Workers’ Compensation and
Rehabilitation Act 2003
Workers’
Compensation and Rehabilitation Regulation 2014
Part 1
Preliminary
1
Short
title
This regulation may be cited as the Workers’ Compensation and
Rehabilitation Regulation 2014.
2
Commencement
This regulation commences on 1 September 2014.
3
Definitions
Schedule 13 defines particular words used in this
regulation.
4
WorkCover’s
capital adequacy—Act, s 453(b)
For section 453(b) of the Act, WorkCover
maintains capital adequacy if WorkCover’s total assets are at least
equal to its total liabilities.
Part 2
Employer
insurance
Division 1
Policies and premium assessments
5
Application for policy
An application for a WorkCover policy must be made
to WorkCover in the approved form.
6
Policies
and renewals
(1)
On payment of the premium shown as payable in
a premium notice issued by WorkCover to an employer, WorkCover
must issue to the employer a policy, in the approved form, for
the period of insurance stated in the notice.
(2)
A policy has no effect until—
(a)
WorkCover receives the premium
payable to WorkCover for the policy or the policy’s
renewal; or
(b)
WorkCover enters into an
instalment plan.
7
Assessment of premium
(1)
This section does not apply to a policy for
household workers.
(2)
WorkCover must assess the premium payable
under a policy for each period of insurance shown in a premium
notice.
8
Declaration of wages
(1)
This section does not apply to an employer who
employs only household workers.
(2)
Each employer, other than a self-insurer,
must, on or before 31 August in each year, lodge with WorkCover
a declaration of wages so WorkCover can assess the employer’s
premium.
(3)
The declaration must be in—
(a)
the approved form; or
(b)
with WorkCover’s approval—another
form acceptable to WorkCover.
(4)
If an employer does not comply with subsection (2), the employer must pay an
additional premium under schedule 1.
(5)
The additional premium payable under schedule 1 is the amount specified opposite
the time after 31 August in a year when the employer complies
with subsection (2).
9
Value of
board and lodging
(1)
This section applies if an employer provides,
or is to provide, board to a worker during a period of
insurance.
(2)
The value of board provided is taken to be
wages paid, or to be paid, by the employer to the worker.
(3)
For each week the employer provides, or is to
provide, board, the value of board is at least equal to—
(a)
the weekly allowance for board
provided for under the industrial instrument
governing the calling in which the worker is
engaged; or
(b)
if paragraph (a) does not apply—6% of
QOTE.
(4)
In this section—
board means
accommodation, meals, laundry services or any other
entitlement having a monetary value provided when
lodging.
10
Payment
of premium by instalments
(1)
WorkCover may accept payment of a premium by
instalments under an instalment plan approved by WorkCover if
WorkCover is satisfied that payment of the premium by the due
date would impose financial hardship on the employer.
(2)
The instalment plan is subject to the
following conditions—
(a)
interest at a rate specified by
WorkCover’s board by gazette notice must be added to
the amount of each instalment;
(b)
interest must be calculated from
the due date;
(c)
the interest rate that applies at
the start of the instalment plan remains constant
until the plan ends;
(d)
on acceptance of the instalment
plan, the employer must, if required by WorkCover,
enter into a payment arrangement acceptable to
WorkCover;
(e)
if an instalment of premium is not
paid on or before the due date for payment of the
instalment—
(i)
the total amount of unpaid
instalments and interest on outstanding
instalments to that day immediately becomes
payable to WorkCover; and
(ii)
an additional premium under
section 11 applies to the unpaid
instalments and interest; and
(iii)
the policy for which the
premium is payable stops having effect; and
(iv)
the employer contravenes
section 48 of the
Act.
11
Additional premium for late payment of premium—Act, ss 61 and 62
(1)
This section applies if, on or before the due
date, an employer does not pay—
(a)
the amount of premium payable
under a premium notice; or
(b)
the amount by which a final
assessment of premium by an industrial magistrate or
the Industrial Court is more than the amount of
premium paid under section 551(4) of the Act.
(2)
However, this section does not apply if—
(a)
the employer employs only
household workers; or
(b)
WorkCover has accepted payment of
the amount under an instalment plan and instalments
are paid under the plan.
(3)
For sections 61 and 62 of the Act, the additional premium payable is—
(a)
if the amount is paid to WorkCover
within 30 days after the due date—5% of the amount;
or
(b)
if the amount is paid to WorkCover
after 30 days but within 60 days after the due
date—10% of the amount; or
(c)
if the amount is paid to WorkCover
after 60 days after the due date or if no payment is
made—10% of the amount plus interest at the annual
rate mentioned in section 10(2)(a) for the period from the due date, or
a later date decided by WorkCover, until the amount
and all additional premium is paid to
WorkCover.
12
Premium
for appeals—Act, s 569(2)(a)
(1)
For section 569(2)(a) of the
Act,
premium, for an employer for a period of insurance, is an amount
calculated using the formula—
(2)
In subsection (1)—
rate means the rate for
the employer’s industry or business specified in the
notice under section 54 of the
Act
that applies to the period of insurance.
wages means—
(a)
the wages of the employer
for the preceding period of insurance; or
(b)
if the employer has only
been insured for part of a period of insurance—a
reasonable estimate of the wages of the employer
for the period of insurance.
13
Former
employer may apply to cancel policy
(1)
This section applies if a person (a former employer) wishes to
cancel a policy because the person has stopped employing
workers.
(2)
This section does not apply to a former
employer of only household workers.
(3)
The former employer must give WorkCover—
(a)
written notice that the former
employer—
(i)
stopped employing workers on
and from a date stated in the notice; and
(ii)
wishes to cancel the policy;
and
(b)
written details of—
(i)
the address to which any
document addressed to the former employer may be
sent; and
(ii)
the former employer’s wages
in relation to the period (last employment
period) starting on 1 July last
preceding the day on which employment of workers
stopped and ending on that day.
14
Cancellation of policy if workers no longer employed
(1)
This section applies if—
(a)
a person (a former employer) has
notified WorkCover under section 13(3) that the former employer has stopped
employing workers; or
(b)
WorkCover is satisfied, after
making reasonable enquiries, that a person (also a
former employer) has
stopped employing workers.
(2)
WorkCover may cancel the former employer’s
policy.
(3)
WorkCover must assess the premium payable by
the former employer for the period during which the Act required the former employer to
maintain a policy.
(4)
If the premium paid by the former employer for
the last employment period is—
(a)
greater than the amount of premium
assessed under subsection (3)—WorkCover must
refund the amount overpaid to the former employer;
or
(b)
less than the amount of premium
assessed under subsection (3)—the former employer
must pay WorkCover the amount of the deficit on or
before the due date under a final premium notice
issued for the amount of the deficit.
(5)
Nothing in this section is taken to limit
chapter 2, part 3, division 2 of the Act.
Division 2
Employer excess
15
Excess
period—Act, s 65(2)
For section 65(2) of the Act, the
prescribed amount is the lesser of the following—
(a)
QOTE;
(b)
the amount of weekly compensation
payable to a worker under chapter 3, part 9 of the Act.
Division 3
Self-insurance
16
Application fees—Act, s 70(c)
For section 70(c) of the Act, the
prescribed fee is—
(a)
for a single employer—$15,000;
or
(b)
for a group employer—$20,000.
17
Annual
levy—Act, s 81(2)
(1)
For section 81(2) of the
Act, the
prescribed way to calculate the annual levy is using the
formula—
(2)
In subsection (1)—
estimated claims liability
means estimated claims liability calculated
under part 3, division 4 stated in the most recent
actuarial report agreed by the Regulator, or decided by
the arbiter, under that division, before a date fixed by
the Regulator by gazette notice.
rate means the rate
published in the gazette notice under section 81 of the Act
for the particular financial year.
18
Provisional annual levy—not agreed or decided
(1)
This section applies if—
(a)
the Regulator and the self-insurer
have not agreed on the calculation of estimated
claims liability under part 3, division 4; and
(b)
the arbiter has not decided the
estimated claims liability.
(2)
The Regulator may use the estimated claims
liability amount (the provisional annual levy)
assessed by the approved actuary to ensure the self-insurer’s
compliance with section 81 of the Act.
19
Adjusted annual levy—agreed
(1)
If the Regulator and the self-insurer agree
under section 62 on the estimated claims liability
amount (agreed amount), the Regulator
must give the self-insurer an adjusted levy notice based on the
agreed amount within 14 days after the Regulator and the
self-insurer agree to the amount.
(2)
If the agreed amount is more than the
provisional annual levy, the self-insurer must pay the Regulator
the difference between the provisional annual levy and the
amount of the annual levy actually payable by the
self-insurer.
(3)
If the agreed amount is less than the
provisional annual levy paid by the self-insurer, the Regulator
must pay the self-insurer the difference between the actual
annual levy payable and the amount paid as the provisional
annual levy.
20
Adjusted annual levy—not agreed but decided
(1)
This section applies if the Regulator and the
self-insurer do not agree to an amount under section 19 and the amount (the decided adjusted amount) decided
by the arbiter under section 63(1) is not the same as the amount of the estimated
claims liability used to calculate the provisional annual
levy.
(2)
If subsection (1) applies, the Regulator must
give the self-insurer an adjusted levy notice based on the
decided adjusted amount within 14 days after the Regulator or
the self-insurer receives notice of the amount.
(3)
If the amount of the adjusted levy is more
than the provisional annual levy, the self-insurer must pay the
Regulator the difference between the provisional annual levy and
the amount of the annual levy actually payable by the
self-insurer.
(4)
If the amount of the adjusted levy is less
than the provisional annual levy paid by the self-insurer, the
Regulator must pay the self-insurer the difference between the
actual annual levy payable and the amount paid as the
provisional annual levy.
21
Additional amount for late payment of levy—Act, s 82(1)
For section 82(1) of the Act, the
additional amount payable is—
(a)
if the amount is paid to the Regulator
within 30 days after the due date—5% of the amount;
or
(b)
if the amount is paid to the Regulator
after 30 days but within 60 days after the due date—10%
of the amount; or
(c)
if the amount is paid to the Regulator
after 60 days after the due date or if no payment is
made—10% of the amount plus interest at a rate specified
by the Regulator by gazette notice for the period from
the due date, or a later date decided by the Regulator,
until the amount and all additional amounts are paid to
the Regulator.
22
Conditions of licence—Act, s 83
For section 83(1)(a) of the Act, a self-insurer’s licence is subject to the
condition that the self-insurer must lodge with the Regulator, for
each year or part of a year of the licence, a declaration in the
approved form of the self-insurer’s wages.
s 22 amd 2016 Act No. 44
s 49
23
Premium
payable after cancellation of self-insurer’s licence—Act, s 98
(1)
For section 98 of the Act, the premium payable by the former
self-insurer for the first 2 periods of insurance after
cancellation is to be calculated according to the method and at
the rate specified by WorkCover, by gazette notice under section 54 of the Act, as if the employer were a new employer.
(2)
However, the rate under subsection (1) must not be less than the rate
calculated using the formula—
(3)
In subsection (2)—
administrative costs
means the administrative costs associated with
claims incurred during the final period of licence,
calculated by multiplying payments + liability by
0.095.
final period of licence
means—
(a)
for an employer licensed as
a self-insurer for 3 or more years immediately
before cancellation of the licence—3 years;
or
(b)
for an employer licensed as
a self-insurer for less than 3 years immediately
before cancellation of the licence—the period of
the licence.
liability means an
actuarial estimate of the outstanding liability at the
end of the self-insurer’s licence for claims incurred
during the final period of licence, excluding liability
for the excess period.
payments means the
actual payments made by the former self-insurer, less
recoveries received and payments made that are the
equivalent of amounts payable for the excess period, for
claims incurred during the final period of
licence.
wages means the wages of
the self-insurer during the final period of
licence.
24
Deemed
levy for appeals—Act, s 569(2)(a)
(1)
The deemed levy, for a self-insurer for a
financial year of the self-insurer’s licence, is an amount
calculated using the formula—
(2)
In this section—
estimated claims liability
means estimated claims liability calculated
under part 3, division 4 that was used to calculate
the annual levy under section 17.
rate means the rate
published in the gazette under section 81 of the Act
for the particular financial year.
Part 3
Calculation of
self-insurer’s liability
Division 1
Outstanding liability
Subdivision 1
Preliminary
25
Calculation of outstanding liability—Act, s 87(2)
For section 87(2) of the
Act, the
amount of a self-insurer’s outstanding liability must be
calculated under this division.
Subdivision 2
Actuarial calculations and
reports
26
Appointment of actuary
WorkCover and the employer must each appoint
an actuary to calculate an outstanding liability amount.
27
Regulator to give actuary information
The Regulator must give each appointed actuary
the information necessary to enable the actuaries to calculate
the employer’s outstanding liability within the time mentioned
in section 29(3).
28
Actuarial calculation
A calculation of the outstanding liability
must—
(a)
be prepared under the actuarial
standard; and
(b)
apply a central estimate of the
liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the outstanding liability;
and
(e)
not include a prudential margin;
and
(f)
be based, as far as practicable,
on the employer’s claims experience from claims
incurred before the employer becomes or became a
self-insurer; and
(g)
be based on data as at the
assessment day.
29
Actuarial report
(1)
For each calculation of an outstanding
liability amount the appointed actuary must prepare an
actuarial report under the actuarial standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the employer; and
(ii)
the average amount of claims
for damages against the employer; and
(iii)
claims anticipated to have
been incurred by the employer for which no formal
claim has been lodged; and
(iv)
the frequency of claims for
compensation against the employer; and
(v)
the frequency of claims for
damages against the employer; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the employer to pay the
amount; and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including accuracy of the data;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
(3)
Each appointed actuary must prepare the
actuarial report within 35 days after the day a self-insurer
lodges an application for self-insurance.
30
Summary report
(1)
The appointed actuaries must jointly
prepare a summary report that—
(a)
includes the individual
actuarial reports; and
(b)
states how the individual
reports agree or differ and the reasons for the
difference.
(2)
The actuaries must give a copy of the
completed summary report to the Regulator, WorkCover and the
employer within 2 months after the day the application for
self-insurance is lodged.
31
Agreement on amount
WorkCover and the employer may agree on the
employer’s outstanding liability having regard to the summary
report.
32
Reference to arbiter if no agreement on amount
(1)
WorkCover or the employer may advise the
Regulator that WorkCover and the employer do not agree on
the outstanding liability amount.
(2)
If the Regulator is advised under subsection (1), the Regulator must refer
the summary report to the arbiter to decide the outstanding
liability amount.
33
Payment of amount
(1)
WorkCover must pay the outstanding
liability amount—
(a)
agreed to by WorkCover and the
employer; or
(b)
if there is no
agreement—decided by the arbiter.
(2)
WorkCover must pay the employer—
(a)
75% of the outstanding
liability amount on the day the licence commences;
and
(b)
the balance within 1 month
after the day the licence commences.
(3)
WorkCover’s actuary must adjust the
outstanding liability amount paid to the employer to take
into account—
(a)
compensation and damages
payments made between the assessment day and the
day the employer becomes liable for the employer’s
outstanding liability amount; and
(b)
claims lodged against the
employer between the assessment day and the day
the employer becomes liable for the employer’s
outstanding liability amount.
34
Transfer of claims information
WorkCover must give the employer claims
information in relation to the employer’s outstanding liability
before the day the licence commences.
Division 2
Total
liability
Subdivision 1
Preliminary
35
Calculation of total liability after change in self-insurer’s
membership—Act s 90(9)
For section 90(9) of the
Act, the
amount of total liability after a change in the self-insurer’s
membership must be calculated under this division.
Subdivision 2
Actuarial calculations and
reports
36
Appointment of actuary
The relevant parties must each appoint an
actuary to calculate the total liability amount.
37
Relevant parties to give actuaries information
The relevant parties must give each appointed
actuary, in the form approved by the Regulator, the information
necessary to enable the actuaries to complete the calculation
within the time mentioned in section 39(3).
38
Actuarial calculation
A calculation of the total liability amount
must—
(a)
be prepared under the actuarial
standard; and
(b)
apply a central estimate of the
liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the outstanding liability;
and
(e)
not include a prudential margin;
and
(f)
be based, as far as practicable,
on the claims experience of the employer or member
of a group employer that is the subject of the
transfer of liability; and
(g)
be based on data as at the
assessment day.
39
Actuarial report
(1)
For each calculation of a total liability
amount the appointed actuary must prepare an actuarial
report under the actuarial standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the employer; and
(ii)
the average amount of claims
for damages against the employer; and
(iii)
claims anticipated to have
been incurred by the employer for which no formal
claim has been lodged; and
(iv)
the frequency of claims for
compensation against the employer; and
(v)
the frequency of claims for
damages against the employer; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the employer to pay the
amount; and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including its accuracy;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
(3)
Each appointed actuary must prepare the
actuarial report within 35 days after the consent day.
40
Summary report
(1)
The actuaries must jointly prepare a
summary report that—
(a)
includes the individual
actuarial reports; and
(b)
states how the individual
reports agree or differ.
(2)
The actuaries must give a copy of the
completed summary report to the parties and the Regulator
within 2 months after the consent day.
41
Agreement on amount
The relevant parties may agree on the total
liability amount having regard to the summary report.
42
Reference to arbiter if no agreement on amount
(1)
A relevant party may advise the Regulator
that the parties do not agree on the total liability
amount.
