urethra injuryExample of the injury3 to 6a bladder injury, from which the injured person will fully recover, with some relatively long-term interference with natural bladder functionDivision 11Spleen and pancreas injuries79Injuries to the pancreasComment about appropriate level of ISV10 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 pseudocyst80Loss of spleen (complicated)Example of the injury8 to 20loss of spleen if there will be a risk, that is not minor, of ongoing internal infection and disorders caused by the lossComment 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.81Injury to the spleen or uncomplicated loss of spleenExample of the injury0 to 7laceration 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 fullyComment about appropriate level of ISVAn 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 12Hernia injuries82Severe herniaExample of the injury11 to 20a hernia if after repair there is either or both—(a)ongoing pain; or(b)a restriction on physical activities, sport or employment83Moderate herniaExample of the injury6 to 10a hernia that after repair has some real risk of recurring in the short-term84Minor herniaExample of the injury0 to 5an uncomplicated inguinal hernia, whether or not repairedPart 6Orthopaedic injuriesDivision 1Cervical spine injuriesGeneral comment for items 85 to 89•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 85, 86 or 87 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.85Extreme cervical spine injuryComment41 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 compromiseComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment 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 whole person impairment of at least 60%.86Serious cervical spine injuryComment16 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 surgeryComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if—(a)the injured person 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 person 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 whole person impairment of about 28%.87Moderate cervical spine injury—fracture, disc prolapse or nerve root compression or damageComment about appropriate level of ISV5 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.88Moderate cervical spine injury—soft tissue injuryComment5 to 10The injury will cause moderate permanent impairment, for which there is objective evidence, of the cervical spine.Comment about appropriate level of ISVAn ISV of not more than 10 will be appropriate if there is whole person impairment of 8% caused by a soft tissue injury for which there is no radiological evidence.89Minor cervical spine injuryComment0 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 injurya soft tissue or whiplash injury if symptoms are minor and the injured person 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 causedComment 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 2Thoracic spine or lumbar spine injuriesGeneral comment for items 90 to 94•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 90, 91 or 92 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.90Extreme thoracic or lumbar spine injuryComment36 to 60These 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 injurya fracture involving compression of a thoracic or lumbar vertebral body of more than 50%, with neurological impairmentComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 25%.•An ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of at least 45%.91Serious thoracic or lumbar spine injuryComment16 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 injurya fracture involving at least 25% compression of 1 thoracic or lumbar vertebral bodyComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if—(a)the injured person 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 person 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 whole person impairment of 24%.92Moderate thoracic or lumbar spine injury—fracture, disc prolapse or nerve root compression or damageComment about appropriate level of ISV5 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.93Moderate thoracic or lumbar spine injury—soft tissue injuryComment5 to 10The injury will cause moderate permanent impairment, for which there is objective evidence, of the thoracic or lumbar spine.Comment about appropriate level of ISVAn ISV of not more than 10 will be appropriate if there is whole person impairment of 8% caused by a soft tissue injury for which there is no radiological evidence.94Minor thoracic or lumbar spine injuryExample of the injury0 to 4a 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 injuryComment about appropriate level of ISV•An ISV at or near the top of the range will be appropriate, whether or not the injured person 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 3Shoulder injuriesGeneral comment for items 95 to 98•Injuries under items 95 to 98 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 95 to 98An 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.95Extreme shoulder injuryComment31 to 50These 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 palsiesAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment of 45% and complete loss of all shoulder function of the dominant upper limb.96Serious shoulder injuryComment16 to 30The injury will involve serious trauma to the shoulder causing serious permanent impairment.Examples of the injury•a crush injury•a serious fracture with secondary arthritis•nerve palsies from which the injured person will partially recover•established non-union of a clavicular or scapular fracture despite open reduction and internal fixation (ORIF)•established non-union of a clavicular or scapular fracture if surgery is not appropriate or not possible, and there is significant functional impairmentAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 25% and the injury is to the dominant upper limb.97Moderate shoulder injuryExamples of the injury6 to 15•traumatic adhesive capsulitis with discomfort, limitation of movement and symptoms persisting or expected to persist for about 2 years•permanent and significant soft tissue disruption, for example, from tendon tears or ligament tears•a fracture, from which the injured person has made a reasonable recovery, requiring open reduction and internal fixation•nerve palsies from which the injured person has made a good recovery•painful persisting dislocation of the acromioclavicular joint•an injury to the sternoclavicular joint causing permanent, painful instabilityAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 6%.•An ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 12% and the injury is to the dominant upper limb.98Minor shoulder injuryExamples of the injury0 to 5•soft tissue injury with considerable pain from which the injured person makes an almost full recovery in less than 18 months•fracture from which the injured person has made an uncomplicated recovery•strain injury of the acromioclavicular joint or sternoclavicular jointDivision 4Amputation of upper limbsComment about appropriate level of ISV for items 99 to 100.3An ISV at or near the top of the range will generally only be appropriate if the amputation is of the dominant upper limb.99Loss of both upper limbs, or loss of 1 arm and extreme injury to the other armComment55 to 85The effect of the injury is to reduce the injured person to a state of considerable helplessness.Examples of factors affecting ISV assessment•whether the amputations are above or below the elbow (the loss of the elbow joint adds greatly to the disability)•the length of any stump suitable for use with a prosthesis•severity of any phantom painsAdditional comment about appropriate level of ISV•An ISV of 70 to 85 will be appropriate if—(a)both upper limbs are amputated at the shoulder; or(b)1 arm is amputated at the shoulder, and there is a loss of function in the other arm, causing whole person impairment of 60%.•An ISV of 65 to 80 will be appropriate if—(a)both upper limbs are amputated through the elbow or above the elbow but below the shoulder; or(b)1 arm is amputated through the elbow or above the elbow but below the shoulder, and there is a loss of function in the other arm, causing whole person impairment of 57%.•An ISV of 55 to 75 will be appropriate if—(a)both upper limbs are amputated below the elbow; or(b)1 arm is amputated below the elbow, and there is a loss of function in the other arm, causing whole person impairment of 54%.100Loss of 1 upper limbExamples of factors affecting ISV assessment•whether the amputation is above or below the elbow (the loss of the elbow joint adds greatly to the disability)•whether the amputation was of the dominant arm•the length of any stump suitable for use with a prosthesis•severity of any phantom pains•extent of any disability in the other arm100.1An upper limb amputation at the shoulder50 to 65100.2An upper limb amputation through the elbow or above the elbow but below the shoulder40 to 65Additional comment about appropriate level of ISV for item 100.2•An ISV at or near the bottom of the range will generally be appropriate if there is an amputation through the elbow.