(2)
If the Regulator is advised under subsection (1), the Regulator must refer
the summary report to the arbiter to decide the total
liability amount.
43
Payment of amount
(1)
The old insurer must pay the total
liability amount to the new insurer for the total
liability—
(a)
agreed to by the old insurer
and the new insurer; or
(b)
if there is no
agreement—decided by the arbiter.
(2)
The old insurer must pay the total
liability amount—
(a)
within 3 months after the
consent day; or
(b)
on a later day agreed to by
the parties.
(3)
The old insurer’s actuary must adjust the
liability amount paid to the new insurer to take into
account—
(a)
compensation and damages
payments made between the assessment day and the
day the new insurer assumes liability; and
(b)
claims lodged against the
employer or member between the assessment day and
the day the new insurer assumes liability.
(4)
The old insurer must advise the Regulator
of the following no later than the day the total liability
amount is paid—
(a)
the total liability
amount;
(b)
the day the new insurer
assumes liability;
(c)
details of the parties and the
member leaving or becoming part of the
self-insurer.
44
Transfer of claims information
The old insurer must give the new insurer
claims information in relation to the liability no later than
the day the total liability amount is paid.
Division 3
Liability after cancellation of self-insurer’s licence
Subdivision 1
Preliminary
45
Calculation of liability after cancellation—Act, s 102(3)
For section 102(3) of the
Act, the
amount for a former self-insurer’s liability must be calculated
under this division.
Subdivision 2
Actuarial calculations and
reports
46
Appointment of actuary
WorkCover and a former self-insurer must each
appoint an actuary to calculate the former self-insurer’s
liability amount.
47
Former self-insurer to give actuaries information
The former self-insurer must give the
actuaries, in the form approved by the Regulator, the
information necessary to enable the actuaries to complete the
calculation within the time mentioned in section 49(3).
48
Actuarial calculation
A calculation of a former self-insurer’s
liability amount must—
(a)
be prepared under the actuarial
standard; and
(b)
apply a central estimate of the
liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the outstanding liability;
and
(e)
not include a prudential margin;
and
(f)
be based, as far as practicable,
on the employer’s claims experience from claims
incurred before the employer becomes or became a
self-insurer; and
(g)
be based on data as at the
assessment day.
49
Actuarial report
(1)
For each calculation of a former
self-insurer’s liability amount the appointed actuary must
prepare an actuarial report under the actuarial
standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the employer; and
(ii)
the average amount of claims
for damages against the employer; and
(iii)
claims anticipated to have
been incurred by the employer for which no formal
claim has been lodged; and
(iv)
the frequency of claims for
compensation against the employer; and
(v)
the frequency of claims for
damages against the employer; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the employer to pay the
amount; and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including its accuracy;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
(3)
Each appointed actuary must prepare an
actuarial report within 35 days after the cancellation
day.
50
Summary report
(1)
The appointed actuaries must jointly
prepare a summary report that—
(a)
includes the individual
actuarial reports; and
(b)
states how the individual
reports agree or differ.
(2)
The appointed actuaries must give a copy
of the summary report to the Regulator, WorkCover and the
former self-insurer within 2 months after the cancellation
day.
51
Agreement on amount
WorkCover and the former self-insurer may
agree on the former self-insurer’s liability amount having
regard to the summary report.
52
Reference to arbiter if no agreement on amount
(1)
WorkCover or the former self-insurer may
advise the Regulator that WorkCover and the former
self-insurer do not agree on the self-insurer’s liability
amount.
(2)
If the Regulator is advised under subsection (1), the Regulator must refer
the summary report to the arbiter to decide the
self-insurer’s liability amount.
53
Payment of amount
(1)
The former self-insurer’s liability amount
the former self-insurer must pay WorkCover is—
(a)
the amount (the agreed amount) agreed
to by WorkCover and the former self-insurer;
or
(b)
if there is no agreement, the
amount (the decided amount)
decided by the arbiter.
(2)
The former self-insurer’s actuary must
adjust the amount to take into account—
(a)
compensation and damages
payments made between the assessment day and the
cancellation day; and
(b)
claims lodged against the
former self-insurer between the assessment day and
the cancellation day.
Division 4
Estimated claims liability
Subdivision 1
Preliminary
54
Calculation of estimated claims liability—Act, s 84(3)(b)
For section 84(4)(b) of the
Act, the
amount of the estimated claims liability must be calculated
under this division.
s 54 amd 2016 Act No. 44
s 53
sch 1
Subdivision 2
Actuarial calculations and
reports
55
Approved actuary
The approved actuary must calculate the
estimated claims liability amount.
56
Self-insurer to give Regulator and approved actuary
information
The self-insurer must give the self-insurer’s
data to the Regulator and the approved actuary, in the form
approved by the Regulator.
57
Actuarial calculation
A calculation of a estimated claims liability
amount must—
(a)
be prepared under the actuarial
standard; and
(b)
apply a central estimate of the
liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the liability; and
(e)
not include a prudential margin;
and
(f)
be based, as far as practicable,
on the self-insurer’s claims experience; and
(g)
be based on the self-insurer’s
data as at—
(i)
the last day of the
financial quarter immediately before the
anniversary of the day the renewed licence
commences; or
(ii)
another day fixed by the
Regulator.
58
Actuarial report
(1)
For each calculation of an estimated
claims liability amount the approved actuary must prepare an
actuarial report under the actuarial standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the employer; and
(ii)
the average amount of claims
for damages against the employer; and
(iii)
claims anticipated to have
been incurred by the employer for which no formal
claim has been lodged; and
(iv)
the frequency of claims for
compensation against the employer; and
(v)
the frequency of claims for
damages against the employer; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the employer to pay the
amount; and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including its accuracy;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
59
Copy of actuarial report to Regulator and self-insurer
The approved actuary must give a copy of the
actuarial report to the Regulator and the self-insurer by the
day fixed by the Regulator or a later day agreed between the
Regulator and the actuary.
60
Regulator to advise self-insurer whether agreement on
amount
Within 35 days after the approved actuary
gives the Regulator a copy of the actuarial report, the
Regulator must advise the self-insurer whether the Regulator
agrees or does not agree with the approved actuary’s assessment
of the estimated claims liability.
61
Reference to Regulator’s actuary if no agreement on
amount
(1)
After receiving a copy of the approved
actuary’s report, the Regulator may ask an actuary (Regulator’s actuary) to
calculate the amount of the self-insurer’s estimated claims
liability and give the Regulator an actuarial report made
under section 58.
(2)
The Regulator must give the Regulator’s
actuary the approved actuary’s report and the self-insurer’s
data.
62
Agreement on amount
If, at any time, the Regulator and the
self-insurer agree on the calculation of estimated claims
liability, having regard to the approved actuary’s actuarial
report or any Regulator’s actuary’s actuarial report, the
estimated claims liability is the amount agreed to by the
Regulator and the self-insurer.
63
Reference to arbiter
(1)
If the Regulator and the self-insurer do
not agree on the calculation, the Regulator must refer the
approved actuary’s report, the self-insurer’s data and any
Regulator’s actuary’s actuarial report to the arbiter for
decision.
(2)
The Regulator must make the referral
within 14 days after the day the Regulator advises the
self-insurer that the Regulator does not agree with the
self-insurer’s approved actuary’s actuarial report under
section 60.
Division 5
Self-insurers who become non-scheme employers
Subdivision 1
Preliminary
64
Calculation of non-scheme employer’s liability—Act, s 105I(2)
For section 105I(2) of the
Act, the
amount for a non-scheme employer’s liability must be calculated
under this division.
Subdivision 2
Actuarial calculations and
reports
65
Appointment of actuary
WorkCover and the non-scheme employer must
each appoint an actuary to calculate a non-scheme employer’s
liability amount.
66
Non-scheme employer to give actuaries information
The non-scheme employer must give the
actuaries, in the form approved by the Regulator, the
information necessary to enable the actuaries to complete the
calculation within the time mentioned in section 68(3).
67
Actuarial calculation
A calculation of a non-scheme employer’s
liability amount must—
(a)
be prepared under the actuarial
standard; and
(b)
apply a central estimate of the
liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the liability; and
(e)
not include a prudential margin;
and
(f)
be based, as far as practicable,
on the non-scheme insurer’s claims experience;
and
(g)
be based on data that only relates
to the period before the cancellation day.
68
Actuarial report
(1)
For each calculation of a non-scheme
employer’s liability amount each appointed actuary must
prepare an actuarial report under the actuarial
standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the non-scheme employer;
and
(ii)
the average amount of claims
for damages against the non-scheme employer;
and
(iii)
claims anticipated to have
been incurred by the non-scheme employer for which
no formal claim has been lodged; and
(iv)
the frequency of claims for
compensation against the non-scheme employer;
and
(v)
the frequency of claims for
damages against the non-scheme employer; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the non-scheme employer to pay
the amount; and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including its accuracy;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
(3)
Each appointed actuary must prepare an
actuarial report on the actuary’s calculation within 35 days
after the cancellation day.
69
Summary report
(1)
The actuaries must jointly prepare a
summary report that—
(a)
includes the individual
actuarial reports; and
(b)
states how the individual
reports agree or differ.
(2)
The actuaries must give a copy of the
summary report to the Regulator, WorkCover and the
non-scheme employer within 2 months after the cancellation
day.
70
Agreement on amount
WorkCover and the non-scheme employer may
agree on the non-scheme employer’s liability amount having
regard to the summary report.
71
Reference to arbiter if no agreement on amount
(1)
WorkCover or the non-scheme employer may
advise the Regulator that WorkCover and the non-scheme
employer do not agree on the non-scheme employer’s liability
amount.
(2)
If the Regulator is advised under subsection (1), the Regulator must refer
the summary report to the arbiter to decide the non-scheme
employer’s liability amount.
72
Payment of amount
(1)
The amount the non-scheme employer must
pay WorkCover for the liability is—
(a)
the amount (the agreed amount) agreed
to by WorkCover and the non-scheme employer;
or
(b)
if there is no agreement—the
amount (the decided amount)
decided by the arbiter.
(2)
The agreed amount or decided amount paid
to WorkCover must be adjusted by the non-scheme employer’s
actuary to take into account—
(a)
compensation and damages
payments made between the assessment day and the
cancellation day; and
(b)
claims lodged against the
non-scheme employer between the assessment day and
the cancellation day.
Subdivision 3
Calculation—finalised
non-scheme employer’s liability
73
Calculation of finalised non-scheme employer’s liability
amount—Act, s 105I(2)
For section 105I(2) of the
Act, the
amount for finalisation of a non-scheme employer’s liability
must be calculated under this subdivision.
74
Appointment of actuary
WorkCover and the non-scheme employer must
each appoint an actuary, at the end of 4 years after the
cancellation day, to calculate the finalised non-scheme
employer’s liability amount.
75
WorkCover to give actuaries information
WorkCover must give the appointed actuaries
the information necessary to enable the actuaries to complete
the calculation within the time mentioned in section 77(3).
76
Actuarial calculation
(1)
For each calculation of a finalised
non-scheme employer’s liability amount must the appointed
actuary must prepare an actuarial report under the actuarial
standard.
(2)
The actuarial report must state the
following—
(a)
be prepared under the
actuarial standard; and
(b)
apply a central estimate of
the liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the liability; and
(e)
not include a prudential
margin; and
(f)
be based, as far as
practicable, on the non-scheme insurer’s claims
experience; and
(g)
apply the same risk free rate
of return that was used in the calculation of the
non-scheme employer’s liability amount; and
(h)
have regard to compensation
and damages payments made in relation to the
liability between the day WorkCover became liable
for compensation and damages for the non-scheme
employer’s liability and the end of 4 years after
that day; and
(i)
be based on data as at the
last day of the last financial quarter for which
data is available at the end of 4 years after the
day WorkCover became liable for compensation and
damages for the non-scheme employer’s liability
amount.
(3)
The data relied on under subsection (2)(i) may only relate to the period before the
exit date.
77
Actuarial report
(1)
For each calculation of a finalised
non-scheme employer’s liability amount, each appointed
actuary must prepare an actuarial report under the actuarial
standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the non-scheme employer;
and
(ii)
the average amount of claims
for damages against the non-scheme employer;
and
(iii)
claims anticipated to have
been incurred by the non-scheme employer for which
no formal claim has been lodged; and
(iv)
the frequency of claims for
compensation against the non-scheme employer;
and
(v)
the frequency of claims for
damages against the non-scheme employer; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the non-scheme employer to pay
the non-scheme employer’s liability amount;
and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including its accuracy;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
(3)
Each appointed actuary must prepare an
actuarial report on the actuary’s calculation within 35 days
after the end of 4 years after the day WorkCover became
liable for compensation and damages for the non-scheme
employer’s liability.
78
Summary report
(1)
The actuaries must jointly prepare a
summary report that—
(a)
includes the individual
actuarial reports; and
(b)
states how the individual
reports agree or differ.
(2)
The actuaries must give a copy of the
completed summary report to the Regulator, WorkCover and the
non-scheme employer within 2 months after the end of 4 years
after the day WorkCover became liable for compensation and
damages for the non-scheme employer’s liability.
79
Agreement on amount
WorkCover and the finalised non-scheme
employer liability amount may agree on the finalised non-scheme
employer liability amount having regard to the summary
report.
80
Reference to arbiter if no agreement on amount
(1)
WorkCover or the finalised non-scheme
employer may advise the Regulator that WorkCover and the
finalised non-scheme employer do not agree on the finalised
non-scheme employer’s liability amount.
(2)
If the Regulator is advised under subsection (1), the Regulator must refer
the summary report to the arbiter to decide the finalised
non-scheme employer’s liability amount.
81
Payment of amount
(1)
If the amount (the agreed amount) agreed to by
WorkCover and the non-scheme employer or, if there is no
agreement, the amount (the decided amount) decided by
the arbiter, for the calculation is more than the non-scheme
employer’s liability amount—
(a)
the amount the non-scheme
employer must pay WorkCover for the non-scheme
employer’s liability is the agreed amount or
decided amount; and
(b)
the non-scheme employer must
pay WorkCover—
(i)
the difference between the
amount of the payment (the interim payment) made
under section 72 and the agreed amount or
decided amount for the non-scheme employer’s
liability; and
(ii)
interest on the difference,
from the day the whole of the interim payment was
paid, at the same risk free rate of return that
was used in the calculation of the non-scheme
employer’s liability amount.
(2)
If the agreed amount or decided amount is
less than the interim payment—
(a)
the amount the non-scheme
employer must pay WorkCover for the non-scheme
employer’s liability is the agreed amount or
decided amount; and
(b)
WorkCover must pay the
non-scheme employer—
(i)
the difference between the
interim payment and the agreed amount or decided
amount for the liability; and
(ii)
interest on the difference,
from the day the whole of the interim payment was
paid, at the same risk free rate of return that
was used in the calculation of an amount for the
liability under subdivision 2.
(3)
WorkCover or the non-scheme employer must
pay the amount of the difference within 28 days after—
(a)
WorkCover and the non-scheme
employer agree on the recalculation; or
(b)
if there is no agreement,
WorkCover or the non-scheme employer receives the
statement of the arbiter’s decision about the
recalculation.
(4)
On payment of the amount—
(a)
the non-scheme employer’s
liability is finalised for section 105I(5) of the Act; and
(b)
no further amount is payable
for the liability.
Division 6
Total
liability—member of a group who becomes non-scheme employer
Subdivision 1
Preliminary
82
Calculation of non-scheme members’ total liability—Act, s 105O(3)(a)
For section 105O(3)(a) of the Act, the amount of total liability after a change
in the self-insurer’s membership must be calculated under this
division.
Subdivision 2
Actuarial calculations and
reports
83
Appointment of actuary
(1)
The old insurer and WorkCover must each
appoint an actuary to calculate the total liability
amount.
(2)
An actuary appointed by the old insurer
must be approved by the non-scheme member.
84
Parties to give actuaries information
The old insurer and WorkCover must give the
appointed actuaries, in the form approved by the Regulator, the
information necessary to enable the actuaries to complete the
calculation within the time mentioned in section 86(3).
85
Actuarial calculation
A calculation of a total liability amount
must—
(a)
be prepared under the actuarial
standard; and
(b)
apply a central estimate of the
relevant liability; and
(c)
apply the risk free rate of
return; and
(d)
include claims administration
expenses of 7% of the outstanding liability;
and
(e)
not include a prudential margin;
and
(f)
be based, as far as practicable,
on the claims experience of the employer or member
of a group employer that is the subject of the
transfer of liability; and
(g)
be based on data as at the
assessment day.
86
Actuarial report
(1)
For each calculation of a total liability
amount each appointed actuary must prepare an actuarial
report under the actuarial standard.
(2)
The actuarial report must state the
following—
(a)
the amount;
(b)
the key assumptions made for
the calculation;
(c)
how the key assumptions have
been derived, including—
(i)
the average amount of claims
for compensation against the non-scheme member;
and
(ii)
the average amount of claims
for damages against the non-scheme member;
and
(iii)
claims anticipated to have
been incurred by the non-scheme member, for which
no formal claim has been lodged; and
(iv)
the frequency of claims for
compensation against the non-scheme member;
and
(v)
the frequency of claims for
damages against the non-scheme member; and
(vi)
the net amount of the claims
after allowing for future inflation (inflated value);
and
(vii)
the net present value of the
inflated value after allowing for income from
assets set aside by the non-scheme member to pay
the amount; and
(viii)
the rate of inflation
used;
(d)
the nature of the data used in
the calculation;
(e)
the actuary’s assessment of
the data, including accuracy of the data;
(f)
how the actuary interpreted
the data;
(g)
the actuarial model used in
the calculation;
(h)
the results of the
calculation;
(i)
the actuary’s confidence in
the results of the calculation.