•An ISV at or near the top of the range will be appropriate if there is a short stump because a short stump may create difficulties in the use of a prosthesis.100.3An upper limb amputation below the elbow35 to 60Additional comment about appropriate level of ISV for item 100.3An ISV at or near the top of the range will be appropriate if there is an amputation through the forearm with residual severe pain in the stump and phantom pains.Division 5Elbow injuriesComment about appropriate level of ISV for items 101 to 104An ISV at or near the top of the range will generally only be appropriate if the injury is to the elbow of the dominant upper limb.101Extreme elbow injuryComment26 to 50The injury will involve an extremely severe elbow injury, falling short of amputation, leaving little effective use of the elbow joint.Examples of the injury•whole person impairment for the injury of between 24% and 42%•a complex elbow fracture, or dislocation, with secondary complications•joint disruption, with poor outcome after surgery•degloving•permanent nerve palsies•an injury causing severe limitation of elbow movement with the joint constrained in a non-functional position102Serious elbow injuryComment13 to 25The injury will involve significant disability and require major surgery.Examples of the injury•a serious fracture with secondary arthritis•a crush injury•nerve palsies from which the injured person will partially recover•permanent, poor restriction of range of motion with the elbow constrained in a satisfactory functional positionAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 23% and the injury is to the elbow of the dominant upper limb.103Moderate elbow injuryComment6 to 12The injury will cause moderate long-term disability but does not require protracted surgery.Examples of the injury•soft tissue disruption, for example, a ligament or tendon tear•a fracture, from which the injured person has made a reasonable recovery, requiring open reduction and internal fixation•nerve palsies from which the injured person has made a good recoveryAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 5%.•An ISV at or near the top of the range will be appropriate if there is a moderately severe injury to the elbow of the dominant upper limb—(a)requiring prolonged treatment; and(b)causing whole person impairment of 10%.104Minor elbow injuryComment0 to 5The injury will cause no permanent damage and no permanent impairment of function.Examples of the injury•a fracture with an uncomplicated recovery•a soft tissue injury with pain, minor tennis elbow syndrome or lacerationsDivision 6Wrist injuriesComment about appropriate level of ISV for items 105 to 108An ISV at or near the top of the range will generally only be appropriate if the injury is to the wrist of the dominant upper limb.105Extreme wrist injuryComment25 to 40The injury will involve severe fractures, or a dislocation, causing a high level of permanent impairment.Examples of the injury•a severe fracture or dislocation with secondary joint complications•joint disruption with poor outcome after surgery•degloving•permanent nerve palsiesAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 36% and the injury is to the wrist of the dominant upper limb.106Serious wrist injuryExamples of the injury16 to 24•an injury causing significant permanent loss of wrist function, for example, severe problems with gripping or pushing objects, but with some useful movement remaining•non-union of a carpal fracture•severe carpal instabilityAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 20% and the injury is to the wrist of the dominant upper limb.107Moderate wrist injuryExamples of the injury6 to 15•a wrist injury that is not serious and causes some permanent disability, for example, some persisting pain and stiffness•persisting radio-ulnar instability•recurrent tendon subluxation or entrapmentAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 6%.•An ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 12%.108Minor wrist injuryExamples of the injury0 to 5•a fracture from which the injured person almost fully recovers•a soft tissue injury, for example, severe bruising•continued pain following carpal tunnel releaseDivision 7Hand injuriesGeneral comment for items 109 to 120Hands are cosmetically and functionally the most important part of the upper limbs.Comment about appropriate level of ISV for items 109 to 120•The appropriate ISV for loss of a hand is only a little less than the appropriate ISV for the loss of the relevant arm.•An ISV at or near the top of the range will generally be appropriate if the injury is to the dominant hand.109Total or effective loss of both handsExample of the injury51 to 75a serious injury causing extensive damage to both hands making them little more than uselessExamples of factors affecting ISV assessment•the level of residual capacity left in either hand•severity of any phantom pains if there has been an amputation or amputationsAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if both hands remain attached to the forearms and are of some cosmetic importance.•An ISV at or near the top of the range will be appropriate if both hands are amputated through the wrist.110Serious injury to both handsComment40 to 50The injury will involve significant loss of function in both hands, for example, loss of 50% or more of the use of each hand.111Total or effective loss of 1 handExamples of the injury35 to 60•a crushed hand that has been surgically amputated•traumatic amputation of all fingers and most of the palmExample of factor affecting ISV assessmentseverity of any phantom pain if there has been an amputationAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there has been an amputation of the fingers at the metacarpophalangeal joints, but the thumb remains, and there is whole person impairment for the injury of 32%.•An ISV at or near the top of the range will be appropriate if—(a)there has been amputation of the dominant hand at the wrist; and(b)there is residual severe pain in the stump and ongoing complications, for example, chronic regional pain syndrome or neuroma formation.112Amputation of the thumb or part of the thumbExamples of factors affecting ISV assessment15 to 28•the level of amputation, for example, at carpo metacarpal (CMC) joint, through the distal third of the thumb metacarpal, at the metacarpophalangeal (MCP) joint or thumb interphalangeal (IP) joint•whether the injury is to the dominant hand•the extent of any damage to the fingersAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if—(a)there has been an amputation through the interphalangeal joint of the thumb; and(b)there is whole person impairment for the injury of 11%.•An ISV at or near the middle of the range will be appropriate if there has been an amputation through the proximal phalanx.•An ISV at or near the top of the range will be appropriate if—(a)there has been an amputation at the base of the thumb at the carpometacarpal (CMC) joint level of the dominant hand; and(b)there are ongoing debilitating complications.113Amputation of index, middle and ring fingers, or any 2 of themComment15 to 30The amputation will cause complete loss or nearly complete loss of 2 or all of the following fingers of the hand—•index finger•middle finger•ring finger.Example of factor affecting ISV assessmentthe level of the amputation, for example, whether the hand has been made to be of very little use and any remaining grip is very weakAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if 2 fingers, whether index, middle or ring fingers, are amputated at the level of the proximal interphalangeal joints.•An ISV at or near the middle of the range will be appropriate if there is whole person impairment for the injury of 19%.•An ISV at or near the top of the range will be appropriate if—(a)the index, middle and ring fingers are amputated at the level of the metacarpophalangeal joint (MCP joint) or there is whole person impairment for the injury of at least 27%; and(b)the injury is to the dominant hand.114Amputation of individual fingersExamples of factors affecting ISV assessment5 to 20•whether the amputation was of the index or middle finger•the level of the amputation•any damage to other fingers short of amputationAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if—(a)there has been an amputation at the level of the distal interphalangeal joint of the little or ring finger; or(b)there is whole person impairment for the injury of 3%.•An ISV of not more than 11 will be appropriate if—(a)there has been an amputation of the index or middle finger at the proximal interphalangeal joint (PIP joint); or(b)there is whole person impairment for the injury of 8%.•An ISV at or near the top of the range will be appropriate if there is complete loss of the index or middle finger of the dominant hand, and serious impairment of the remaining fingers causing whole person impairment of at least 15%.115Amputation of thumb and all fingersCommentAs the injury will cause effective loss of the hand, see item 111.116Any other injury to 1 or more of the fingers or the thumbComment about appropriate level of ISV for items 116.1 to 116.4An ISV of not more than 5 will be appropriate if substantial function of the hand remains.Examples of factors affecting ISV•whether the injury is to the thumb, or index or middle finger•any damage to other fingers•whether the injury is to the dominant hand116.1Extreme injury to 1 or more of the fingers or the thumb16 to 25Example of the injurytotal loss of function of 1 or more of the fingers, with the joints ankylosed in non-functional positionsAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 14%.•An ISV at or near the top of the range will be appropriate if there is an injury to the thumb of the dominant hand causing total loss of function of the thumb.116.2Serious injury to 1 or more of the fingers or the thumb11 to 15Examples of the injury•a severe crush injury causing ankylosis of the fingers•a bursting wound, or an injury causing severe finger damage, causing residual scarring and dysfunction•an injury leaving a digit that interferes with the remaining function of the hand•division of 1 or more of the long flexor tendons of the finger, with unsuccessful repair116.3Moderate injury to 1 or more of the fingers or the thumb6 to 10CommentThere will be permanent discomfort, pain or sensitive scarring.Examples of the injury•moderate injury to the thumb or index finger causing loss of movement or dexterity•a crush injury causing multiple fractures of 2 or more fingers•division of 1 or more of the long flexor tendons of the finger, with moderately successful repairAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 8% and the injury is to the dominant hand.116.4Minor injury to 1 or more of the fingers or the thumb0 to 5Example of the injuryan uncomplicated fracture or soft tissue injury that has healed with minimal residual symptomsAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is a straightforward fracture of 1 or more of the fingers, with complete resolution within a short time.