(3)
Each appointed actuary must prepare an
actuarial report within 35 days after the final day.
87
Summary report
(1)
The actuaries must jointly prepare a
summary report that—
(a)
includes the individual
actuarial reports; and
(b)
states how the individual
reports agree or differ.
(2)
The actuaries must give a copy of the
completed summary report to the Regulator, WorkCover and the
old insurer, within 2 months after the final day.
88
Agreement on amount
The old insurer and WorkCover may agree on the
liability amount having regard to the summary report.
89
Reference to arbiter if no agreement on amount
(1)
WorkCover or the old insurer may advise
the Regulator that WorkCover and the old insurer do not
agree on the liability amount.
(2)
If the Regulator is advised under subsection (1), the Regulator must refer
the summary report to the arbiter to decide the liability
amount.
90
Payment of amount
(1)
For section 105O(3)(b) of the Act, the old insurer must pay the agreed
amount or decided amount—
(a)
within 3 months after the
final day; or
(b)
on a later day agreed to by
the old insurer and WorkCover.
(2)
The old insurer must pay WorkCover—
(a)
the non-scheme member’s total
liability amount (the agreed amount) agreed
to by the old insurer and WorkCover; or
(b)
if there is no agreement—the
non-scheme member’s total liability amount (the
decided amount)
decided by the arbiter.
(3)
The agreed amount or decided amount paid
to WorkCover must be adjusted by the actuary of the old
insurer to take into account—
(a)
compensation and damages
payments made between the assessment day and the
final day; and
(b)
claims lodged against the
non-scheme member between the assessment day and
the final day.
(4)
The old insurer must advise the Regulator
of the following no later than the day the total liability
amount must be paid—
(a)
the amount of the total
liability;
(b)
the day WorkCover assumes
liability;
(c)
details of the old insurer and
the non-scheme member.
91
Transfer of claims information
The old insurer must give WorkCover claims
information in relation to the liability no later than the day
the agreed or decided amount is paid.
Division 7
Actuarial arbiter
92
Function of actuarial arbiter
The functions of the actuarial arbiter are—
(a)
to consider the actuarial reports and
the calculations of an amount for liability made under
this part; and
(b)
to decide on an amount for the
liability.
93
Selection and appointment of actuarial arbiter
(1)
The arbiter is to be selected by a selection
panel consisting of—
(a)
2 individuals nominated by the
Regulator; and
(b)
2 individuals nominated by
WorkCover; and
(c)
2 individuals nominated by the
Association of Self Insured Employers of
Queensland.
(2)
The arbiter must be a Fellow of the Institute
of Actuaries or be an Accredited Member of the Institute.
(3)
The Regulator must appoint the arbiter for a
term of not more than 3 years.
(4)
The arbiter’s conditions of appointment are to
be set out in the contract made between the Regulator and the
arbiter.
94
Arbiter
must decide amount
(1)
After considering the actuarial reports and
the calculations of an amount for the liability by the
actuaries, the arbiter must decide on—
(a)
the central estimate for the
liability; and
(b)
an amount for the liability.
(2)
An amount for the liability decided by the
arbiter must not be—
(a)
more than the higher of the
amounts calculated by the actuaries; and
(b)
less than the lower of the
amounts.
(3)
The arbiter must give a written statement of
the arbiter’s decision, and the reasons for the decision, within
21 days after the summary report is referred to the
arbiter.
95
Arbiter’s decision is final
The arbiter’s decision is final.
96
Arbiter’s costs
The arbiter’s costs in deciding a liability amount
are to be paid in equal amounts by the following—
(a)
if the decision is for an amount of
outstanding liability—WorkCover and the employer;
(b)
if the decision is for an amount of
the total liability—the relevant parties;
(c)
if the decision is for an amount of
liability after cancellation of the self-insurer’s
licence—WorkCover and the former self-insurer;
(d)
if the decision is for an amount of
estimated claims liability—the Regulator and the
self-insurer;
(e)
if the decision is for an amount for
non-scheme employer’s liability—WorkCover and the
non-scheme employer;
(f)
if the decision is for an amount for a
recalculation of a non-scheme employer’s
liability—WorkCover and the non-scheme employer;
(g)
if the decision is for an amount for
the total liability of a non-scheme member—WorkCover and
the old insurer.
Part 4
Compensation
Division 1
Calculation of NWE
97
Calculation of NWE—Act, s 106(3)
This division prescribes the way to calculate the
NWE for section 106(3) of the Act.
98
What
amounts may be taken into account
(1)
In calculating the NWE the following may be
taken into account—
(a)
amounts paid to the worker by way
of overtime, higher duties, penalties and allowances
that are of a regular nature, required by an
employer;
(b)
amounts that would have continued
if not for the injury may be taken into
account.
(2)
However, amounts mentioned in the Act, schedule 6, definition
wages, paragraphs (a) to (d)
must not be taken into account in calculating the NWE.
99
NWE if
impracticable to calculate rate of worker’s remuneration
(1)
This section applies if it is impracticable,
at the date of injury to a worker, to calculate the rate of the
worker’s remuneration because of—
(a)
the period of time for which the
worker has been employed; or
(b)
the terms of the worker’s
employment.
(2)
In calculating the rate of the worker’s
remuneration, regard must be had to—
(a)
the NWE during the 12 months
immediately before the date of injury of a person
employed by the same employer who—
(i)
is employed under the same
or a comparable relevant industrial agreement or
the same or comparable terms and conditions, the
worker; and
(ii)
performs the same or
comparable work as the worker; or
(b)
if paragraph (a) does not apply—the
NWE during the 12 months immediately before the date
of injury of a person employed by another employer
who—
(i)
is employed under the same
or comparable relevant industrial agreement or the
same or comparable terms and conditions as the
worker; or
(ii)
receives the same or
comparable remuneration as the worker and performs
the same or comparable work as the worker.
100
NWE if
worker worked for 2 or more employers
(1)
This section applies if a worker has worked
under concurrent contracts of service with 2 or more employers,
under which the worker has worked at 1 time for 1 employer and
at another time for another of the employers.
(2)
The worker’s NWE is to be calculated as if
earnings under all the contracts were earnings in the employment
of the employer for whom the worker was working when the injury
was sustained.
101
NWE if
insurer considers calculation unfair
(1)
This section applies if an insurer considers
that the calculation of NWE under this division would be
unfair.
(2)
The NWE may be calculated in a way the insurer
considers to be fair, and the calculation under this subsection
is taken to be the worker’s NWE.
Division 2
Compensation application and other procedures
102
Application for compensation to include evidence or particulars—Act, s 132(3)(b)
(1)
For section 132(3)(b) of the
Act, the
following evidence or particulars are prescribed—
(a)
the injury and its cause;
(b)
the nature, extent and duration of
incapacity resulting from the injury;
(c)
if the injury is, or results in,
the death of a worker, proof of—
(i)
the worker’s death;
and
(ii)
the identity of the worker;
and
(iii)
the relationship to the
worker, and dependency, of persons claiming to be
the worker’s dependants;
(d)
if the injury is a latent onset
injury that is a terminal condition and the worker
has dependants—proof of the relationship to the
worker of persons claiming to be the worker’s
dependants.
(2)
In this section—
dependant, of a worker,
means a member of the worker’s family who is completely
or partly dependent on the worker’s earnings.
member of the family, of
a worker, means—
(a)
the worker’s—
(i)
spouse; or
(ii)
parent, grandparent or
step-parent; or
(iii)
child, grandchild or
stepchild; or
(iv)
brother, sister,
half-brother or half-sister; or
(b)
if the worker stands in the
place of a parent to another person—the other
person; or
(c)
if another person stands in
the place of a parent to the worker—the other
person.
103
If
dentist, doctor or nurse practitioner not available
(1)
This section applies if—
(a)
a person does not lodge a
certificate in the approved form with an application
made under section 132, 132A or 132B of the Act in relation to a
worker; and
(b)
the certificate can not be
provided because the dentist, doctor or nurse
practitioner required to give the certificate under
the section was not available to attend the
worker.
(2)
The person must complete and lodge with the
insurer a declaration in the approved form.
(3)
For a non-fatal injury, the declaration—
(a)
may be accepted by the insurer
only once for injury to the worker in any 1 event;
and
(b)
is acceptable proof of incapacity
of the worker for up to 3 days.
(4)
The declaration is taken to be a certificate
in the approved form for section 132(3)(a),
132A(3)(c)(i) or
132B(3)(c)(i) of the
Act.
s 103 amd 2015
SL No. 135
s 4
104
Certificate given by dentist, doctor or nurse practitioner
(1)
This section applies if—
(a)
a certificate in the approved form
is not lodged with an application made under section 132, 132A or 132B of the Act in relation to a
worker who sustains an injury; and
(b)
the worker sustained the injury in
another State or country.
(2)
The insurer must accept a written certificate
that is substantially to the effect of the approved form from
the dentist, doctor or nurse practitioner who attended the
worker.
(3)
The certificate is taken to be a certificate
in the approved form for section 132(3)(a),
132A(3)(c)(i) or
132B(3)(c)(i) of the
Act.
(4)
Also, on the insurer’s request, the dentist,
doctor or nurse practitioner who attended the worker must give a
detailed report on the worker’s condition to the insurer within
10 days after receiving the request.
(5)
The fee payable to the dentist, doctor or
nurse practitioner for the report is an amount that the insurer
considers to be reasonable, having regard to the relevant table
of costs.
s 104 amd 2015
SL No. 135
s 5
105
Application for compensation for assessment of DPI—Act, s 132A(3)(c)(ii)
For section 132A(3)(c)(ii) of the
Act, the following evidence or
particulars are prescribed—
(a)
proof of the injury and its
cause;
(b)
proof of the nature, extent and
duration of incapacity resulting from the injury.
105A
Application for certificate of dependency—Act, s 132B(3)(c)(ii)
For section 132B(3)(c)(ii) of the
Act, the following evidence is
prescribed—
(a)
proof of the injury and its
cause;
(b)
proof of the identity of the
worker;
(c)
proof of the worker’s death;
(d)
proof of the relationship to the
worker, and dependency, of the person claiming to be the
worker’s dependant.
s 105A ins 2015
SL No. 135
s 6
106
Request for examination of claimant or worker—Act, ss 135 and 510
(1)
A request under sections 135 and 510 of the
Act for a
personal examination must be made in writing.
(2)
The request must specify—
(a)
the name of the doctor or other
registered person, who is not employed by the
insurer under a contract of service, engaged to make
the examination; and
(b)
if the doctor is a specialist—the
field of specialty; and
(c)
the day, time and place for the
examination.
(3)
A doctor or other registered person who
examines a claimant or worker must, within 10 days after the
examination, give the insurer—
(a)
a written report on the
examination; and
(b)
an itemised account for the
examination.
(4)
Fees payable to a doctor or other registered
person for the examination—
(a)
are payable by the insurer;
and
(b)
are payable for—
(i)
making the examination;
and
(ii)
giving a report to the
insurer; and
(c)
are the costs accepted by the
insurer to be reasonable, having regard to the
relevant table of costs.
Division 3
Entitlement to compensation for permanent impairment—generally
div hdg amd 2015
SL No. 135
s 7
107
Additional lump sum compensation—workers with latent onset injuries
that are terminal—Act, s 128B(2)(c)
For section 128B(2)(c) of the Act, the additional lump sum compensation, and
graduated scale, set out in schedule 2 are prescribed.
108
Calculating lump sum compensation—Act, s 180(1)
For section 180(1) of the Act, the lump
sum compensation for a worker’s DPI is calculated by multiplying the
maximum statutory compensation by the worker’s DPI.
Example—
A worker’s DPI is assessed as 10%. The
maximum statutory compensation is $307,385. The lump sum
compensation is $30,738.50.
109
Additional lump sum compensation for workers with DPI of 30% or
more—Act, s 192(2)
For section 192(2) of the Act, the
additional lump sum compensation, and graduated scale, set out in
schedule 3 are prescribed.
s 109 amd 2015
SL No. 135
s 8
110
Additional lump sum compensation for gratuitous care (occupational
therapist’s assessment)—Act, ss 193(4) and 224(3)
For sections 193(4) and 224(3) of the Act, the
prescribed way of assessing the worker’s level of dependency is the
way stated in the modified barthel index.
111
Additional lump sum compensation for gratuitous care (occupational
therapist’s report)—Act, ss 193(5)(b) and 224(4)(b)
For sections 193(5)(b) and 224(4)(b) of the
Act, the following information,
relating to the level of day to day care (the level of care) provided by a person at the worker’s
home, is prescribed—
(a)
whether the level of care was provided
to the worker before the worker sustained the
impairment;
(b)
whether the level of care would
ordinarily be provided in the worker’s home;
(c)
if the level of care is likely to
continue to be provided in the worker’s home;
(d)
the number of hours of the level of
care required by the worker.
112
Additional lump sum compensation for gratuitous care—Act, s 193(6)
(1)
For section 193(6) of the
Act, the
additional lump sum compensation, and graduated scale, set out
in schedule 4 are prescribed.
(2)
For section 193(6)(c) of the
Act, the
occupational therapist’s report is prescribed.
(3)
In this section—
occupational therapist’s
report means the report prepared by the
occupational therapist under section 193(5)
of the Act.
Division 3A
Entitlement to additional compensation for permanent impairment—Act, s 193A
div hdg ins 2015
SL No. 135
s 9
Subdivision 1
Preliminary
sdiv hdg ins 2015
SL No. 135
s 9
112A
Definitions for div 3A
In this division—
injury means an injury
mentioned in section 193A(1) of the Act.
panel means the panel
established under section 112R.
qualifying condition
means the condition prescribed by section 112D.
section 193A
compensation, for an injury, means the
additional lump sum compensation mentioned in section 193A(2)
of the Act
for the injury.
section 193A notice
see section 112G(1).
specified worker means a
worker to whom section 193A of the
Act
applies.
s 112A ins 2015
SL No. 135
s 9
112B
Operation of div 3A
For section 193A of the Act, this division prescribes the following—
(a)
the amount of section 193A compensation for an
injury;
(b)
the condition to which an
entitlement to section 193A
compensation is subject;
(c)
the process for deciding whether
the condition mentioned in paragraph (b) is satisfied for a
specified worker;
(d)
the establishment of a panel to
review decisions made by insurers about section 193A compensation.
s 112B ins 2015
SL No. 135
s 9
Subdivision 2
Amount and condition of
entitlement
sdiv hdg ins 2015
SL No. 135
s 9
112C
Amount of compensation—Act, s 193A(2)(a)
For section 193A(2)(a) of the Act, the amount of section 193A compensation for
an injury sustained by a specified worker in relation to whom
the qualifying condition is satisfied is the amount provided for
under schedule 4A.
s 112C ins 2015
SL No. 135
s 9
112D
Qualifying condition—Act, s 193A(2)(b)
(1)
For section 193A(2)(b) of the Act, this section prescribes the condition
applying to an entitlement to section 193A compensation
for an injury sustained by a specified worker.
(2)
The worker is entitled to section 193A compensation only if—
(a)
the insurer is satisfied, on
the balance of probabilities, the worker’s
employer is, or would have been, liable to pay
damages to the worker; but
(b)
the worker can not seek
damages because of the application of former
section 237(1)(a)(i).
(3)
In this section—
former section 237(1)(a)(i)
means section 237(1)(a)(i) of the Act, as in force from 15
October 2013 until 31 January 2015.
s 112D ins 2015
SL No. 135
s 9
Subdivision 3
Process for deciding
qualifying condition
sdiv hdg ins 2015
SL No. 135
s 9
112E
Application of sdiv 3
This subdivision applies if—
(a)
a worker’s DPI has been decided;
and
(b)
the worker is a specified
worker.
Notes—
1
Section 193A of the Act applies only if a worker’s DPI has
been decided—see section 191 of the Act.
2
Also, see chapter 3, part 10 of the Act for provisions
about—
•
assessing a worker’s injury
to decide if the injury has resulted in a DPI;
and
•
giving the worker a notice
of assessment stating the DPI for the injury;
and
•
an insurer making an offer
of compensation to the worker.
s 112E ins 2015
SL No. 135
s 9
112F
Insurer to consider qualifying condition
An insurer must decide—
(a)
whether the insurer has enough
information to decide whether the qualifying
condition is satisfied for the worker; and
(b)
if the insurer decides it has
enough information—whether the qualifying condition
is satisfied for the worker.
s 112F ins 2015
SL No. 135
s 9
112G
Notification
(1)
After deciding the matters mentioned in
section 112F, the insurer must give the
worker a notice (a section 193A notice in
the approved form.
(2)
If the insurer decides the qualifying
condition is satisfied for the worker, the section 193A notice must state the amount
of section 193A compensation to which the
worker is entitled for the worker’s injury.