•An ISV at or near the top of the range will be appropriate if there has been—(a)a fracture causing minor angular or rotational malunion of the thumb, or index or middle finger, of the dominant hand; or(b)some adherence of a tendon following surgical repair, limiting full function of the digit.117Extreme hand injuryComment31 to 45•The injury will involve a severe traumatic injury to the hand, which may include amputation of part of the hand, causing gross impairment of the hand.•A hand injury causing whole person impairment for the injury of 35% will generally fall within this item.Examples of the injury•an injury reducing a hand’s capacity to 50% or less•an injury involving the amputation of several fingers that are rejoined to the hand leaving it clawed, clumsy and unsightly•an amputation of some fingers and part of the palm causing grossly reduced grip and dexterity and gross disfigurementAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if the injured hand has some residual usefulness for performing activities of daily living.•An ISV at or near the top of the range will be appropriate if the injured hand—(a)has little or no residual usefulness for performing activities of daily living; and(b)is the dominant hand.118Serious hand injuryExamples of the injury16 to 30•a severe crush injury causing significantly impaired function despite surgery•serious permanent tendon damageAdditional comment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 20%.119Moderate hand injuryExamples of the injury6 to 15•a crush injury, penetrating wound or deep laceration, requiring surgery•moderately serious tendon damage•a hand injury causing whole person impairment for the injury of between 5% and 12%120Minor hand injuryExamples of the injury0 to 5a soft tissue injury, or an injury that does not require surgery, with nearly full recovery of hand functionDivision 8Upper limb injuries, other than injuries mentioned in divisions 3 to 7Comment about appropriate level of ISV for items 121 to 124An ISV at or near the top of the range will generally only be appropriate if the injury is to the dominant upper limb.121Extreme upper limb injury, other than an injury mentioned in divisions 3 to 7Comment36 to 65The injury will involve an extremely serious upper limb injury, falling short of amputation, leaving the injured person little better off than if the whole arm had been lost.Examples of the injury•a serious brachial plexus injury affecting peripheral nerve function•a non-union of a fracture, with peripheral nerve damage to the extent that an arm is nearly uselessAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 31%.•An ISV at or near the top of the range will be appropriate if—(a)there is a complete brachial plexus lesion shown by a flail arm and paralysis of all muscles of the hand; and(b)the injury is to the dominant limb.•An ISV at or near the top of the range will also be appropriate if there is a serious crush injury that causes whole person impairment for the injury of 55%.122Serious upper limb injury, other than an injury mentioned in divisions 3 to 7Examples of the injury21 to 35•a serious fracture of the humerus, radius or ulna, or any combination of the humerus, radius and ulna, if there is significant permanent residual impairment of function•a brachial plexus injury requiring nerve grafts with partial recovery of shoulder and elbow function and normal hand functionAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 16%.•An ISV at or near the top of the range will be appropriate if there is an injury to the dominant limb causing whole person impairment of 30%.123Moderate upper limb injury, other than an injury mentioned in divisions 3 to 7Examples of the injury6 to 20•a fracture that causes impairment of associated soft tissues, including nerves and blood vessels•a fracture with delayed union or infection•multiple fractures of the humerus, radius or ulna, or multiple fractures of any combination of the humerus, radius and ulnaAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 6%.•An ISV in the lower half of the range will be appropriate if there is a complicated fracture of the humerus, radius or ulna, or any combination of the humerus, radius and ulna—(a)requiring open reduction and internal fixation; and(b)from which the injured person has recovered or is expected to recover.•An ISV at or near the top of the range will be appropriate if there is a crush injury causing significant skin or muscle loss with permanent residual impairment.•An ISV at or near the top of the range will also be appropriate if there is whole person impairment for the injury of 15%.124Minor upper limb injury, other than an injury mentioned in divisions 3 to 7Example of the injury0 to 5an uncomplicated fracture of the humerus, radius or ulna, or any combination of the humerus, radius and ulna, from which the injured person has fully recovered within a short timeAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there are soft tissue injuries, lacerations, abrasions and contusions, from which the injured person will fully or almost fully recover.•An ISV at or near the top of the range will be appropriate if there is a brachial plexus injury from which the injured person has substantially recovered within a few weeks, leaving some minor functional impairment.Division 9Pelvis or hip injuriesGeneral comment for items 125 to 128•The most serious injuries to the pelvis or hips can be as devastating as a leg amputation and will have similar ISVs.•However, the appropriate ISV for other injuries to the pelvis or hips will generally be no higher than about 20.Examples of factors affecting ISV assessment for items 125 to 128•exceptionally severe specific sequelae will increase the level of ISV•the availability of remedies, for example, a total hip replacement is an important factor in assessing an ISV•age125Extreme pelvis or hip injuryExamples of the injury46 to 65•an extensive pelvis fracture•degloving•permanent nerve palsiesComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 40%.•An ISV at or near the top of the range will be appropriate if the injured person is not able to mobilise without a wheelchair and is relatively young.126Serious pelvis or hip injuryComment26 to 45There will be substantial residual disability, for example, severe lack of bladder and bowel control, sexual dysfunction, or deformity making the use of 2 canes or crutches routine.Examples of the injury•a fracture dislocation of the pelvis involving both ischial and pubic rami•traumatic myositis ossificans with formation of ectopic bone around the hip•a fracture of the acetabulum leading to degenerative changes and leg instability requiring an osteotomy, with the likelihood of future hip replacement surgeryComment about appropriate level of ISVAn ISV at or near the bottom of the range will be appropriate for an injury causing whole person impairment for the injury of 20%.127Moderate pelvis or hip injuryExamples of the injury11 to 25•a significant pelvis or hip injury, with no major permanent disability•a hip fracture requiring a hip replacement•a fracture of the sacrum extending into the sacro-iliac joint causing ongoing significant symptoms and whole person impairment of at least 10%Comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 10%.•An ISV at or near the top of the range will be appropriate if there is a fracture requiring a hip replacement that is only partially successful, so that there is a clear risk of the need for revision surgery.128Minor pelvis or hip injuryExamples of the injury0 to 10•an uncomplicated fracture of 1 or more of the bones of the pelvis or hip that does not require surgery or cause permanent impairment•undisplaced coccygeal fractures•undisplaced or healed pubic rami fractures•an injury to the coccyx, requiring surgery that is successfulComment 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 person fully recovers.•An ISV at or near the middle of the range will be appropriate if there is whole person impairment for the injury of 5%.•An ISV at or near the top of the range will be appropriate if the person has ongoing coccydynia and difficulties with sitting.Division 10Amputation of lower limbsSubdivision 1Amputation of both lower limbsExamples of factors affecting ISV assessment for items 129 and 130•the level of each amputation•severity of any phantom pain•pain in the stumps•extent of any ongoing symptoms129Loss of both lower limbs above or through the kneeComment about appropriate level of ISV55 to 70An ISV at or near the top of the range will be appropriate if each amputation is near the hips so neither stump can be used with a prosthesis.130Below the knee amputation of both lower limbsComment about appropriate level of ISV50 to 65•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 48%.•An ISV at or near the top of the range will be appropriate if—(a)both legs are amputated just below the knees leaving little or no stumps for use with prostheses; and(b)there is poor quality skin cover; and(c)there is a chronic regional pain syndrome.Subdivision 2Amputation of 1 lower limbExamples of factors affecting ISV assessment for items 131 and 132•the level of the amputation•severity of any phantom pain•whether there have been problems with a prosthesis, for example, pain and further damage to the stump131Above or through the knee amputation of 1 lower limbComment about appropriate level of ISV35 to 50•An ISV at or near the bottom of the range will be appropriate if the amputation is through or just above the knee.