(3)
If the insurer decides the qualifying
condition is not satisfied for the worker, the section 193A notice must state—
(a)
the insurer’s decision;
and
(b)
that the worker may ask the
insurer for written reasons for the decision;
and
(c)
that the worker may apply to
the panel for a review of the decision only if the
worker has asked the insurer for the reasons for
the decision.
(4)
If the insurer decides it does not have
enough information to decide whether the qualifying
condition is satisfied for the worker, the section 193A notice must state—
(a)
the insurer’s decision;
and
(b)
that the worker may, within 60
business days after receiving the notice, give the
insurer information to enable the insurer to
decide whether the qualifying condition is
satisfied for the worker; and
(c)
that, if the worker does not
give the insurer the information within the period
mentioned in paragraph (b)—
(i)
the qualifying condition
will be taken not to be satisfied for the worker;
and
(ii)
the worker will not be
entitled to section 193A
compensation; and
(iii)
the worker will not have a
right to apply to the panel for a review of the
matters mentioned in subparagraphs (i) and (ii).
s 112G ins 2015
SL No. 135
s 9
112H
Worker may request reasons
(1)
This section applies if an insurer has
given the worker a section 193A notice stating the insurer
has decided the qualifying condition is not satisfied for
the worker.
(2)
The worker may, within 10 business days
after receiving the notice, ask the insurer for written
reasons for the decision.
(3)
The insurer must give the worker the
reasons for the decision within 10 business days after
receiving the worker’s request.
s 112H ins 2015
SL No. 135
s 9
112I
Giving information
(1)
This section applies if the insurer has
given the worker a section 193A notice stating the insurer
does not have enough information to decide whether the
qualifying condition is satisfied for the worker.
(2)
The worker—
(a)
may give the insurer
information relevant to the decision within 60
business days after receiving the section 193A notice; and
(b)
if the worker gives
information to the insurer under paragraph (a)—must advise the
insurer whether the worker has engaged a lawyer
and incurred legal costs in giving the
information.
(3)
Despite subsection (2)(a), the insurer may, at the worker’s request,
decide to allow the worker to give the insurer information
after the period mentioned in the subsection has ended if
the worker has a reasonable excuse for not giving the
information during the period.
(4)
The qualifying condition is taken not to
be satisfied for the worker if the worker does not give the
insurer information relevant to the decision during the
period—
(a)
mentioned in subsection (2)(a); or
(b)
decided by the insurer under
subsection (3).
s 112I ins 2015
SL No. 135
s 9
112J
Decision based on worker’s information
(1)
This section applies if the worker has
given the insurer information under section 112I.
(2)
The insurer must consider the information
and decide whether the qualifying condition is satisfied for
the worker.
(3)
The insurer must make the decision within
the later of the following periods to end—
(a)
60 business days after
receiving the information from the worker;
(b)
if the insurer meets with the
worker under section 112K—10 business days after
the day of the meeting.
(4)
If the insurer decides the qualifying
condition is satisfied for the worker, the insurer must give
the worker a written notice in the approved form stating the
amount of section 193A compensation to which the
worker is entitled for the worker’s injury.
(5)
If the insurer decides the qualifying
condition is not satisfied for the worker, the insurer must
give the worker written reasons for the decision.
(6)
If the insurer does not make a decision
within the period mentioned in subsection (3), the insurer is taken to
have decided the qualifying condition is not satisfied for
the worker.
s 112J ins 2015
SL No. 135
s 9
112K
Meeting before decision made
(1)
This section applies if—
(a)
the worker has given the
insurer information under section 112I; and
(b)
the insurer proposes to decide
the qualifying condition is not satisfied for the
worker.
(2)
Before making the decision, the insurer
must—
(a)
give the worker an opportunity
to meet with the insurer to discuss the proposed
decision; and
(b)
if the worker agrees to meet
with the insurer—give the worker any relevant
information the insurer holds at least 10 business
days before the meeting.
(3)
The insurer is not required to give the
worker more than 1 opportunity to meet with the
insurer.
(4)
In this section—
relevant information,
in relation to a worker, means information, other
than information given to the insurer by the worker,
that the insurer intends to consider for making the
proposed decision.
s 112K ins 2015
SL No. 135
s 9
Subdivision 4
Review of insurer’s
decision
sdiv hdg ins 2015
SL No. 135
s 9
112L
Definition for sdiv 4
In this subdivision—
decision, of an insurer,
includes a decision taken to have been made by the
insurer under section 112J(6).
s 112L ins 2015
SL No. 135
s 9
112M
Application of sdiv 4
This subdivision applies to a worker—
(a)
who, under subdivision 3, has received written
reasons for an insurer’s decision that the
qualifying condition is not satisfied for the
worker; or
(b)
in relation to whom an insurer is
taken to have decided that the qualifying condition
is not satisfied under section 112J(6).
s 112M ins 2015
SL No. 135
s 9
112N
Application for review
(1)
The worker may apply to the panel for a
review of the decision within 20 business days after—
(a)
the worker receives written
reasons for the decision; or
(b)
the day on which the worker
becomes aware the insurer has failed to decide
whether the qualifying condition is satisfied for
the worker within the period mentioned in section 112J(3).
(2)
The application must include the
following—
(a)
the worker’s reasons for
asking for a review of the decision;
(b)
if the worker has received
written reasons for the decision—the
reasons;
(c)
if the worker has not already
had an opportunity to give the insurer information
about whether the qualifying condition is
satisfied for the worker—any information the
worker wants the panel to consider in support of
the worker’s application;
(d)
if the worker has engaged a
lawyer and incurred legal costs in relation to the
application—a statutory declaration verifying the
worker has engaged the lawyer and incurred legal
costs.
(3)
The worker must give the insurer a copy of
the application.
s 112N ins 2015
SL No. 135
s 9
112O
Insurer to give information to panel
As soon as practicable after receiving a copy
of the worker’s application under section 112N, the insurer must give the panel
and the worker any information the insurer has considered in
deciding whether the qualifying condition is satisfied for the
worker.
s 112O ins 2015
SL No. 135
s 9
112P
Review by panel
(1)
After considering the application and
reviewing the insurer’s decision, the panel must decide
to—
(a)
confirm the decision; or
(b)
cancel the decision and
substitute a new decision.
(2)
The panel must give the worker and the
insurer written notice of its decision and the reasons for
its decision.
(3)
The panel’s decision—
(a)
is final; and
(b)
if the decision is to
substitute a new decision—is taken to be the
insurer’s decision that the qualifying condition
is satisfied for the worker.
(4)
To remove any doubt, it is declared that
the panel may review the insurer’s decision without
receiving oral submissions.
s 112P ins 2015
SL No. 135
s 9
112Q
Insurer must notify amount of entitlement
(1)
This section applies if the insurer is
notified by the panel that the insurer’s decision is
substituted with a new decision that the qualifying
condition is satisfied for the worker.
(2)
The insurer must give the worker a written
notice in the approved form stating the amount of section 193A compensation to which the
worker is entitled for the worker’s injury.
s 112Q ins 2015
SL No. 135
s 9
Subdivision 5
Establishment of
panel
sdiv hdg ins 2015
SL No. 135
s 9
112R
Panel—Act, s 193A(3)
(1)
For section 193A(3) of
the Act,
there is to be a panel made up of 1 chairperson and 2 other
members.
(2)
The function of the panel is to meet, as
required, to review decisions under subdivision 4.
s 112R ins 2015
SL No. 135
s 9
112S
Appointment to panel
(1)
The Minister must appoint a chairperson
and 2 other members to the panel, on terms decided by the
Minister.
(2)
The Minister must ensure that each person
appointed to the panel—
(a)
is qualified, or eligible to
qualify, as a lawyer; and
(b)
has demonstrated significant
experience relevant to the laws of personal injury
and negligence.
s 112S ins 2015
SL No. 135
s 9
112T
Administrative matters
The Regulator may decide administrative
matters about the panel that are not provided for under this
subdivision, including, for example, the way in which the panel
members must meet.
s 112T ins 2015
SL No. 135
s 9
Subdivision 6
Miscellaneous
sdiv hdg ins 2015
SL No. 135
s 9
112U
Liability not affected
To remove any doubt, it is declared that a
decision made by an insurer or the panel under this division
does not impose liability on, or otherwise affect the liability
of, the insurer or an employer for any other purpose or
proceeding.
s 112U ins 2015
SL No. 135
s 9
Division 3AA
Entitlement to compensation for pneumoconiosis
div hdg ins 2017
Act No. 27
s 35
112V
Working out pneumoconiosis score—Act, s 36F
For section 36F(b)
of the Act, the way set out in schedule 4B is prescribed.
s 112V ins 2017 Act No. 27
s 35
112W
Lump
sum compensation for workers with pneumoconiosis—Act, s 128G
(1)
For section 128G(2) of the Act, the lump sum compensation, and
graduated scale, set out in schedule 4C are prescribed.
(2)
For section 128G(3) of the Act, the pneumoconiosis bands set out
in schedule 4C are prescribed.
s 112W ins 2017 Act No. 27
s 35
Division 4
Liability for caring allowance
113
Payment of caring allowance—Act, s 225(a)
(1)
For section 225(a) of the
Act, if an
insurer pays a caring allowance, the prescribed way of payment
is for the insurer to—
(a)
decide the number of hours of the
level of care required by the worker having regard
to the occupational therapist’s report, and the
graduated scale set out in schedule 5; and
(b)
decide the allowance having regard
to the information in the occupational therapist’s
report; and
(c)
pay the allowance at an hourly
rate equal to the carer pension rate divided by
35.
(2)
In this section—
carer pension rate means
the weekly amount of the maximum single carer pension
rate payable from time to time under a Commonwealth law,
but does not include an amount for allowances such as
rent assistance or family payment.
occupational therapist’s report
means the report prepared by the occupational
therapist under section 224(3)
of the Act.
Part 5
Rehabilitation
Division 1
Rehabilitation and return to work coordinators
114
Functions of rehabilitation and return to work coordinator—Act, s 41(b)
For section 41(b) of the Act, the
following functions are prescribed—
(a)
initiate early communication with an
injured worker in order to clarify the nature and
severity of the worker’s injury;
(b)
provide overall coordination of the
worker’s return to work;
(c)
if a rehabilitation and return to work
plan is required—
(i)
consult with the worker and
the worker’s employer to develop the suitable
duties program component of the plan; and
(ii)
ensure the program is
consistent with the current medical certificate or
report for the worker’s injury;
(d)
liaise with—
(i)
any person engaged by the
employer to help in the worker’s rehabilitation
and return to work; and
(ii)
the insurer about the
worker’s progress and indicate, as early as
possible, if there is a need for the insurer to
assist or intervene.
115
Criteria for employer to appoint rehabilitation and return to work
coordinator—Act, s 226(1)
(1)
For section 226(1) of the
Act, the
following criteria is prescribed—
(a)
for an employer who employs
workers at a workplace in a high risk industry—the
wages of the employer in Queensland for the
preceding financial year were more than 2,600 times
QOTE;
(b)
otherwise—the wages of the
employer in Queensland for the preceding financial
year were more than 5,200 times QOTE.
(2)
For the purpose of section 226(3)(a) of the
Act, an
employer is taken to have established a workplace, or started to
employ workers at the workplace, when the employer first meets
the criteria.
(3)
An employer may appoint a person as the
rehabilitation and return to work coordinator for more than 1
workplace if the person can reasonably perform the person’s
functions as a rehabilitation and return to work coordinator for
each workplace.
(4)
In this section—
high risk industry means
an industry specified by the Regulator by gazette
notice.
Division 2
Guidelines for standard for rehabilitation
116
Standard for rehabilitation—Act, s 228(2)
For section 228(2) of the Act, the
standard for the rehabilitation that the employer must provide is
contained in the guidelines made by the Regulator for the purpose of
this section.
117
Availability of guidelines
(1)
The Regulator must keep a copy of each
guideline, as in force from time to time, available for
inspection, free of charge at—
(a)
the department’s head office;
and
(b)
other places the Regulator
considers appropriate.
(2)
Also, the Regulator must publish each
guideline, as in force from time to time, on the department’s
website.
Part 5A
Treatment, care
and support payments
pt hdg ins 2016
Act No. 44
s 50
Division 1
Assessing entitlement
div hdg ins 2016
Act No. 44
s 50
Subdivision 1
Preliminary
sdiv hdg ins 2016 Act No. 44
s 50
117A
Definitions for division
In this division—
childrens functional independence
measure instrument means the functional
independence measure instrument adapted for paediatrics and
described on the department’s website.
functional independence measure
instrument means a clinical tool used to
assess the functional ability of a person by scoring motor
and cognitive items against a scale and described on the
department’s website.
s 117A ins 2016 Act No. 44
s 50
Subdivision 2
Eligibility
criteria
sdiv hdg ins 2016 Act No. 44
s 50
117B
Purpose of subdivision
For section 232M(2)(a) of the Act, this subdivision prescribes the
eligibility criteria for particular serious personal
injuries.
s 117B ins 2016 Act No. 44
s 50
117C
Eligibility criteria for permanent spinal cord injury
(1)
The eligibility criteria for a permanent
spinal cord injury resulting in a permanent neurological
deficit are—
(a)
the permanent neurological
deficit is classified as grade A, B, C or D on the
ASIA impairment scale, as assessed under the
ISNCSCI; and
(b)
the injury has resulted in a
residual significant impact on the function of the
autonomic nervous system, evidenced by a score of
0 for an item relating to bladder, bowel or sexual
function, as assessed under the ISAFSCI.
(2)
In this section—
ASIA impairment scale
means the scale, known as the American Spinal Injury
Association impairment scale, used for measuring
impairment resulting from a spinal cord injury and
published by the American Spinal Injury
Association.
ISAFSCI means the
document called ‘International standards to document
remaining autonomic function after spinal cord injury’,
published by the American Spinal Injury
Association.
ISNCSCI means the
document called ‘International standards for
neurological classification of spinal cord injury’,
published by the American Spinal Injury
Association.
s 117C ins 2016 Act No. 44
s 50
117D
Eligibility criteria for traumatic brain injury
(1)
The eligibility criteria for a traumatic
brain injury resulting in a permanent impairment are—
(a)
any or all of the following
apply—
(i)
the injury results in
post-traumatic amnesia lasting 7 days or more as
evidenced by an assessment using an approved
scale;
(ii)
the worker is or was in a
coma, other than an induced coma, for 1 hour or
more as a result of the injury;
(iii)
brain imaging shows a
significant brain abnormality as a result of the
injury; and
(b)
the worker’s functional
ability as a result of the injury is assessed as 5
or less for a motor or cognitive item using—
(i)
for an adult—the functional
independence measure instrument; or
(ii)
for a child—the childrens
functional independence measure instrument.
(2)
In this section—
approved scale, for
assessing post-traumatic amnesia, means—
(a)
the Westmead PTA scale;
or
(b)
a clinically accepted scale
similar to the Westmead PTA scale approved by the
Regulator for this definition.
Westmead PTA scale means
the clinical tool, known as the Westmead Post-traumatic
Amnesia Scale, used to assess the period a person
suffers post-traumatic amnesia.
s 117D ins 2016 Act No. 44
s 50
117E
Eligibility criterion for the amputation of a leg through or above
the femur
(1)
The eligibility criterion for the
amputation of a leg through or above the femur is that the
amputation involves the loss of 65% or more of the length of
the femur.
(2)
For subsection (1), the percentage of the
length of the femur lost must be worked out by—
(a)
comparing the length of the
femur before and after the amputation using X-rays
taken before and after the amputation; or
(b)
if X-rays of the femur are not
available—comparing the length of the femur of the
amputated leg with the length of the contralateral
femur.
(3)
To remove any doubt, it is declared that
the eligibility criterion in subsection (1) may be satisfied even if
the worker suffers from a personal injury that is the
amputation of more than 1 limb or parts of different
limbs.
s 117E ins 2016 Act No. 44
s 50
117F
Eligibility criteria for the amputation of more than 1 limb or
parts of different limbs
(1)
The eligibility criteria for the
amputation of more than 1 limb or parts of different limbs
are—
(a)
the amputations involve the
loss of 50% or more of the length of each of the
worker’s tibias; or
(b)
both of the worker’s upper
limbs are amputated at or above the first
metacarpophalangeal joint of the thumb and index
finger of each hand; or
(c)
the amputations involve—
(i)
the loss of 50% or more of
the length of 1 of the worker’s tibias; and
(ii)
1 of the worker’s upper
limbs being amputated at or above the first
metacarpophalangeal joint of the thumb and index
finger of the same hand.
(2)
For subsection (1), the percentage of the
length of the tibia lost must be worked out by—
(a)
comparing the length of the
tibia before and after the amputation using X-rays
taken before and after the amputation; or
(b)
if X-rays of the tibia are not
available—comparing the length of the tibia of the
amputated leg with the length of the contralateral
tibia; or
(c)
if the length of the
contralateral tibia can not be determined—using
the estimated knee height based on overall height
before the amputation.
s 117F ins 2016 Act No. 44
s 50
117G
Eligibility criteria for a full thickness burn to all or part of
the body
The eligibility criteria for a full thickness
burn to all or part of the body are—
(a)
the full thickness burn is
to—
(i)
for a worker younger than 16
years—more than 30% of the total body surface
area; or
(ii)
for a worker 16 years or
older—more than 40% of the total body surface
area; or
(iii)
both hands; or
(iv)
the face; or
(v)
the genital area; and
(b)
the worker’s functional ability as
a result of the injury is assessed as 5 or less for
a motor or cognitive item using—
(i)
for an adult—the functional
independence measure instrument; or
(ii)
for a child—the childrens
functional independence measure instrument.
s 117G ins 2016 Act No. 44
s 50
117H
Eligibility criterion for an inhalation burn resulting in a
permanent respiratory impairment
The eligibility criterion for an inhalation
burn resulting in a permanent respiratory impairment is that the
worker’s functional ability as a result of the injury is
assessed as 5 or less for a motor or cognitive item using—
(a)
for an adult—the functional
independence measure instrument; or
(b)
for a child—the childrens
functional independence measure instrument.
s 117H ins 2016 Act No. 44
s 50
117I
Eligibility criterion for permanent blindness caused by
trauma
(1)
The eligibility criterion for permanent
blindness caused by trauma is that the injured person has a
visual defect, or a combination of visual defects, that
result in visual loss that is, or is equivalent to—
(a)
visual acuity of less than
6/60 in both eyes, assessed using the Snellen
scale after correction by suitable lenses;
or
(b)
the constriction of the
worker’s field of vision to 10 degrees or less of
the arc around central fixation in the worker’s
better eye, regardless of corrected visual acuity
(equivalent to 1/100 white test object).
(2)
In this section—
Snellen scale means the
scale for measuring visual acuity using rows of letters
printed in decreasing sizes.
s 117I ins 2016 Act No. 44
s 50
Subdivision 3
Assessing eligibility
criteria
sdiv hdg ins 2016 Act No. 44
s 50
117J
Requirements for using functional independence measure instrument
or childrens functional independence measure instrument to assess
injuries
An assessment using the functional
independence measure instrument or childrens functional
independence measure instrument may be used for deciding whether
a serious personal injury meets the eligibility criteria for the
injury only if the assessment is carried out by a person who
is—
(a)
accredited by the Australasian
Rehabilitation Outcomes Centre to carry out the
assessment; and
(b)
approved by the insurer to carry
out the assessment.
s 117J ins 2016 Act No. 44
s 50
Division 2
Assessing worker’s needs
div hdg ins 2016
Act No. 44
s 50
Subdivision 1
Assessment
process
sdiv hdg ins 2016 Act No. 44
s 50
117K
Assessment generally
(1)
For section 232O(2)(a) of the Act, this section prescribes
requirements about assessing a matter mentioned in section 232O(1)(a) of the Act.
(2)
In carrying out the assessment, the
insurer must, to the extent practicable, consult with the
worker about the following matters—
(a)
the treatment, care and
support needs resulting from the serious personal
injury the worker considers are necessary and
reasonable;
(b)
the treatment, care or support
needed by the worker for any other injury
resulting from the same event as the serious
personal injury;
(c)
the worker’s abilities and
limitations;
(d)
the worker’s individual
goals.
(3)
The insurer may also consult with any
other person the insurer considers appropriate.
s 117K ins 2016 Act No. 44
s 50
117L
Intervals for carrying out assessments
For section 232O(2)(a) of the Act, an assessment under section 232O(1)(a) of the Act for an eligible worker must be
carried out—
(a)
as soon as practicable after the
insurer decides the worker is entitled to treatment,
care and support payments; and
(b)
if an assessment has been
previously carried out for the worker—within 1 year
after the last assessment was carried out.
s 117L ins 2016 Act No. 44
s 50
Subdivision 2
Matters for deciding
necessary and reasonable treatment, care and support needs
sdiv hdg ins 2016 Act No. 44
s 50
117M
Purpose of subdivision
(1)
For section 232N(b) of the Act, this subdivision prescribes
matters the insurer must consider in deciding whether an
eligible worker’s treatment, care and support needs
resulting from the worker’s serious personal injury are
necessary and reasonable in the circumstances.
(2)
This subdivision does not limit the
matters the insurer may consider in making a decision
mentioned in subsection (1).
s 117M ins 2016 Act No. 44
s 50
117N
Benefit to worker
(1)
The insurer must consider whether
providing treatment, care or support for, or relating to,
the worker’s treatment, care and support needs—
(a)
is likely to maximise the
worker’s independence, participation in the
community and employment; and
(b)
will assist the worker in
managing the injury.
(2)
In considering the matters mentioned in
subsection (1), the insurer must also
have regard to the following matters—
(a)
whether the treatment, care or
support relates directly to the worker’s
individual goals;
(b)
whether the treatment, care or
support will improve or maintain the worker’s
ability to conduct daily activities or participate
in the community or employment;
(c)
whether the treatment, care or
support has been provided to the worker
previously, resulting in an improvement to, or
assistance in managing, the worker’s injury;
(d)
whether the treatment, care or
support has a measurable outcome;
(e)
whether the worker has agreed
or is likely to agree that the treatment, care or
support will benefit the worker in the ways
mentioned in subsection (1);
(f)
any associated risks of the
treatment, care or support to the worker, weighed
against the expected benefit of the treatment,
care or support to the worker.
s 117N ins 2016 Act No. 44
s 50
117O
Appropriateness of service
(1)
The insurer must consider whether
treatment, care or support for, or relating to, the worker’s
treatment, care and support needs—
(a)
is consistent with other
treatment, care or support being received by the
worker; and
(b)
is consistent with current
clinical practice and other industry best practice
for the treatment, care or support of persons with
similar injuries.
(2)
In considering the matters mentioned in
subsection (1), the insurer must also
have regard to the following matters—
(a)
whether the treatment, care or
support will be consistent with the worker’s
future treatment, care or support needs;
(b)
whether the treatment, care or
support relates directly to the worker’s
individual goals;
(c)
whether the treatment, care or
support could be harmful to the worker;
(d)
whether similar treatment,
care or support is already being, or is to be,
provided to the worker for the injury;
(e)
whether there is evidence that
supports the effectiveness of the treatment, care
or support.
Examples of evidence—
•
peer-reviewed journal
articles
•
inclusion of the treatment
in clinical guidelines and frameworks
•
successful clinical
trials
•
inclusion in the medical
benefits schedule administered by the
Commonwealth
s 117O ins 2016 Act No. 44
s 50
117P
Appropriateness of provider
(1)
The insurer must consider whether
treatment, care or support for, or relating to, the worker’s
treatment, care and support needs is provided by an
appropriate provider.
(2)
In considering the matter mentioned in
subsection (1), the insurer must also
have regard to the following matters—
(a)
whether the provider, or the
provider’s staff, are appropriately qualified to
provide the treatment, care or support;
(b)
whether the provider is
appropriate having regard to, for example, the
worker’s location, age, culture and ethnicity;
(c)
whether the provider is
acceptable to the worker;
(d)
whether the provider has or
may have a conflict of interest in providing the
treatment, care or support to the worker;
(e)
whether the provider’s fee is
reasonable;
(f)
if, under section 232K(2) of the Act, the treatment, care or
support must be provided by a registered
provider—whether the provider is a registered
provider.
s 117P ins 2016 Act No. 44
s 50
117Q
Cost-effectiveness
(1)
The insurer must consider whether
treatment, care or support for, or relating to, the worker’s
treatment, care and support needs is cost-effective.
(2)
In considering the matter mentioned in
subsection (1), the insurer must also
have regard to the following matters—
(a)
the likely benefit to the
worker of receiving the treatment, care or support
weighed against the cost of providing the
treatment, care or support to the worker;
(b)
the cost of the treatment,
care or support compared with the cost of the same
or similar treatment, care or support provided by
other suitable providers;
(c)
whether there is a more
cost-effective way to provide the treatment, care
or support;
Examples—
•
considering whether leasing
equipment would be more cost-effective than
purchasing new equipment
•
considering whether the
treatment, care or support can be more
appropriately funded under another scheme
(d)
whether the cost of the
treatment, care or support is reasonable having
regard to the period for which it is required;
(e)
whether the cost of the
treatment, care or support exceeds an amount
prescribed for the treatment, care or support
under section 232R(4) of the Act.
s 117Q ins 2016 Act No. 44
s 50
Subdivision 3
Other matters relating to
assessing needs
sdiv hdg ins 2016 Act No. 44
s 50
117R
Additional requirement about assessing particular treatment, care
or support
(1)
This section applies if the insurer is
assessing a worker’s needs for, or relating to—
(a)
home modification; or
(b)
transport modification;
or
(c)
workplace modification;
or
(d)
attendant care and support
services that are personal assistance services or
services to assist a person to participate in the
community.
(2)
In carrying out the assessment, the
insurer must obtain and consider information about the needs
mentioned in subsection (1) from a person who is
appropriately qualified to give advice about the
needs.
Example of
appropriately qualified persons—
an occupational therapist
specialising in home or workplace
modifications
s 117R ins 2016 Act No. 44
s 50
117S
Treatment, care or support that must be provided by a registered
provider
For section 232K(2)(b) of the Act, the following treatment, care or
support is prescribed—
(a)
a home modification;
(b)
workplace modification;
(c)
a service for the coordination of
treatment, care or support.
Example for
paragraph (c)—
a case manager engaged to coordinate a
worker’s treatment, care and support
s 117S ins 2016 Act No. 44
s 50
Subdivision 4
Support plans and service
requests
sdiv hdg ins 2016 Act No. 44
s 50
117T
Support plans
(1)
For section 232O(3) of the Act, this section prescribes
requirements about an eligible worker’s support plan.
(2)
The support plan must state—
(a)
the name of the worker;
and
(b)
the outcomes of the assessment
under section 232O(1)(a) of the Act; and
(c)
the matters stated in section 117K(2), if known by the insurer; and
(d)
any treatment, care and
support needs resulting from the worker’s serious
personal injury the insurer considers are
necessary and reasonable in the circumstances;
and
(e)
any treatment, care or support
resulting from any other injury resulting from the
same event as the serious personal injury that the
insurer considers is necessary and reasonable in
the circumstances; and
(f)
any other treatment, care or
support for the serious personal injury, or any
other injury resulting from the same event as the
serious personal injury, the insurer agrees to,
wholly or partly, pay for under chapter 4A of the Act, having regard to the
following matters—
(i)
whether the treatment, care
or support is needed by the worker as a result of
the injury;
(ii)
whether it would be fair and
reasonable in the circumstances for the insurer to
pay for the treatment, care or support, wholly or
partly;
(iii)
whether providing the
treatment, care or support will, or is likely to,
reduce the worker’s treatment, care and support
needs for the injury;
(iv)
whether the insurer
considers, wholly or partly, paying for the
treatment, care or support is more practical or
cost-effective than the insurer paying for the
worker’s treatment, care and support needs for the
injury, without compromising the level of
treatment, care or support received by the worker
under chapter 4A of the Act;
(v)
whether the treatment, care
or support is excluded treatment, care or
support;
(vi)
where the treatment, care or
support is to be provided, including, for example,
whether the treatment, care or support is to be
provided outside Australia; and
(g)
the intervals at which an
assessment under section 232O(1)(a) of the Act will be carried out for
the worker.
(3)
The support plan must be consistent with
an existing decision on a service request relating to the
worker.
(4)
However, subsection (3) applies only to the extent
the support plan relates to the period covered by the
existing decision.
s 117T ins 2016 Act No. 44
s 50
117U
Amending support plans
(1)
For section 232O(5) of the Act, this section prescribes
requirements about amending an eligible worker’s support
plan under section 232O(4)(a) of the Act.
(2)
An amendment of the support plan must be
consistent with an existing decision on a service request
relating to the worker.
(3)
However, subsection (2) applies only to the extent
the support plan relates to the period covered by the
existing decision.
s 117U ins 2016 Act No. 44
s 50
117V
Deciding service request
(1)
For section 232P(4) of the Act, this section prescribes the
matters an insurer must consider in deciding a service
request relating to an eligible worker.
(2)
The insurer must consider the following
matters—
(a)
whether or not the requested
service relates to—
(i)
the worker’s treatment, care
and support needs resulting from the worker’s
serious personal injury; or
(ii)
the worker’s need for
treatment, care or support resulting from another
injury resulting from the same event as the
worker’s serious personal injury;
(b)
if the requested service
relates to the treatment, care and support needs
mentioned in paragraph (a)(i)—whether or not the needs are
necessary and reasonable in the
circumstances;
(c)
if the requested service
relates to the treatment, care or support
mentioned in paragraph (a)(ii)—whether or not the treatment, care
or support is necessary and reasonable in the
circumstances;
(d)
if the requested service does
not relate to treatment, care and support needs or
treatment, care or support mentioned in paragraph (a), or the insurer does
not consider the needs or the treatment, care or
support mentioned in the paragraph are necessary
and reasonable in the circumstances—whether or not
the insurer considers the insurer should, wholly
or partly, pay for the requested service under
chapter 4A of the Act, having regard to the
matters mentioned in section 117T(2)(f).
s 117V ins 2016 Act No. 44
s 50
Division 3
Payment options
div hdg ins 2016
Act No. 44
s 50
117W
Circumstances in which payment request may be made
(1)
For section 232Q(3)(b) of the Act, this section prescribes the
circumstances for making a payment request for an expense for
the treatment, care or support of an eligible worker.
(2)
A payment request may not be made for the
expense if—
(a)
the person has entered into a
funding agreement with the insurer for the
treatment, care or support; and
(b)
the expense was incurred in the
period covered by the funding agreement.
(3)
A payment request must be made within 6 months
after the expense is incurred.
(4)
However, the insurer may accept a later
payment request if the insurer considers it is fair and
reasonable in the circumstances to accept the request.
s 117W ins 2016 Act No. 44
s 50
117X
Deciding payment request
(1)
For section 232R(2) of the Act, this section prescribes matters
about an insurer deciding a payment request for an expense for
the treatment, care or support of an eligible worker.
(2)
If the insurer makes an information request
and the person of whom it is made does not provide the
information requested by the stated day or a later day agreed
between the insurer and the person—
(a)
the payment request lapses;
and
(b)
the insurer is not required to
approve or refuse the request.
(3)
The insurer must approve the payment request
if—
(a)
the expense is incurred in the
eligibility period for the worker; and
(b)
the treatment, care or support the
request relates to is an approved service for the
worker.
(4)
To remove any doubt, it is declared that the
insurer may approve the payment request even though the
treatment, care or support the request relates to is not an
approved service for the worker.
(5)
In this section—
approved service does not
include treatment, care or support that is excluded
treatment, care or support, unless—
(a)
if a support plan has been
made for the eligible worker—the excluded
treatment, care or support is specifically stated
in the support plan to be—
(i)
treatment, care or support
for, or relating to, the worker’s treatment, care
and support needs resulting from the worker’s
serious personal injury the insurer considers is
necessary and reasonable in the circumstances;
or
(ii)
treatment, care or support
resulting from another injury resulting from the
same event as the worker’s serious personal injury
the insurer considers is necessary and reasonable
in the circumstances; or
(iii)
treatment, care or support
the insurer agrees to, wholly or partly, pay for
under chapter 4A of the Act; or
(b)
if a support plan has not been
made for the eligible worker—the excluded
treatment, care or support is specifically
approved under an approval of a service request
relating to the worker.
information request, for a
payment request, means a written request made by the
insurer—
(a)
asking a relevant person for
further information about the payment request by a
stated day of at least 10 business days after the
insurer makes the request; and
(b)
stating that, if the requested
information is not given to the insurer by the
stated day, the payment request will lapse.
relevant person, for an
information request, means—
(a)
the person who made the
payment request; or
(b)
if the person who made the
payment request is not the eligible worker—the
eligible worker.
s 117X ins 2016 Act No. 44
s 50
117Y
Limit
on amount payable under payment request
For section 232R(4)
of the Act, the amount prescribed is—
(a)
for medical treatment or
rehabilitation—the amount stated in the relevant table
of costs; or
(b)
for hospitalisation of the worker as
an in-patient at a private hospital—the amount stated in
section 217(3) of the Act; or
(c)
for hospitalisation of the worker as
an in-patient at a public hospital—the amount stated in
section 218A(3) of the Act.
s 117Y ins 2016 Act No. 44
s 50
Division 4
Review
of entitlement
div hdg ins 2016
Act No. 44
s 50
117Z
Review of worker’s entitlement
(1)
This section prescribes matters for a review
of a worker’s entitlement to treatment, care and support
payments under section 232S of the Act.
(2)
The insurer must give the worker written
notice of the review at least 20 business days before carrying
out the review.
(3)
In carrying out the review, the insurer may
ask the worker to give the insurer information needed to make a
decision about the worker’s entitlement at the end of the
review.
s 117Z ins 2016 Act No. 44
s 50
Part 6
Damages
Division 1
Particulars in notice of claim
118
Notice
of claim for damages—Act, s 275
For section 275(3) of the Act, the
particulars contained in this division are prescribed.
119
Particulars of claimant and worker
(1)
A notice of claim must include—
(a)
the worker’s—
(i)
full name and any other
known names; and
(ii)
residential address;
and
(iii)
date of birth; and
(iv)
gender; and
(v)
usual occupation and, if
that differs from the nature of employment at the
time the worker was injured, the nature of the
employment at that time; and
(b)
the name and address of every
employer of the worker at the time the worker was
injured.
(2)
Also, if the claimant is not the worker, the
notice of claim must include the claimant’s—
(a)
full name and any other known
names; and
(b)
residential address; and
(c)
date of birth; and
(d)
gender.