•An ISV at or near the top of the range will be appropriate if the amputation is near the hip and a prosthesis can not be used.132Below the knee amputation of 1 lower limbComment about appropriate level of ISV31 to 45•An ISV at or near the bottom of the range will be appropriate in a straightforward case of a below-knee amputation with no complications.•An ISV at or near the top of the range will be appropriate if there is an amputation close to the knee joint, leaving little or no stump for use with a prosthesis.Division 11Lower limb injuries, other than injuries mentioned in division 9 or 10 or divisions 12 to 15133Extreme lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15Comment31 to 55These are the most severe injuries short of amputation, leaving the injured person little better off than if the whole leg had been lost.Examples of the injury•extensive degloving of the lower limb•an injury causing gross shortening of the lower limb•a fracture that has not united despite extensive bone grafting•serious neurovascular injury•a lower limb injury causing whole person impairment of 40%134Serious lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15Comment21 to 30•Removal of extensive muscle tissue and extensive scarring may have a significant enough impact to fall within this item.•An injury to multiple joints or ligaments causing instability, prolonged treatment and a long period of non-weight-bearing may have a significant enough impact to fall within this item, but generally only if those results are combined.Example of the injurymultiple complex fractures of the lower limb that are expected to take years to heal and cause serious deformity and serious limitation of mobilityComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 16%.•An ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 25%.135Moderate lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15Examples of the injury11 to 20•a fracture causing impairment of associated soft tissues, including nerves and blood vessels•a fracture with delayed union or infection•multiple fractures of the femur, tibia or fibula, or multiple fractures of any combination of the femur, tibia and fibulaExamples of factors affecting ISV assessment•period of non-weight-bearing•presence or risk of degenerative change•imperfect union of a fracture•muscle wasting•limited joint movement•unsightly scarring•permanently increased vulnerability to future damageComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 10%.•An ISV at or near the middle of the range will be appropriate if there is a deep vein thrombosis requiring treatment for life.•An ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 15%.136Minor lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15Example of the injury0 to 10an uncomplicated fracture of the femur, tibia or fibula, from which the injured person has fully recoveredComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is a deep vein thrombosis requiring treatment for less than 6 months, from which the injured person will fully recover.•An ISV at or near the bottom of the range will also be appropriate if—(a)there are soft tissue injuries, lacerations, cuts, bruising or contusions, from which the injured person will fully or almost fully recover; and(b)any residual disability will be minor.•An ISV at or near the top of the range will be appropriate if there is a deep vein thrombosis requiring treatment for at least 1 year.•An ISV at or near the top of the range will also be appropriate if the injured person is left with impaired mobility or a defective gait.•An ISV at or near the top of the range will also be appropriate if there is whole person impairment for the injury of 9%.Division 12Knee injuriesGeneral comment for items 137 to 140The availability of remedies, for example, a total knee replacement, is an important factor in assessing an ISV under this division.137Extreme knee injuryExample of the injury25 to 40a severe knee injury if there is a disruption of the joint, gross ligamentous damage, loss of function after unsuccessful surgery, lengthy treatment and considerable painComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 20%.•An ISV at or near the top of the range will be appropriate if a total knee replacement was needed and—(a)it is very likely that the knee replacement will need to be repeated; or(b)there are ongoing severe symptoms, poor function and whole person impairment for the injury of more than 30%.138Serious knee injuryComment11 to 24The injury may involve—(a)ongoing pain, discomfort, limitation of movement, instability or deformity; and(b)a risk, in the long-term, of degenerative changes caused by damage to the joint surfaces, muscular wasting or ligamentous or meniscal injury.Example of the injurya leg fracture extending into the knee joint, causing pain that is constant, permanent and limits movement or impairs agilityComment about appropriate level of ISVAn ISV at or near the middle of the range will be appropriate if there is a ligamentous injury, which required surgery and prolonged rehabilitation, causing whole person impairment of 15% and functional limitation.139Moderate knee injuryExamples of the injury6 to 10a dislocation or torn cartilage or meniscus causing ongoing minor instability, wasting and weaknessComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 8%.140Minor knee injuryExamples of the injury0 to 5•a partial cartilage, meniscal or ligamentous tear•a laceration•a twisting or bruising injuryDivision 13Ankle injuriesComment about appropriate level of ISV for items 141 to 144The appropriate ISV for the vast majority of ankle injuries is 1 or 2.141Extreme ankle injuryExamples of the injury21 to 35•a transmalleolar fracture of the ankle with extensive soft tissue damage causing 1 or more of the following—(a)severe deformity with varus or valgus malalignment;(b)a risk that any future injury to the relevant leg may lead to a below-knee amputation of the leg;(c)marked reduction in walking ability with constant dependence on walking aids;(d)inability to place the relevant foot for even load-bearing distribution•an ankylosed ankle in a severely misaligned position with severe ongoing pain and other debilitating complications•whole person impairment for the injury of more than 20%Examples of factors affecting ISV assessment•a failed arthrodesis•regular disturbance of sleep•need for an orthosis for load bearing and walking142Serious ankle injuryExample of the injury11 to 20an injury requiring a long period of treatment, a long time in plaster or insertion of pins and plates, if—(a)there is permanent significant ankle instability; or(b)the ability to walk is severely limited on a permanent basisExamples of factors affecting ISV assessment•unsightly scarring•the significance of any malunion•a requirement for modified footwear•whether, and to what degree, there is swelling following activityAdditional comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 10%.•An ISV at or near the top of the range will be appropriate if a major tendon controlling foot or ankle movement is severed.143Moderate ankle injuryExamples of the injury6 to 10a fracture, ligamentous tear or similar injury causing moderate disability, for example—•difficulty in walking on uneven ground•awkwardness on stairs•irritation from metal plates•residual scarringAdditional comment about appropriate level of ISVAn ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 6%.144Minor ankle injuryExamples of the injury0 to 5a sprain, ligamentous or soft tissue injury or minor or undisplaced fractureExamples of factors affecting ISV assessment•whether the injured person has fully recovered from the injury, and if not, whether there is any tendency for the ankle to give way•whether there is scarring, aching or discomfortDivision 14Foot injuriesSubdivision 1Amputations145Amputation of both feetExamples of factors affecting ISV assessment32 to 65•severity of any phantom pain•pain in the stumps•extent of any ongoing symptomsComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there are amputations of both feet at the forefoot (transmetatarsal level amputations).•An ISV of about 40 will be appropriate if there are amputations of both feet at the mid foot (tarsometatarsal level or Lisfranc amputations).•An ISV at or near the top of the range will be appropriate if each amputation is at the level of the ankle (Syme’s amputation) and the stumps can not be used with prostheses.146Amputation of 1 footExamples of factors affecting ISV assessment20 to 35•severity of any phantom pain•pain in the stump•extent of any ongoing symptomsComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if the amputation is at the forefoot (transmetatarsal level amputation).•An ISV of about 26 will be appropriate if the amputation is at the mid foot (tarsometatarsal level or Lisfranc amputation).•An ISV at or near the top of the range will be appropriate if the amputation is at the level of the ankle (Syme’s amputation) and the stump can not be used with a prosthesis.Subdivision 2Other foot injuries147Extreme foot injury that is not an amputationComment13 to 25There will be permanent and severe pain or very serious permanent disability.Example of the injuryan unusually severe foot injury causing whole person impairment of 15% or more, for example, a heel fusion or loss of the tibia-calcaneum angleComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is subtalar fibrous ankylosis in a severely malaligned position, ongoing pain and whole person impairment for the injury of 24%.148Serious foot injuryExamples of the injury9 to 12•a severe midfoot deformity causing whole person impairment of 8%•a lower level loss of the tibia-calcaneum angle149Moderate foot injuryExample of the injury4 to 8a displaced metatarsal fracture causing permanent deformity, with ongoing symptoms of minor severity, for example, a limp that does not prevent the injured person engaging in most daily activities150Minor foot injuryExamples of the injury0 to 3a simple metatarsal fracture, ruptured ligament, puncture wound or similar injuryComment about appropriate level of ISVAn ISV of 2 or less will be appropriate if there is a straightforward foot injury, for example, a fracture, laceration or contusions, from which the injured person will fully recover.Division 15Toe injuries151Extreme toe injuryExamples of factors affecting ISV assessment for items 151.1 to 151.3•whether the amputation was traumatic or surgical•extent of the loss of the forefoot•residual effects on mobility151.1Amputation of all toes8 to 20Comment about appropriate level of ISV•An ISV at or near the middle of the range will be appropriate if the amputation is through the metatarsophalangeal joints (MTP joints) of all toes.•An ISV at or near the top of the range will be appropriate if there is complete amputation of all toes and amputation of a substantial part of the forefoot.151.2Amputation of the great toe6 to 12Example of factor affecting ISV assessment for item 151.2the level at which the amputation happens or any ongoing symptomsComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there is complete loss of the great toe and ball of the foot caused by an amputation through the first metatarsal bone.151.3Amputation of individual lesser toes3 to 5Example of factor affecting ISV assessment for item 151.3the level at which the amputation happens or any ongoing symptomsComment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is an amputation of 1 lesser toe and—(a)there is no ongoing pain; and(b)there is little or no loss of function of the foot; and(c)the cosmetic effect of the amputation is minor.•An ISV at or near the top of the range will be appropriate if there is complete amputation of all lesser toes and part of the forefoot.152Serious toe injuryComment8 to 12The injury will cause serious and permanent disability.Examples of the injury•a severe crush injury causing ankylosis of the toes•a bursting wound, or an injury causing severe toe damage, with significant symptoms153Moderate toe injuryComment4 to 7There will be permanent discomfort, pain or sensitive scarring.Examples of the injury•a moderate injury to the great toe•a crush injury causing multiple fractures of 2 or more toesComment about appropriate level of ISVAn ISV at or near the top of the range will be appropriate if there has been more than 1 unsuccessful operation, or there are persisting stabbing pains, impaired gait or similar effects.154Minor toe injuryExamples of the injury0 to 3a relatively straightforward fracture or soft tissue injuryComment about appropriate level of ISVAn ISV of 1 will be appropriate if there is a straightforward fracture of 1 or more toes with complete resolution within a short time.Division 16Limb disordersGeneral commentThe ISV for a limb disorder must be assessed having regard to the item of this schedule that—(a)relates to the part of the body affected by the disorder; and(b)is for an injury that has a similar level of adverse impact to the disorder.Examples of a limb disorder•tenosynovitis (inflammation of synovial sheaths of tendons usually resolving with rest over a short period and sometimes leading to ongoing symptoms of loss of grip and dexterity)•peripheral nerve injury (the constriction of the motor or sensory nerves or thickening of surrounding tissue, for example, carpal tunnel syndrome or sciatica)•epicondylitis (inflammation around the elbow joint, for example, medially (golfer’s elbow) or laterally (tennis elbow))•vascular disorders, for example, deep vein thrombosisExamples of factors affecting ISV assessment•whether the disorder is bilateral or one sided•the level of pain, swelling, tenderness or crepitus or other symptoms•the capacity to avoid a recurrence of symptoms•the ability to engage in daily activities•the availability and likely benefit of surgery•whether the disorder is to a dominant or non-dominant limbPart 7Scarring to parts of the body other than the faceGeneral comment•This part applies to external appearance and physical condition of the skin only, and includes scarring to the scalp, trunk and limbs.•Facial scarring must be assessed under part 3, division 2.•This part does not apply to adhesions, or scarring, of internal organs.•This part will usually apply to an injury involving skeletal damage only if the skeletal damage is minor.•Many of the physical injuries mentioned in this schedule involve some scarring from the initial injury and subsequent surgery, including skin grafting, to repair the injury and this has been taken into account in fixing the range of ISVs for the injuries.Example—The ISV range for an injury causing a closed fracture of a limb takes into account the potential need for open reduction and internal fixation of the fracture and the resulting surgical wound and scar.Examples of factors affecting ISV assessment for items 155.1 to 155.4•location of a scar•age•adverse psychological reaction•likelihood of a scar fading or becoming less noticeable over time155Scarring to a part of the body other than the face155.1Extreme scarring to a part of the body other than the face14 to 25Comment about appropriate level of ISV•An ISV at or near the bottom of the range will be appropriate if there is—(a)extensive scarring to 1 or more of the limbs and significant cosmetic disfigurement; and(b)either—(i)the need to keep the limb or limbs covered or wear special clothing; or(ii)ongoing limitation in the ability to participate in activities because of cosmetic disfigurement or functional impairment.•An ISV at or near the top of the range will be appropriate if there is gross permanent scarring over an extensive area or areas of the body, with ongoing pain and other symptoms.155.2Serious scarring to a part of the body other than the face9 to 13CommentThere is serious scarring—(a)requiring extensive medical treatment or surgery; and(b)causing significant ongoing limitation in the ability to participate in activities because of cosmetic disfigurement or functional impairment.Examples of the injury•significant scarring over the upper and lower arm requiring skin grafting if—(a)there are post-operative complications requiring additional medical treatment for up to 18 months; and(b)there is maximum medical improvement within 2 years after the scarring is caused•hypertrophic (keloid) scarring caused by a burn to the front of the neck, with an intermittent sensation of burning, itching or irritation155.3Moderate scarring to a part of the body other than the face4 to 8Examples of the injury•several noticeable scars that are hypertrophic (keloid)•a significant linear scar in an area of cosmetic importance, for example, the front of the neck155.4Minor scarring to a part of the body other than the face0 to 3Examples of the injury•scarring caused by a superficial burn that heals within a few weeks and causes some minor change of pigmentation in a noticeable area•a single noticeable scar, or several superficial scars, to 1 or both of the legs, arms or hands, with some minor cosmetic damagePart 8Burn injuriesGeneral comment•The ISV for a burn injury must be assessed having regard to the item of this schedule that—(a)relates to the part of the body affected by the burn injury; and(b)is for an injury that has a similar level of adverse impact to the burn injury.•Burns to the face must be assessed under part 3, division 2.•In burns cases, the ISV for an injury to a part of the body causing functional impairment will generally be at or near the top of the range for an injury to that part of the body.•In serious burns cases, the effects of scarring are more comprehensive and less able to be remedied than the effects of scarring from other causes.Part 9Injuries affecting hair156Extreme injury affecting head hairExample of the injury11 to 15total permanent loss of head hair157Serious injury affecting head hairExample of the injury4 to 10damage to head hair, caused by, for example, defective waving or tinting, if—(a)the physical effect of the damage is—(i)dermatitis; or(ii)tingling or burning of the scalp, causing dry, brittle hair that breaks off or falls out, or both; and(b)the physical effect leads to depression, loss of confidence and inhibited social lifeComment about appropriate level of ISVAn ISV in the upper half of the range will be appropriate if—(a)thinning continues and prospects of regrowth are poor; or(b)there is a partial loss of areas of hair and regrowth is slow.158Moderate injury affecting head hair or loss of body hairExamples of the injury0 to 3•hair that has been pulled out leaving bald patches•the same example applies as for item 157 but with fewer or only moderate symptomsExample of factor affecting ISV assessmentlength of time before regrowthPart 10Dermatitis159Extreme dermatitisExamples of the injury11 to 20permanent dermatitis having a severe effect on employment and domestic capability, with some mental disorder160Serious dermatitisExample of the injury8 to 10dermatitis that—(a)lasts for years or indefinitely; and(b)involves cracking and soreness; and(c)affects employment and domestic capability; and(d)causes marked adverse psychological reaction161Moderate dermatitisExample of the injury3 to 7dermatitis lasting for a significant period, but settling with treatment or a change of personal conduct, or both162Minor dermatitisExamples of the injury0 to 2itching, skin irritation or a rash, alone or in combination, that resolves with treatment within a few months of the start of treatmentSchedule 5Matters relevant to PIRS assessment by medical expertsection 7(1)Part 1Explanation of the PIRS1PIRS rates permanent impairment caused by mental disorderThe PIRS set out in schedule 6 rates permanent impairment caused by a mental disorder.Note—PIRS ratings are referred to in schedule 4, part 2. A PIRS rating is capable of being accepted by a court under schedule 3, section 6 only if it is—