120
Particulars of event
A notice of claim must include the
following—
(a)
the date, time and place of the
event;
(b)
the claimant’s description of the
facts of the circumstances surrounding the worker’s
injury;
(c)
the names and addresses of all
witnesses to the injury, and their relationship, if any,
to the worker;
(d)
the name and address of any person on
behalf of the claimant’s employer to whom the claimant
reported the injury and the details of their
employment;
(e)
the full particulars of the negligence
alleged against the claimant’s employer and any other
party on which the claim is based;
(f)
if a party other than the claimant’s
employer is involved—
(i)
the liability expressed as a
percentage that the claimant holds the other party
responsible; and
(ii)
details of the notice of
claim given to the party.
121
Injury
particulars
(1)
A notice of claim must include, full
particulars of the nature and extent of—
(a)
all injuries alleged to have been
sustained by the claimant or worker because of the
event resulting in the injury; and
(b)
the degree of permanent impairment
that the claimant alleges has resulted from the
injuries; and
(c)
the amount of damages sought under
each head of damage claimed by the claimant and the
method of calculating each amount; and
(d)
how the claimant or worker is
currently affected by the injuries.
(2)
Also, the notice of claim must include all
personal injuries, illnesses and impairments of a medical,
psychiatric or psychological nature sustained by the claimant or
worker, either before or after the event—
(a)
that may affect—
(i)
the extent of the permanent
impairment resulting from the injury to which the
claim relates: or
(ii)
the amount of damages in
another way; and
(b)
for which the claimant has claimed
damages, compensation or benefits—
(i)
the name and address of any
person against whom a claim for damages or
compensation was made; and
(ii)
if an insurer or other
insurance provider was involved in that claim—the
name and address of that entity.
122
Particulars of hospital, treatment and rehabilitation
(1)
A notice of claim must include the name and
address of each of the following—
(a)
each hospital at which the
claimant or worker has been treated for the
injury;
(b)
each doctor who treated the
claimant or worker for the injury;
(c)
each provider of treatment or
rehabilitation services assessed, treated, or
provided treatment or rehabilitation services for,
permanent impairment arising from the injury.
(2)
Also, if section 121(2) applies, the notice of claim must include the
name and address of—
(a)
each hospital at which the
claimant or worker has been treated for an injury,
illness or impairment; and
(b)
each doctor who treated the
claimant for the injury, illness or
impairment.
123
Particulars if claim for diminished income earning capacity
If the claimant claims damages for diminished
income earning capacity, a notice of claim must include the
following particulars of the claimant’s employment for the 3 year
period immediately before the event, and the period since the
event—
(a)
the name and address of each of the
claimant’s employers;
(b)
the period of employment by each
employer;
(c)
the capacity in which the claimant was
employed by each employer;
(d)
the claimant’s gross and net (after
tax) earnings for each period of employment;
(e)
the periods during which the claimant
was receiving payments from Centrelink on behalf of the
department in which the Social Security
Act 1991 (Cwlth) is
administered;
(f)
the periods during which the claimant
received no income, and the reasons why the claimant was
not receiving any income.
Note—
See also section 276 of the Act.
124
Particulars if injury causes death
(1)
A notice of claim relating to an injury
causing death must include the following additional
particulars—
(a)
if the claimant is the spouse of
the deceased worker—
(i)
the relevant date; and
(ii)
the relevant place;
and
(iii)
the claimant’s net (after
tax) weekly income immediately before and after
the worker’s death; and
(iv)
the age to which the
claimant intended to work and the basis of the
claimant’s future employment, that is, whether
full-time or part-time; and
(v)
details of any health
problems that the claimant currently has;
and
(vi)
the amount of average weekly
financial benefit derived by the claimant from the
deceased worker before the worker’s death and the
method of calculating the amount; and
(vii)
the expected date of birth
of a posthumous child of the relationship;
and
(viii)
details of any remarriage or
start of a marriage-like relationship; or
(b)
if the claimant is not the spouse
of the deceased worker—
(i)
the claimant’s relationship
to the deceased worker; and
(ii)
the claimant’s net (after
tax) weekly earnings; and
(iii)
the age to which the
claimant would have been dependent on the deceased
worker and the basis of the dependency; and
(iv)
details of any health
problems that the claimant currently has;
and
(v)
the amount of average weekly
financial benefit derived by the claimant from the
deceased worker immediately before the worker’s
death and the method of calculating the
amount.
(2)
In this section—
relevant date
means—
(a)
the date of marriage;
or
(b)
the date the civil
partnership had effect; or
(c)
the date on which the de
facto relationship started.
relevant place
means—
(a)
the place of the marriage;
or
(b)
the place of registration of
the civil partnership; or
(c)
the residential address
where the de facto relationship started.
s 124 amd 2016 SL No. 15
s 22
sch 1
125
Particulars of mitigation
A notice of claim must include all steps taken by
the worker or claimant to mitigate their loss.
Division 2
General
provisions
126
Time
for adding another person as contributor—Act, s 278A(1)
For section 278A(1) of the Act, the
prescribed time is the later of the following—
(a)
30 business days after the insurer
receives the notice of claim;
(b)
5 business days after the insurer
identifies someone else as a contributor.
127
Contribution notice to contain particular information—Act, s 278B(1)(a)
For section 278B(1)(a) of the Act, the following information is prescribed—
(a)
the contributor’s full name;
(b)
the contributor’s business
address;
(c)
the contributor’s postal
address;
(d)
the name and contact details of the
contributor’s legal representatives, if appointed;
(e)
the contributor’s ABN, if any;
(f)
if the contributor is a
corporation—
(i)
the corporation’s ACN;
and
(ii)
the corporation’s registered
office.
Part 7
Assessment of
damages
128
Prescribed
amount of damages for loss of consortium or loss of servitium—Act, s 306M(1)(b)
For an injury sustained during a period stated in an
item of the following table, the amount stated in the item is
prescribed.
Item
Period (dates inclusive)
Amount
1
1 July 2010 to 30 June 2011
$35,340
2
1 July 2011 to 30 June 2012
$36,350
3
1 July 2012 to 30 June 2013
$38,290
4
1 July 2013 to 30 June 2014
$39,430
5
1 July 2014 to 30 June 2015
$40,920
6
1 July 2015 to 30 June 2017
$41,920
7
1 July 2017 to 30 June 2018
$42,650
8
1 July 2018 to 30 June 2019
$43,960
9
1 July 2019 and after
$45,290
s 128 sub 2015 SL No. 47
s 12
amd 2017
SL No. 110
s 12; 2018
SL No. 82
s 10; 2019
SL No. 113
s 10
129
Rules for
assessing injury scale value—Act, s 306O(1)(c)(i)
For section 306O(1)(c)(i) of the Act, a court must have regard to the following—
(a)
for assessment of the ranges of injury
scale value—the ranges mentioned in schedule 9;
(b)
for matters to which a court is to have
regard in the application of schedule 9—the rules mentioned in schedule 8;
(c)
for the PIRS that must be used with
schedule 9—the scales mentioned in
schedule 11;
(d)
for matters relevant to the application of
schedule 11 and requirements with which a
medical expert must comply in assessing a PIRS rating—the
matters mentioned in schedule 10.
130
General
damages calculation provisions—Act, s 306P(2), definition general damages calculation
provisions
(1)
For each period stated in a table in schedule 12, this section and that table are the
general damages calculation provisions for the period.
(2)
For an injury within the injury scale value stated
in an item of a table, the general damages are the sum of—
(a)
the base amount for the item (if any);
and
(b)
the variable amount for the
item.
(3)
In this section—
variable amount means
the amount worked out in the way stated in the
column of a table with the heading ‘variable
amount’.
s 130 sub 2015 SL No. 47
s 13
131
Prescribed
amount of award for future loss—Act, s 306R(2)
For an injury sustained during a period stated in an
item of the following table, the amount stated in the item is
prescribed.
Item
Period (dates inclusive)
Amount
1
1 July 2010 to 30 June 2011
$117,800
2
1 July 2011 to 30 June 2012
$121,160
3
1 July 2012 to 30 June 2013
$127,620
4
1 July 2013 to 30 June 2014
$131,420
5
1 July 2014 to 30 June 2015
$136,400
6
1 July 2015 to 30 June
2017
$139,740
7
1 July 2017 to 30 June
2018
$142,160
8
1 July 2018 to 30 June
2019
$146,540
9
1 July 2019 and after
$150,970
s 131 sub 2015 SL No. 47
s 13
amd 2017
SL No. 110
s 13; 2018
SL No. 82
s 11; 2019
SL No. 113
s 11
Part 8
Costs
Division 1
Proceeding before industrial magistrate or industrial commission
132
Costs—proceeding before industrial magistrate or industrial
commission
(1)
A decision to award costs of a proceeding
heard by an industrial magistrate or the industrial commission
is at the discretion of the magistrate or commission.
(2)
If the magistrate or commission awards
costs—
(a)
costs in relation to counsel’s or
solicitor’s fees are as under the Uniform Civil
Procedure Rules 1999, schedule 2, part 2, scale C;
and
(b)
costs in relation to witnesses’
fees and expenses are as under the Uniform Civil
Procedure (Fees) Regulation 2019,
part 3; and
(c)
costs in relation to bailiff’s
fees are as under the Uniform Civil
Procedure (Fees) Regulation 2019,
schedule 2, part 2.
(3)
The magistrate or commission may allow costs
up to 1.5 times the amounts provided for under subsection (2)(a), in total or in relation to any item, if the
magistrate or commission is satisfied the amounts are inadequate
having regard to—
(a)
the work involved; or
(b)
the importance, difficulty or
complexity of the matter to which the proceeding
relates.
s 132 amd 2018
SL No. 127
s 77; 2019 SL No. 168
s 37
sch 5
133
Payment of additional amount for costs
(1)
This section applies if—
(a)
the Regulator or an insurer is
required to pay costs in a proceeding in relation to
a witness who—
(i)
is a medical practitioner;
or
(ii)
gives evidence of a
professional nature; and
(b)
the amount of fees and expenses
payable in relation to the witness by the party that
called the witness is more than the amount of costs
allowed by the industrial magistrate or the
industrial commission.
(2)
The Regulator or the insurer may, on the
application of the party that called the witness, pay an
additional amount for costs that the Regulator or the insurer is
satisfied are reasonable, having regard to the subject matter of
the proceeding.
Division 2
Claim
for damages
134
Who
this division applies to
This division applies to a claimant who is—
(a)
a worker whose DPI is 20% or more;
or
(b)
a worker who has a terminal condition;
or
(c)
a dependant.
135
Costs
before proceeding started
(1)
This section prescribes the legal professional
costs of a claim before a proceeding is started.
(2)
If a claimant recovers at least $150,000 net
damages, the costs are—
(a)
if the claim is settled—
(i)
without holding a compulsory
conference—120% of the amount in schedule 6, column A; or
(ii)
after a compulsory
conference is held—the amounts in schedule 6, columns A and B;
and
(b)
for investigation of liability by
an expert—the amount in schedule 6, column C; and
(c)
for an application to the
court—the amount in schedule 6, column D.
(3)
If a claimant recovers net damages of $50,000
or more but less than $150,000, the costs are 85% of the amount
calculated under subsection (2).
(4)
If a claimant recovers less than $50,000 net
damages, the costs are 85% of the amount calculated under
subsection (2) multiplied by the proportion
that the net damages bear to $50,000.
Example of
subsection (4)—
If the net damages recovered are
$30,000, the costs are (85% of the amount calculated
under subsection (2)) x
3/5.
(5)
However, if a court in the proceeding awards
the payment of legal costs, the costs recoverable under subsections (2), (3) and (4) are multiplied by 120%.
(6)
In this section—
net damages means the
damages recovered less the compensation paid by an
insurer.
136
Costs
after proceeding started
(1)
This section prescribes the legal professional
costs of a claim after a proceeding is started.
(2)
The costs are chargeable under the relevant
scales of costs for work done for or in a proceeding in the
court.
(3)
However, the costs do not include—
(a)
the cost of work performed before
the proceeding is started; or
(b)
the cost of work performed before
the proceeding is started that is performed again
after the proceeding is started.
137
Outlays
(1)
In addition to legal costs, the following
outlays incurred by the claimant are allowed—
(a)
1 hospital report fee for each
hospital that treated the worker’s injury;
(b)
1 report fee for each doctor in
general practice who treated the worker’s
injury;
(c)
1 medical specialist’s report fee
for each medical discipline reasonably relevant and
necessary for the understanding of the worker’s
injury;
(d)
1 report fee of an expert
investigating liability, of not more than $1,000,
less any proportion of the fee agreed to be paid by
the insurer;
(e)
Australian Taxation Office or tax
agents’ fees for supplying copies of income tax
returns;
(f)
fees charged by the claimant’s
previous employers for giving information necessary
for the claimant to complete the notice of claim,
but not more than $50 for each employer;
(g)
fees charged by a mediator of an
amount previously agreed to by the insurer;
(h)
filing fees or other necessary
charges incurred in relation to an application to
the court before a proceeding is started;
(i)
reasonable fees for sundry items
properly incurred, other than photocopying
costs.
(2)
The fees—
(a)
are allowable only for reports
mentioned in subsection (1)(a) to (d) disclosed before the start of
proceedings; and
(b)
for subsection (1)(a) to (c)—are payable according to the
recommended Australian Medical Association scale of
fees.
Part 9
Medical
assessment tribunals
138
Medical
assessment tribunals—Act, s 492
For section 492 of the Act each of the following is prescribed—
(a)
the General Medical Assessment
Tribunal;
(b)
specialty medical tribunals, including the
following—
(i)
the Cardiac Assessment
Tribunal;
(ii)
the Orthopaedic Assessment
Tribunal;
(iii)
the Dermatology Assessment
Tribunal;
(iv)
the Ear, Nose and Throat
Assessment Tribunal;
(v)
the Neurology/Neurosurgical
Assessment Tribunal;
(vi)
the Ophthalmology Assessment
Tribunal;
(vii)
the Disfigurement Assessment
Tribunal;
(c)
the Composite Medical Assessment
Tribunal.
139
Constitution of General Medical Assessment Tribunal
(1)
For deciding a matter referred to the General
Medical Assessment Tribunal, the tribunal is constituted by—
(a)
if the chairperson is a
specialist—
(i)
the chairperson; and
(ii)
2 appointees to the panel of
doctors for the tribunal chosen by the
chairperson; or
(b)
if the chairperson is not a specialist
and there is at least 1 deputy chairperson who is a
specialist—
(i)
a deputy chairperson who is
a specialist chosen by the Regulator; and
(ii)
2 appointees to the panel of
doctors for the tribunal chosen by the deputy
chairperson; or
(c)
otherwise—
(i)
the chairperson; and
(ii)
2 appointees to the panel of
doctors for the tribunal designated by the
chairperson.
(2)
When choosing a member of the panel for the
tribunal under subsection (1)(a)(ii), (b)(ii) or (c)(ii), the chairperson or deputy
chairperson must consider the medical specialty that is relevant to
the matters referred to the tribunal.
(3)
In this section—
specialist means a
specialist in the medical specialty relevant to the matters
referred to the tribunal.
140
Chairperson and deputy chairperson of General Medical Assessment
Tribunal
(1)
A chairperson must preside over meetings of the
General Medical Assessment Tribunal.
(2)
However, if a deputy chairperson is designated
under section 139(1)(b)(i)
for deciding a matter referred to the General Medical Assessment
Tribunal, the deputy chairperson must act as chairperson and preside
over the meetings of the tribunal for deciding the matter.
(3)
Also, if the chairperson is not available to
attend to the business of the General Medical Assessment Tribunal,
other than deciding a matter mentioned in subsection (2), a deputy chairperson must act as
chairperson.
(4)
A deputy chairperson may act as a member of the
General Medical Assessment Tribunal only if the deputy chairperson
has been chosen for the purpose—
(a)
under section 139; or
(b)
by the chairperson.
141
Constitution of a specialty medical tribunal
(1)
For deciding a matter referred to a specialty
medical tribunal, the tribunal is constituted by—
(a)
its chairperson; and
(b)
2 appointees to the panel of doctors
for the tribunal, including persons appointed to the
panel as deputy chairpersons, chosen by the
chairperson.
(2)
When choosing a member of the panel for a
specialty medical tribunal, the chairperson must consider the
medical specialty that is relevant to the matters referred to the
tribunal for decision.
142
Chairperson and deputy chairperson of a specialty medical
tribunal
(1)
The chairperson must preside over meetings of a
specialty medical tribunal.
(2)
If the chairperson is not available to attend to
the business of a specialty medical tribunal—
(a)
if there is only 1 deputy chairperson
of the tribunal—the deputy chairperson must act as
chairperson; or
(b)
if there is more than 1 deputy
chairperson of the tribunal—a deputy chairperson
designated by the chairperson must act as
chairperson.
143
Constitution of Composite Medical Tribunal
(1)
The constitution of a Composite Medical Tribunal
is to be decided by—
(a)
the chairperson of the tribunal;
and
(b)
if the chairperson of the tribunal is
not the chairperson of the General Medical Assessment
Tribunal—the chairperson of the General Medical
Assessment Tribunal; and
(c)
the chairperson of each specialty
medical assessment tribunal relevant to the matters to
be decided.
(2)
The chairpersons must consult with the secretary
of a Composite Medical Tribunal about the constitution of the
tribunal.
(3)
When deciding the constitution of a Composite
Medical Tribunal, the chairpersons must consider the medical
specialty that is relevant to the matter referred to the tribunal
for decision.
(4)
For deciding a matter referred to a Composite
Medical Tribunal, the tribunal is constituted by—
(a)
a chairperson; and
(b)
at least 2 but not more than 4
appointees to the panel of doctors for the composite
tribunal chosen by the chairperson.
(5)
For a serious personal injury matter, the
chairperson is the chairperson of the General Medical Assessment
Tribunal.
(6)
The composite tribunal must consist of at least 1
specialist for each type of injury that is a subject of the
reference to the tribunal.
(7)
However, the number of specialists for each type
of injury must be equal.
Example—
A worker has a post-traumatic stress
disorder and a fractured arm, leg, and ribs. The tribunal
would consist of—
(a)
1 psychiatrist and 1
orthopaedic surgeon; or
(b)
2 psychiatrists and 2
orthopaedic surgeons.
(8)
If, because of subsection (6), there would be an even number of
members on the composite tribunal, the chairperson must also
designate a physician to be a member of the tribunal.
Example—
A worker has 3 different types of
injuries. The tribunal would consist of the chairperson and
3 specialists. A physician is also to be a member of the
tribunal.
(9)
In this section—
serious personal injury matter
means a matter referred to the tribunal under—
(a)
section 500(1)(fa), (fb) or (fc) of the Act; or
(b)
the National Injury
Insurance Scheme (Queensland) Act
2016, section 113.
s 143 amd 2016
Act No. 44
s 51
144
Chairperson and deputy chairperson of Composite Medical Tribunal
(1)
The chairperson must preside over meetings of a
Composite Medical Tribunal.
(2)
If the chairperson is not available to attend to
the business of a Composite Medical Tribunal—
(a)
if there is only 1 deputy chairperson
of the tribunal—the deputy chairperson must act as
chairperson; or
(b)
if there is more than 1 deputy
chairperson of the tribunal—a deputy chairperson
designated by the chairperson must act as
chairperson.
Part 10
Miscellaneous
145
Declaration of designated courts—Act, s 114(4), definition designated court
(1)
This section is made for section 114(4) of the Act, definition designated court, paragraph (b).
(2)
Each court, tribunal or decision-making body
mentioned in schedule 7, column 2, set out opposite the name
of a State in schedule 7, column 1, is declared.
146
Declaration of provisions—Act, s 322(2), definition a
State’s legislation about damages for a work related
injury
(1)
This section is made for section 322(2) of the Act, definition a
State’s legislation about damages for a work related
injury, paragraph (b).
(2)
Each provision mentioned in schedule 7, column 3, set out opposite the name
of a State in schedule 7, column 1, is declared.
147
Documents
and particulars to be kept—Act, s 532D(1) and (2)
(1)
For section 532D(1) and (2) of the Act, the
following are prescribed—
(a)
if the employer must keep a time and
wages record for the employee under the Industrial
Relations Act 1999, section 366—the time
and wages record; or
(b)
if the employer must keep an
employee’s records under the Fair
Work Act 2009 (Cwlth), section 535—the
employee record; or
(c)
documents, or accurate and complete
copies of documents, required to be kept under a law of
the Commonwealth for payments made to the employer’s
workers or contractors for the performance of work,
including, for example—
(i)
group certificates;
and
(ii)
group employer’s
reconciliation statements; and
(iii)
tax invoices to claim a GST
credit; and
(iv)
invoices from a contractor
received for work; or
(d)
the person’s profit and loss account,
to the extent the account relates to amounts paid for
wages for workers, or to contractors.
(2)
However, a document mentioned in subsection (1)(c)
or (d)
need not contain information an employer or contractor reasonably
believes is—
(a)
confidential; and
(b)
not necessary to enable the Regulator
or WorkCover to calculate the person’s actual
expenditure on wages or for contracts for the period to
which the document relates.
Examples—
•
income and profit lines
•
tax file numbers
(3)
An employer or contractor need not comply with
subsection (1) if—
(a)
the Regulator or WorkCover has given
the employer or contractor notice that a document need
not be kept, and the notice remains in force; or
(b)
the employer or contractor was a
corporation and has been wound up.
(4)
In this section—
employee record see Fair Work Act 2009
(Cwlth), section 12.
time and wages record see
Industrial Relations
Act 1999, section 363.
worker does not include a
household worker.
148
Reasons
for decisions must address certain matters—Act, ss 540(4) and 546(3AA)
(1)
For sections 540(4) and 546(3AA) of the Act, the
following matters are prescribed—
(a)
citation of the provision of the
Act
under which the decision is made; and
(b)
a statement of—
(i)
the evidence considered for
the decision; and
(ii)
the evidence that was
accepted or rejected for the decision and why the
evidence was accepted or rejected; and
(iii)
the conclusions drawn from
the evidence; and
(iv)
the link between the
evidence, the conclusions and the relevant
provision of the Act; and
(v)
the decision made.
(2)
Each reason for a decision must be written in
plain English.
Part 11
Savings and
transitional provision for Workers’ Compensation and Rehabilitation Amendment
Regulation (No. 1) 2015
pt hdg ins 2015 SL No. 135
s 10
149
Decision
about qualifying condition if DPI decided before commencement
(1)
This section applies if—
(a)
before the commencement—a worker’s DPI
was decided; and
(b)
on the commencement—the worker is a
specified worker.
(2)
The insurer must, as soon as practicable after the
commencement, decide the matters mentioned in section 112F for the worker.
s 149 ins 2015
SL No. 135
s 10
Schedule 1
Additional
premium
section 8
Time of lodgement of declaration of
wages
Additional premium
on or after 1 September and not later
than 31 October in 1 calendar year
the greater of—
(a)
5% of assessed premium for
the period of insurance to which the declaration
relates; or
(b)
$5
on or after 1 November and not later
than 30 November in 1 calendar year
the greater of—
(a)
10% of assessed premium for
the period of insurance to which the declaration
relates; or
(b)
$10
on or after 1 December and not later
than 31 December in 1 calendar year
the greater of—
(a)
15% of assessed premium for
the period of insurance to which the declaration
relates; or
(b)
$15
on or after 1 January in the next
calendar year
the greater of—
(a)
20% of assessed premium for
the period of insurance to which the declaration
relates; or
(b)
$20
Schedule 2
Graduated scale for
additional compensation for workers with terminal latent onset injuries
section 107
1
Graduated
scale
(1)
This schedule contains the graduated scale for
additional compensation for a worker who has a terminal condition that
is a latent onset injury.
(2)
The maximum amount of lump sum compensation payable
under this schedule is $307,385.
2
How to use
the graduated scale
The worker’s additional lump sum compensation entitlement
is the amount shown in column 2 that corresponds to the age of the worker
when the worker lodges the worker’s application for compensation as shown in
column 1.
Graduated scale
Column 1
Worker’s age
Column 2
Additional lump sum
compensation
$
70 years or
under
307,385
71
years
276,647
72
years
245,908
73
years
215,170
74
years
184,431
75
years
153,693
76
years
122,954
77
years
92,216
78
years
61,477
79
years
30,739
80 years or
over
nil
Schedule 3
Graduated scale of
additional compensation for workers with DPI of 30% or more
section 109
1
Graduated
scale
(1)
This schedule contains the graduated scale for
additional compensation for a worker who sustains an injury that results
in a DPI of 30% or more.
(2)
The maximum amount of lump sum compensation payable
under this schedule is $307,385.
2
How to use
the graduated scale
A worker who sustains a DPI shown in column 1 is entitled
to additional lump sum compensation in the amount shown for the
corresponding entry in column 2.
Graduated scale
Column 1
DPI
Column 2
Additional lump sum
compensation
%
$
30
11,565
31
18,138
32
24,712
33
31,286
34
37,860
35
44,433
36
51,007
37
57,581
38
64,155
39
70,728
40
77,302
41
83,876
42
90,451
43
97,023
44
103,597
45
110,172
46
116,744
47
123,319
48
129,893
49
136,467
50
143,040
51
149,614
52
156,188
53
162,762
54
169,335
55
175,909
56
182,483
57
189,057
58
195,630
59
202,204
60
208,778
61
215,352
62
221,925
63
228,499
64
235,074
65
241,648
66
248,220
67
254,795
68
261,369
69
267,943
70
274,516
71
281,090
72
287,664
73
294,238
74
300,811
75–100
307,385
sch 3 amd 2015 SL No. 135
s 11
Schedule 4
Graduated scale for
additional compensation for gratuitous care
section 112
1
Graduated
scale
(1)
This schedule contains the graduated scale for
additional compensation for gratuitous care.
(2)
The maximum amount of lump sum compensation payable
under this schedule is $348,210.
2
How to use
the graduated scale
(1)
The DPI is shown in column 1.
(2)
The range of dependency assessed under the modified
barthel index is shown in column 2.
(3)
In column 2—
(a)
moderate is a modified barthel index total
score of 50–74; and
(b)
severe is a modified barthel index total
score of 25–49; and
(c)
total is a modified barthel index total
score of 0–24.
(4)
The worker’s additional lump sum compensation
entitlement is shown for the corresponding entry in column 3.
Graduated
scale
Column 1
DPI
Column 2
Range of dependency
(modified barthel index)
Column 3
Additional lump sum
compensation
%
$
15–39
moderate
severe
total
2,820
5,633
8,438
40–49
moderate
severe
total
5,249
10,682
15,923
50–59
moderate
severe
total
23,239
46,455
69,671
60–69
moderate
severe
total
58,075
104,491
139,312
70–79
moderate
severe
total
81,268
150,924
208,944
80–89
moderate
severe
total
92,872
187,711
278,577
90–94
moderate
severe
total
104,491
208,944
324,994
95–100
moderate
severe
total
116,080
232,191
348,210
Schedule 4A
Section 193A compensation
for specified workers
section 112C
sch hdg ins 2015 SL No. 135
s 12
1
Amount of
section 193A
compensation
Section 193A compensation consists of the following
amounts for an injury sustained by a specified worker in relation to whom
the qualifying condition is satisfied—
(a)
an amount of compensation (the DPI amount)—
(i)
payable under the graduated scale
in section 2 of this schedule;
and
(ii)
applied to multiple injuries in
the way provided for under section 3 of this schedule;
(b)
an amount of compensation (the legal cost amount) payable
towards legal costs if the worker engages a lawyer and incurs
legal costs for particular things done under part 4, division 3A.
s 1 ins 2015 SL No. 135
s 12
2
DPI
amount generally
A worker who sustains a DPI shown in column 1 is entitled
to the amount shown in column 2 opposite the DPI.
Graduated scale
Column 1
DPI
Column 2
DPI amount
%
$
1
6,298
2
12,596
3
18,894
4
25,192
5
31,490
s 2 ins 2015 SL No. 135
s 12
3
DPI
amount for multiple injuries
(1)
This section prescribes the DPI amount if the
worker—
(a)
has sustained multiple injuries from 1
event; and
(b)
receives a notice of assessment for the
worker’s physical injury and another notice of assessment
for the worker’s psychological injury.
(2)
The worker is only entitled to 1 payment for the DPI
amount, being the amount shown in section 2, column 2 opposite the DPI—
(a)
shown in section 2, column 1; and
(b)
that is the higher of the DPI percentages
stated in the notices.
(3)
However, subsection (4) applies if—
(a)
a worker is paid the DPI amount based on a
notice of assessment for an injury; and
(b)
the worker later receives a second notice
of assessment for a different type of injury; and
(c)
the second notice of assessment states a
DPI that is higher than the DPI stated in the first notice
of assessment but is not more than 5%.
(4)
The worker is entitled to another payment for the DPI
amount, being the amount shown in section 2, column 2 opposite the DPI—
(a)
shown in section 2, column 1; and
(b)
that is equal to the difference between
the DPI percentages stated in the notices.
Example of DPI amount
if subsection (4) applies—
A worker with a DPI of 3% is paid a DPI amount
of $18,894 for a physical injury. The worker later receives a
notice of assessment stating a DPI of 5% for a psychological
injury. The worker is entitled to be paid an additional DPI
amount of $12,596 for the difference of 2% between the DPI
percentages.
s 3 ins 2015 SL No. 135
s 12
4
Legal
cost amount
(1)
This section applies if a worker has engaged a lawyer
and incurs legal costs for doing 1 or more things mentioned in column
1.
(2)
The worker is entitled to the amount shown in column 2
opposite each thing for which legal costs were incurred.
Column 1
Circumstance
Column 2
Legal cost amount
$
Giving information to an
insurer under section 112I within the period
mentioned in the section
1,700
The worker and the worker’s
lawyer attending a meeting mentioned in section 112K
2,000
The worker, under section 112N, applying to the panel
to review an insurer’s decision
1,000
The worker giving information
to the panel under section 112N(2)(c)
1,700
Example of when a legal
cost amount is included in section 193A
compensation—
A worker with a DPI of 5% who has engaged a
lawyer to give information to an insurer, attended a meeting
with the lawyer and the insurer, and had the insurer’s decision
reviewed successfully, is entitled to section 193A compensation totalling $36,190,
being $31,490 for the DPI amount and $4,700 for the legal cost
amount.
s 4 ins 2015 SL No. 135
s 12
Schedule 4B
Pneumoconiosis
score
section 112V
sch hdg ins 2017
Act No. 27
s
36
1
Definitions for schedule
In this schedule—
category see section 2(1)(b).
consecutive categories see section 3.
corresponding score, for a category, means the score
in section 2(1), table 1, column 2 that corresponds to the
category.
reading, of a chest x-ray, see section 2.
s 1 ins 2017
Act No. 27
s
36
2
Meaning
of reading of chest x-ray
(1)
A reading, of a chest x-ray, is a process in which a
qualified reader—
(a)
assesses the x-ray for the appearance of
opacities; and
(b)
decides, in accordance with the ILO
classification guidelines, the category in table 1, column 1
(the category) that applies to
the appearance of opacities in the x-ray; and
(c)
records the category decided under paragraph (b).
Table 1
Column 1
Category
Column 2
Score
0/-
0
0/0
0
0/1
0
1/0
15
1/1
20
1/2
25
2/1
50
2/2
55
2/3
60
3/2
75
3/3
80
3/+
85
Category A
90
Category B
95
Category C
100
(2)
In this section—
opacity means—
(a)
a small opacity within the meaning
of the ILO classification guidelines; or
(b)
a large opacity within the meaning
of the ILO classification guidelines.
qualified reader means a doctor
who is qualified and competent to categorise, in accordance with
the ILO classification guidelines, the appearance of opacities
in a chest x-ray.
Example—
a doctor approved as a B Reader by the
National Institute for Occupational Safety and
Health
s 2 ins 2017
Act No. 27
s
36
3
Meaning
of consecutive
categories
Two categories are consecutive categories if the categories—
(a)
start with the same digit, other than 0;
and
(b)
appear in consecutive rows in section 2(1), table 1.
Examples of categories that are consecutive categories—
•
2/1 and 2/2
•
3/3 and 3/+
Examples of categories that are
not consecutive categories—
•
0/0 and 0/1
•
1/2 and 2/1
•
category B and category C
s 3 ins 2017
Act No. 27
s
36
4
Requirement for 2 readings
(1)
A worker’s pneumoconiosis score is worked out by using
2 readings of the same chest x-ray of the worker in the way provided
under subsection (2) or (3).
(2)
If each reading records the same category, the
worker’s pneumoconiosis score is the corresponding score for that
category.
(3)
If each reading records a different category, the
worker’s pneumoconiosis score is—
(a)
if the 2 categories are any combination of
0/-, 0/0 or 0/1—0; or
(b)
if the 2 categories are consecutive
categories—the higher of the corresponding scores for the
consecutive categories; or
Example for
paragraph (b)—
One reading records the category
as 2/2, which has a corresponding score of 55. The
other reading records the category as 2/3, which has
a corresponding score of 60. The worker’s
pneumoconiosis score is 60, being the higher of the
corresponding scores for the consecutive
categories.
(c)
if the 2 categories are any combination of
category A, category B or category C—the higher of the
corresponding scores for the 2 categories.
Example for
paragraph (c)—
One reading records the category
as category A, which has a corresponding score of
90. The other reading records the category as
category C, which has a corresponding score of 100.
The worker’s pneumoconiosis score is 100, being the
higher of the corresponding scores for the 2
categories.
s 4 ins 2017
Act No. 27
s
36
5
Requirement for third reading
(1)
This section applies if the worker’s pneumoconiosis
score can not be worked out under section 4.
(2)
The worker’s pneumoconiosis score is worked out
by—
(a)
obtaining a third reading of the same
chest x-ray; and
(b)
using that reading, with the first 2
readings, in the way provided under subsection (3) or (4).
(3)
If the third reading records the same category as
either of the first 2 readings, the worker’s pneumoconiosis score is the
corresponding score for that category.
(4)
If the third reading records a different category from
both of the first 2 readings, the worker’s pneumoconiosis score
is—
(a)
if 2 of the 3 categories are consecutive
categories—the higher of the corresponding scores for the
consecutive categories; or
Example for
paragraph (a)—
The first 2 readings record the
categories as 1/2 and 2/1. The third reading records
the category as 2/2. Because the categories of 2/1
and 2/2 are consecutive categories, the worker’s
pneumoconiosis score is 55, being the higher of the
corresponding scores for the consecutive
categories.