(a)assessed by a medical expert as required under this schedule and schedule 6; and

(b)provided to the court in a PIRS report as required under section 12.

2Areas of functional impairment(1)The PIRS consists of 6 scales, each of which rates permanent impairment in an area of function.(2)Each scale has 5 classes of impairment, ranging from little or no impairment to total impairment.Part 2Assessment of PIRS rating3Medical expert must comply with requirements(1)A medical expert must comply with this schedule and schedule 6 in assessing a PIRS rating for a mental disorder of an injured person.(2)The medical expert may give an assessment only if the medical expert has examined the injured person.4How to assess a PIRS rating(1)To assess a PIRS rating for a mental disorder of an injured person, a medical expert must follow the steps set out in this section.Note—Section 8 provides an example completed worksheet that could be used to assess a PIRS rating.(2)Step 1—for each area of functional impairment set out in the PIRS, the medical expert must—

(a)decide which level of impairment set out in the PIRS describes the level of impairment caused by the mental disorder of the injured person; and

(b)read off from the PIRS the class (for example, class 1) that corresponds to the level that has been decided.

(3)In deciding which level to choose for an area of functional impairment, the medical expert—

(a)must have regard to—

(i)the examples of indicators of the level of impairment set out in the PIRS for the area to the extent they are relevant in a particular case; and

(ii)all factors the medical expert considers relevant to the injured person’s level of impairment, including, for example, the injured person’s age and pre-existing functional capacity for the area; and

(b)may have regard to the range of percentages of impairment set out in the PIRS for the area as a guide to the level of impairment.

Note—The examples of impairment set out in the PIRS assume a full pre-existing functional capacity for the area which may not be appropriate in a particular case.(4)Step 2—the medical expert must list the class number of the 6 classes read off under step 1 in ascending order.(5)Step 3—the medical expert must work out the median of the class numbers (the median class score) under section 6.(6)Step 4—the medical expert must work out the total of the class numbers (the total class score) by adding together all of the class numbers.(7)Step 5—from the conversion table in section 7, the medical expert must read off the percentage impairment that corresponds to the particular median class score when found in conjunction with the particular total class score.(8)Subject to section 5, the percentage impairment is the PIRS rating assessed by the medical expert for the mental disorder of the injured person.5Assessment if pre-existing mental disorder(1)If an injured person has a pre-existing mental disorder, a medical expert must—

(a)work out a percentage impairment for the pre-existing mental disorder at the time immediately before the injury using the steps set out in section 4 (the pre-injury rating); and

(b)work out a percentage impairment for the current mental disorder using the steps set out in section 4 (the post-injury rating); and

(c)subtract the pre-injury rating from the post-injury rating.

(2)The remaining percentage impairment is the PIRS rating assessed by the medical expert for the mental disorder of the injured person.Editor’s note—See also section 11 (Pre-existing mental disorder).6How to work out a median class score(1)A median class score is the number that would fall at the middle point between the third class number and the fourth class number if all the class numbers are listed in ascending order.(2)If the median class score under subsection (1) is not a whole number, the median class score must be rounded up to the nearest whole number.7Conversion tableThis section sets out the conversion table for use under section 4.Conversion table for percentage impairmentMedian class score12345Total class score60%70%81%91%4%102%5%112%5%122%6%133%7%11%143%7%13%158%15%169%17%179%19%31%1810%22%34%1924%37%2026%41%2128%44%61%2230%47%65%2350%70%2454%74%2557%78%2660%83%2787%2891%2996%30100%8Example worksheetThis section sets out an example of a completed worksheet that could be used to assess a PIRS rating for a mental disorder.Area of functional impairmentClass1Self - care and personal hygiene12Social and recreational activities23Travel34Social functioning55Concentration, persistence and pace56Adaptation5List of class numbers in ascending order:123555Median class score (using section 6):4Total class score:21Percentage impairment (using conversion table in section 7):44%PIRS rating (if no pre-existing mental disorder):44%Part 3Particular cases9Refusal of treatment(1)This section applies if an injured person refuses treatment that could lead to a significant improvement in the level of permanent impairment caused by a mental disorder of the injured person.(2)Despite the injured person’s refusal of treatment, a medical expert may assess a PIRS rating for the mental disorder of the injured person.(3)The refusal of treatment must not affect the medical expert’s assessment of the PIRS rating.(4)The medical expert must note the refusal of treatment in the PIRS report and state in the report the likely effect of treatment and any reasons known to the medical expert for the refusal of treatment.(5)Subsection (6) applies if a PIRS report given to a court states that the injured person refuses treatment that could lead to a significant improvement in the level of permanent impairment caused by the mental disorder of the injured person.(6)The court may, in assessing the ISV for an injury or multiple injuries of the injured person, take into account the refusal of treatment and the matters stated in the PIRS report under subsection (4).(7)In this section—PIRS report means a report under section 12.10Cognitive impairmentIf a medical expert assessing a PIRS rating for a mental disorder of an injured person suspects the injured person has a cognitive impairment, the medical expert must take into account the following factors—

(a)the relevant medical history of the injured person;

(b)any medical treatment, and progress towards rehabilitation, for the cognitive impairment;

(c)any results of radiological scans, including CT and MRI scans, electroencephalograms and psychometric tests made available to the medical expert.

11Pre-existing mental disorderIf a medical expert assessing a PIRS rating for a mental disorder of an injured person considers the injured person had a pre-existing mental disorder, the medical expert must—

(a)make appropriate enquiry into the pre-existing mental disorder; and

(b)consider any psychiatric or psychological reports made available to the medical expert.

Part 4Report of PIRS rating12Court to be given PIRS report(1)This section applies if a party to a proceeding wants a court to accept a PIRS rating assessed by a medical expert for a mental disorder of an injured person.(2)The party must give the court a written report from the medical expert stating the following matters—

(a)the mental disorder diagnosed by the medical expert;

(b)the PIRS rating assessed by the medical expert for the mental disorder of the injured person;

(c)how the PIRS rating is assessed, including—

(i)for each area of functional impairment set out in the PIRS—

(A)the relevant clinical findings; and

(B)the level of impairment set out in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured person; and

(C)the class set out in the PIRS that corresponds to the level that was decided; and

(ii)the median class score and total class score worked out under section 4; and

(iii)if the injured person had a pre-existing mental disorder, the information mentioned in subparagraphs (i) and (ii) in relation to the pre-injury rating and the post-injury rating as defined under section 5;

(d)details of any cognitive impairment of the injured person.

Schedule 6Psychiatric impairment rating scalesection 7(1)Area of functional impairment: self-care and personal hygieneClassLevel of impairmentExamples of indicators of level of impairmentNote—These examples must be had regard to under schedule 5, section 4(3)(a)(i).Percentage impairment rangesNote—These ranges may be had regard to under schedule 5, section 4(3)(b).Class 1Little or no impairment0 to 3%Class 2Mild impairment4 to 10%•can live independently•looks after himself or herself adequately, although may look unkempt occasionally•sometimes misses a meal or relies on takeaway foodClass 3Moderate impairment11 to 30%•can not live independently without regular support•needs prompting to shower daily and wear clean clothes•does not prepare own meals•frequently misses meals•if living independently, a family member or community nurse visits, or needs to visit, 2 to 3 times a week to ensure a minimum level of hygiene and nutritionClass 4Severe impairment31 to 60%•needs supervised residential care•if unsupervised, may accidentally or deliberately hurt himself or herselfClass 5Totally impairedmore than 60%•needs assistance with basic functions, for example, feeding or toiletingArea of functional impairment: social and recreational activitiesClassLevel of impairmentExamples of indicators of level of impairmentNote—These examples must be had regard to under schedule 5, section 4(3)(a)(i).Percentage impairment rangesNote—These ranges may be had regard to under schedule 5, section 4(3)(b).Class 1Little or no impairment0 to 3%•regularly goes to cinemas, restaurants or other recreational venues•belongs to clubs or associations and is actively involved in themClass 2Mild impairment4 to 10%•occasionally goes to social events without needing a support person, but does not become actively involved, for example, by dancing or cheering a teamClass 3Moderate impairment11 to 30%•rarely goes to social events, and usually only when prompted by family or a friend•does not become involved in social events•will not go out without a support person•remains quiet and withdrawnClass 4Severe impairment31 to 60%•never leaves own residence•tolerates the company of a family member or close friend•will go to a different room or garden when a person, other than a family member or close friend, comes to visit someone at own residenceClass 5Totally impairedmore than 60%•can not tolerate living with anybody•extremely uncomfortable when visited by a close family memberArea of functional impairment: travelClassLevel of impairmentExamples of indicators of level of impairmentNote—These examples must be had regard to under schedule 5, section 4(3)(a)(i).Percentage impairment rangesNote—These ranges may be had regard to under schedule 5, section 4(3)(b).Class 1Little or no impairment0 to 3%•can travel to new environments without supervisionClass 2Mild impairment4 to 10%•can travel without a support person, but only in a familiar area, for example, to go to the local shops or visit a neighbourClass 3Moderate impairment11 to 30%•can not travel away from own residence without a support person•there may be problems resulting from excessive anxiety or cognitive impairmentClass 4Severe impairment31 to 60%•finds it extremely uncomfortable to leave own residence even with a trusted personClass 5Totally impairedmore than 60%•can not be left unsupervised, even at own residence•may require 2 or more persons to supervise him or her when travellingArea of functional impairment: social functioningClassLevel of impairmentExamples of indicators of level of impairmentNote—These examples must be had regard to under schedule 5, section 4(3)(a)(i).Percentage impairment rangesNote—These ranges may be had regard to under schedule 5, section 4(3)(b).Class 1Little or no impairment0 to 3%•has no difficulty in forming and sustaining relationships, for example, with a spouse or close friend lasting yearsClass 2Mild impairment4 to 10%•existing relationships are strained•tension and arguments between the injured person and a spouse or close family member•some friendships are lostClass 3Moderate impairment11 to 30%•established relationships are severely strained, as is shown by periods of separation or domestic violence•if the injured person has children, then a spouse, family members or community services are providing most of the care for the childrenClass 4Severe impairment31 to 60%•can not form or sustain long-term relationships•pre-existing relationships, for example, with a spouse or close friend, have ended•can not care for dependants, for example, child dependants (if any) or an elderly parentClass 5Totally impairedmore than 60%•can not function within society•lives away from populated areas•actively avoids social contactArea of functional impairment: concentration, persistence and paceClassLevel of impairmentExamples of indicators of level of impairmentNote—These examples must be had regard to under schedule 5, section 4(3)(a)(i).Percentage impairment rangesNote—These ranges may be had regard to under schedule 5, section 4(3)(b).Class 1Little or no impairment0 to 3%•can complete vocational education and training or a university course within a normal time frameClass 2Mild impairment4 to 10%•can undertake a basic or standard retraining course at a slower pace•can focus on intellectually demanding tasks for up to 30 minutes, then may feel fatigued or develop headachesClass 3Moderate impairment11 to 30%•can not read more than newspaper articles•finds it difficult to follow complex instructions, for example, operating manuals or building plans•can not make significant repairs to motor vehicle or type long documents•can not follow a pattern for making clothes or tapestry or knittingClass 4Severe impairment31 to 60%•able only to read a few lines before losing concentration•has difficulty in following simple instructions•impaired concentration is obvious even during brief conversation•can not live alone or needs regular assistance from family members or community servicesClass 5Totally impairedmore than 60%•needs constant supervision and assistance within an institutional environmentArea of functional impairment: adaptationNote—This area of functional impairment deals with employability.ClassLevel of impairmentExamples of indicators of level of impairmentNote—These examples must be had regard to under schedule 5, section 4(3)(a)(i).Percentage impairment rangesNote—These ranges may be had regard to under schedule 5, section 4(3)(b).Class 1Little or no impairment0 to 3%•can work full-time in the position in which the injured person worked immediately before the injury (the pre-injury position)•the injured person’s duties at work and performance of the duties are consistent with the person’s education and training•can cope with the normal demands of the jobClass 2Mild impairment4 to 10%•can work in the pre-injury position, but for no more than 20 hours a week, for example, because the injured person is no longer happy to work with particular persons•can work full-time in a different position where performance of the relevant duties requires the use of comparable skill and intellect to that required to perform the duties of the pre-injury positionClass 3Moderate impairment11 to 30%•can not work at all in the pre-injury position•only able to work less than 20 hours a week in a different position where performance of the relevant duties requires less skill or is otherwise less demanding, for example, less stressfulClass 4Severe impairment31 to 60%•can not work more than 1 or 2 days at a time•works less than 20 hours a fortnight•the pace at which work is done is reduced•attendance at work is erraticClass 5Totally impairedmore than 60%•needs constant supervision and assistance within an institutional environmentSchedule 7sch 7 sub 2015 SL No. 47 s 6amd 2017 SL No. 110 s 6; 2018 SL No. 82 s 6; 2019 SL No. 113 s 6; 2020 SL No. 117 s 6; 2021 SL No. 52 s 6; 2022 SL No. 80 s 6; 2023 SL No. 50 s 6om 2024 SL No. 94 s 7Schedule 8Dictionarysection 3adverse psychological reaction does not include a mental disorder.AMA 5 means the 5th edition of the Guides to the Evaluation of Permanent Impairment published by the American Medical Association.ankylosis means fixation of a joint in a specific position.digestive system—

(a)means the organs and other parts of the body forming the alimentary tract, and includes the tongue, throat and abdominal wall; but

(b)does not include an organ or other part of the body mentioned in the injury column of schedule 4.

dominant injury, of multiple injuries, means—

(a)if the highest range for 2 or more of the injuries of the multiple injuries is the same—the injury of those injuries selected as the dominant injury by a court assessing an ISV; or

(b)otherwise—the injury of the multiple injuries having the highest range.

Note—The selection of a particular injury as a dominant injury from 2 or more injuries having the same highest range will not affect the outcome of the court’s assessment of an ISV for the multiple injuries.DSM 4 means the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) published by the American Psychiatric Association in 2000.highest range means the range of ISVs having the highest maximum ISV.ISV means injury scale value.Le Fort I fracture means a horizontal segmented fracture of the alveolar process of the maxilla.Le Fort II fracture means a unilateral or bilateral fracture of the maxilla—

(a)in which the body of the maxilla is separated from the facial skeleton and pyramidal in shape; and

(b)that may extend through the body of the maxilla down the midline of the hard palate, through the floor of the orbit and into the nasal cavity.

Le Fort III fracture means a fracture in which the entire maxilla and 1 or more facial bones are completely separated from the brain case.medical expert, for an assessment of a PIRS rating, means a person who—

(a)is appropriately qualified to perform the assessment, including a psychologist, neuropsychologist or psychiatrist; and

(b)has had appropriate training in the use of the PIRS.

mental disorder means a mental disorder recognised under DSM 4.permanent impairment, in relation to an injury, means the impairment an injured person has, or is likely to have, even after maximum medical improvement.PIRS means the psychiatric impairment rating scale set out in schedule 6.PIRS rating, for a mental disorder, means a rating on the PIRS for the permanent impairment caused by the mental disorder.pre-existing, in relation to an injury, means existing at the time immediately before the injury.range, in relation to an ISV for an injury, means the range of ISVs for the injury set out in schedule 4.whole person impairment, in relation to an injury, means an estimate, expressed as a percentage, of the impact of a permanent impairment caused by the injury on the injured person’s overall ability to perform activities of daily living other than employment.