(b)
if 2 of the 3 categories are any
combination of category A, category B or category C—the
higher of the corresponding scores for the 2
categories.
Example for
paragraph (b)—
The first 2 readings record the
categories as 3/+ and category A. The third reading
records the category as category B. The worker’s
pneumoconiosis score is 95, being the higher of the
corresponding scores for category A and category
B.
s 5 ins 2017
Act No. 27
s
36
6
Requirement for fourth and fifth readings
(1)
This section applies if the worker’s pneumoconiosis
score can not be worked out under section 4 or 5.
(2)
The worker’s pneumoconiosis score is worked out
by—
(a)
obtaining a fourth and fifth reading of
the same chest x-ray; and
(b)
using those readings, with the other 3
readings, in the way provided under subsection (3).
(3)
The worker’s pneumoconiosis score is the corresponding
score for the median category of the categories recorded in each of the
5 readings.
Example—
The first 3 readings record the categories as
1/2, 2/1 and 2/3. The fourth and fifth readings record the
categories as 1/2 and 2/1. The 5 categories, in ascending order,
are 1/2, 1/2, 2/1, 2/1 and 2/3. The median category is 2/1, and
the worker’s pneumoconiosis score is 50.
s 6 ins 2017
Act No. 27
s
36
Schedule 4C
Lump sum
compensation for workers with pneumoconiosis
section 112W
sch hdg ins 2017
Act No. 27
s
36
1
Graduated
scale
(1)
This schedule contains the graduated scale for lump
sum compensation for a worker to whom chapter 3, part 3, division 5 of the Act applies.
(2)
The maximum amount of lump sum compensation payable
under chapter 3, part 3, division 5 of the Act is $120,000.
s 1 ins 2017
Act No. 27
s
36
2
How to
use the graduated scale
(1)
A pneumoconiosis band shown in column 1 comprises the
pneumoconiosis scores in the corresponding entry in column 2.
(2)
A worker who has a pneumoconiosis score shown in
column 2 is entitled to lump sum compensation in the amount shown for
the corresponding entry in column 3.
(3)
However, the amount of the lump sum compensation under
subsection (2) is subject to any reduction required
under section 3.
Graduated scale
Column 1
Pneumoconiosis band
Column 2
Pneumoconiosis scores
Column 3
Lump sum compensation
$
1
0
0
2
15
20
25
18,000
24,000
30,000
3
50
55
60
60,000
66,000
72,000
4
75
80
90,000
96,000
5
85
102,000
6
90
108,000
7
95
114,000
8
100
120,000
s 2 ins 2017
Act No. 27
s
36
3
Effect of
worker’s lodgement age
(1)
This section applies if the worker’s lodgement age is
71 years or more.
(2)
For each whole year by which the worker’s lodgement
age is more than 70 years, the amount (the prescribed amount) to which the worker would otherwise be
entitled under section 2(2) must be reduced by an amount equal to 5% of the
prescribed amount.
Example—
A worker with a pneumoconiosis score of 100
has a lodgement age of 72 years. The worker is entitled under
section 2(2) to the amount of $120,000. However, that
amount must be reduced under this subsection by $6,000 for each
of the 2 years by which the worker’s lodgement age is more than
70 years. The amount of the worker’s entitlement under this
schedule is therefore $108,000.
(3)
However, the maximum reduction that may be made under
subsection (2) is an amount equal to 50% of the
prescribed amount.
s 3 ins 2017
Act No. 27
s
36
Schedule 5
Graduated scale of
care required for payment of caring allowance
section 113(1)(a)
1
Graduated
scale
This schedule contains the graduated scale for the payment
of caring allowance.
2
How to use
the graduated scale
(1)
The range of dependency assessed under the modified
barthel index is shown in column 1.
(2)
In column 1—
(a)
minimal is a modified barthel index total
score of 91–99; and
(b)
mild is a modified barthel index total
score of 75–90; and
(c)
moderate is a modified barthel index total
score of 50–74; and
(d)
severe is a modified barthel index total
score of 25–49; and
(e)
total is a modified barthel index total
score of 0–24.
(3)
The maximum number of hours of care required in a week
is shown for the corresponding entry in column 2.
Graduated scale
Column 1
Range of
dependency
(modified barthel
index)
Column 2
Maximum hours of care
required in a week
minimal
<10
mild
13.0
moderate
20.0
severe
23.5
total
27.0
Schedule 6
Legal professional
costs
section 135(2)
Column A
Pre-proceeding notification and
negotiation
Column B
Compulsory conference
Column C
Investigation by expert
Column D
Pre-proceedings court
applications
$2,000
$135 for the first hour or part of an
hour
$105 for each additional hour or part
of an hour
$270
$400
Schedule 7
Designated courts
and provisions that are a State’s legislation about damages for work related
injury
sections 145(2) and 146(2)
Column 1
State
Column 2
Designated court
Column 3
Provisions that are that State’s
legislation about damages for work related
injury
Australian Capital Territory
Magistrates Court
the provisions of the Workers Compensation Act
1951 (ACT)
New South Wales
District Court of New South
Wales
Workers Compensation Commission of New
South Wales
the provisions of the Workers Compensation Act
1987 (NSW) and the Workplace Injury Management and
Workers Compensation Act 1998
(NSW)
Northern Territory
Work Health Court
the provisions of the Workers Rehabilitation and
Compensation Act (NT)
South Australia
Workers Compensation Tribunal
the provisions of the Workers Rehabilitation and
Compensation Act 1986 (SA)
Tasmania
Workers Rehabilitation and
Compensation Tribunal
the provisions of the Workers Rehabilitation and
Compensation Act 1988 (Tas)
Victoria
County Court
Magistrates Court of Victoria
the provisions of the Accident Compensation Act
1985 (Vic) and the Accident Compensation (WorkCover
Insurance) Act 1993 (Vic)
Western Australia
District Court of Western
Australia
the provisions of the Workers’ Compensation and Injury
Management Act 1981 (WA)
Schedule 8
Matters to which
court is to have regard in the application of sch 9
section 129(b)
Part 1
Objectives
of sch 9
(Ranges of injury scale values)
1
Objectives of sch 9
The objectives of schedule 9 include promoting—
(a)
consistency between assessments of general
damages awarded by courts for similar injuries; and
(b)
similar assessments of general damages
awarded by courts for different types of injury that have a
similar level of adverse impact on an injured worker.
Notes—
•
Under section 306O(1) of the Act, if general damages
are to be awarded by a court in relation to an
injury sustained on or after 1 July 2010, the court
must assess an injury scale value as follows—
•
the injured worker’s total
general damages must be assigned a numerical value
(injury scale value) on
a scale running from 0 to 100—the Act, section 306O(1)(a);
•
the scale reflects 100 equal
graduations of general damages, from a case in
which an injury is not severe enough to justify
any award of general damages to a case in which an
injury is of the gravest conceivable kind—the
Act, section 306O(1)(b);
•
in assessing the injury
scale value, the court must—
•
assess the injury scale
value under any rules provided under a regulation;
and
•
have regard to the injury
scale values given to similar injuries in previous
proceedings—the Act, section 306O(1)(c).
•
Under section 306O(2) of the Act, if a court assesses
an injury scale value for a particular injury to be
more or less than any injury scale value prescribed
for or attributed to similar particular injuries
under section 306O(1)(c) of the Act, the court must state
the factors on which the assessment is based that
justify the assessed injury scale value.
Part 2
How to use
sch 9
Division 1
Injury
2
Injury mentioned in sch 9
(1)
In assessing the injury scale value (ISV) for an injury mentioned in
the injury column of schedule 9, a court must consider the range
of injury scale values stated in schedule 9 for the injury.
(2)
The range of ISVs for the injury reflects the
level of adverse impact of the injury on the injured
worker.
3
Multiple injuries
(1)
Subject to section 9, in assessing the ISV for multiple
injuries, a court must consider the range of ISVs for the
dominant injury of the multiple injuries.
(2)
To reflect the level of adverse impact of
multiple injuries on an injured worker, the court may assess the
ISV for the multiple injuries as being higher in the range of
ISVs for the dominant injury of the multiple injuries than the
ISV the court would assess for the dominant injury only.
Note—
This section acknowledges that—
•
the effects of multiple
injuries commonly overlap, with each injury
contributing to the overall level of adverse
impact on the injured worker; and
•
if each of the multiple
injuries were assigned an individual ISV and these
ISVs were added together, the total ISV would
generally be too high.
4
Multiple injuries and maximum dominant ISV inadequate
(1)
This section applies if a court considers the
level of adverse impact of multiple injuries on an injured
worker is so severe that the maximum dominant ISV is inadequate
to reflect the level of impact.
(2)
To reflect the level of impact, the court may
make an assessment of the ISV for the multiple injuries that is
higher than the maximum dominant ISV.
(3)
However, the ISV for the multiple
injuries—
(a)
must not be more than 100;
and
Note—
Under section 306O(1)(a) of the Act, an ISV is assessed
on a scale running from 0 to 100.
(b)
should rarely be more than 25%
higher than the maximum dominant ISV.
(4)
If the increase is more than 25% of the
maximum dominant ISV, the court must give detailed written
reasons for the increase.
(5)
In this section—
maximum dominant ISV, in
relation to multiple injuries, means the maximum ISV in
the range for the dominant injury of the multiple
injuries.
5
Adverse psychological reaction
(1)
This section applies if a court is assessing
an ISV where an injured worker has an adverse psychological
reaction to a physical injury.
(2)
The court must treat the adverse psychological
reaction merely as a feature of the injury.
6
Mental disorder
(1)
This section applies if—
(a)
a court is assessing an ISV;
and
(b)
a PIRS rating for a mental
disorder of an injured worker is relevant under
schedule 9.
(2)
The PIRS rating for the mental disorder of the
injured worker is the PIRS rating accepted by the court.
(3)
A PIRS rating is capable of being accepted by
the court only if it is—
(a)
assessed by a medical expert as
required under schedules 10 and 11; and
(b)
provided to the court in a PIRS
report as required under schedule 10, section 12.
7
Aggravation of pre-existing condition
(1)
This section applies if an injured worker has
a pre-existing condition that is aggravated by an injury for
which a court is assessing an ISV.
(2)
In considering the impact of the aggravation
of the pre-existing condition, the court may have regard only to
the extent to which the pre-existing condition has been made
worse by the injury.
Division 2
Other matters
8
Court must have regard to particular provisions of sch 9
(1)
In addition to providing ranges of ISVs for
particular injuries, schedule 9 sets out provisions relevant to
using schedule 9 to assess an ISV for particular
injuries.
Examples of
relevant provisions—
•
examples of the injury
•
examples of factors
affecting ISV assessment
•
comments about appropriate
level of ISV
(2)
In assessing an ISV, a court must have regard
to those provisions to the extent they are relevant in a
particular case.
(3)
The fact that schedule 9 provides examples of factors
affecting an ISV assessment is not intended to discourage a
court from having regard to other factors it considers are
relevant in a particular case.
9
Court may have regard to other matters
In assessing an ISV, a court may have regard to
other matters to the extent they are relevant in a particular
case.
Examples of other
matters—
•
the injured worker’s age,
degree of insight, life expectancy, pain,
suffering and loss of amenities of life
•
the effects of a pre-existing
condition of the injured worker
•
difficulties in life likely to
have emerged for the injured worker whether or not
the injury happened
•
in assessing an ISV for
multiple injuries, the range for, and other
provisions of schedule 9 in relation to, an
injury other than the dominant injury of the
multiple injuries
10
DPI
The extent of DPI is an important consideration,
but not the only consideration affecting the assessment of an
ISV.
11
Medical report stating DPI
If a medical report states a DPI, it must state
how the DPI is decided, including—
(a)
the clinical findings; and
(b)
how the impairment is calculated;
and
(c)
if the DPI is based on criteria
provided under AMA 5—
(i)
the provisions of AMA 5
setting out the criteria; and
(ii)
if a range of percentages is
available under AMA 5 for an injury of the type
being assessed—the reason for assessing the injury
at the selected point in the range.
Notes—
1
It is not a function of a
doctor to identify—
(a)
the item in schedule 9 to which an injury
belongs; or
(b)
the appropriate ISV for an
injury.
2
A 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.
12
Greater weight to assessments based on AMA 5
(1)
This section does not apply to a medical
assessment of scarring or of a mental disorder.
(2)
In assessing an ISV, a court must give greater
weight to a medical assessment of a DPI based on the criteria
for the assessment of a DPI provided under AMA 5 than to a
medical assessment of a DPI not based on the criteria.
13
Greater weight to assessments of PIRS rating
In assessing an ISV, a court must give greater
weight to a PIRS report provided as required under schedule 10 than to another medical assessment of
the permanent impairment caused by a mental disorder.
14
ISV must be a whole number
An ISV assessed by a court must be a whole
number.
Note—
Under section 306O(1)(a) of
the Act, an
ISV is assessed on a scale running from 0 to 100.
Schedule 9
Ranges of injury
scale values
section 129(a)
Item no.
Injury
Other provisions
Range of injury scale values
(ISVs)
Part 1
Central
nervous system and head injuries
1
Quadriplegia
Examples of factors
affecting ISV assessment
75 to 100
•
Presence and extent of
pain
•
Extent of any residual
movement
•
Degree of insight
•
Adverse psychological
reaction
•
Level of function and
pre-existing function
•
Degree of independence
•
Ability to participate in
daily activities, including employment
•
Presence and extent of
secondary medical complications
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate only if the injured
worker has assisted ventilation, full insight,
extreme physical limitation and gross impairment
of ability to communicate.
2
Paraplegia
Examples of factors
affecting ISV assessment
60 to 80
•
Presence and extent of
pain
•
Extent of any residual
movement
•
Adverse psychological
reaction
•
Level of function and
pre-existing function
•
Degree of independence
•
Ability to participate in
daily activities, including employment
•
Loss of reproductive or
sexual function
•
Bowel or bladder
incontinence
•
Presence and extent of
secondary medical complications
3
Hemiplegia or severe paralysis of more than 1 limb
Comment
Incomplete paralysis causing a
DPI of less than 40% must be assessed under
part 6 if it is the only injury or
the dominant injury of multiple injuries.
Examples of factors
affecting ISV assessment for item 3
The same examples apply as for
item 2.
4
Monoplegia
Comment
See items 5, 6 and 7 and
part 6.
5
Extreme brain injury
Comment
The injury will involve major
trauma to the brain with severe permanent
impairment.
5.1
Substantial insight
remaining
71 to 100
Comment about appropriate
level of ISV for item 5.1
•
An ISV at or near the top of
the range will be appropriate only if the injured
worker needs full-time nursing care and has the
following—
•
substantial insight despite
gross disturbance of brain function
•
significant physical
limitation and destruction of pre-existing
lifestyle
•
epileptic seizures
•
double incontinence
•
little or no language
function
•
little or no meaningful
response to environment.
•
An injured worker with an
injury for which an ISV at or near the top of the
range is appropriate may have some ability to
follow basic commands, recovery of eye opening,
return of postural reflex movement and return to
pre-existing sleep patterns.
Examples of factors
affecting ISV assessment for item 5.1
•
Degree of insight
•
Life expectancy
•
Extent of bodily
impairment
5.2
Substantially reduced
insight
Comment for items 5.2.1 and
5.2.2
•
The injured worker will have
major trauma to the brain with severe permanent
impairment.
•
The injured worker’s insight
of his or her condition may change.
•
Insight may be impaired in
the degree, or continuity of, appreciation of the
injured worker’s condition.
Examples of factors
affecting ISV assessment for items 5.2.1 and
5.2.2
The same examples apply as for
an item 5.1 injury, but reducing levels of insight
progressively reduce the level of suffering and
the appropriate level of ISV.
5.2.1
The injured worker will have
partial or complete insight (as evidenced by
appropriate responses to physical or emotional
stimuli) for not more than half of the person’s
waking hours.
36 to 70
5.2.2
The injured worker will have
infrequent periods of partial insight and will
show unreliable, rare or limited responses to
physical or emotional stimuli.
16 to 35
5.3
Grossly reduced
insight
10 to 15
Comment for item
5.3
The injured worker will be in
a persistent vegetative state and have little or
no insight.
Comment about appropriate
level of ISV for item 5.3
If some minor awareness of
loss remains, an ISV at or near the top of the
range may be appropriate.
6
Serious brain injury
Comment
56 to 70
The injured worker will be
very seriously disabled.
Example of the
injury
Serious brain damage
causing—
(a)
physical impairment, for
example, limb paralysis; or
(b)
cognitive impairment with
marked impairment of intellect and
personality
Examples of factors
affecting ISV assessment
•
Degree of insight
•
Life expectancy
•
Extent of physical
limitations
•
Extent of cognitive
limitations
•
Extent of sensory
limitation, for example, limitation of hearing or
sense of taste or smell
•
Level of function and
pre-existing function
•
Degree of independence
•
Ability to communicate
•
Behavioural or psychological
changes
•
Epilepsy or a high risk of
epilepsy
•
Presence of and extent of
secondary medical complications
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate only if the injured
worker substantially depends on others and needs
substantial professional and other care.
7
Moderate brain injury
Comment
21 to 55
The injured worker will be
seriously disabled, but the degree of the injured
worker’s dependence on others, although still
present, is lower than for an item 6 injury.
Examples of factors
affecting ISV assessment
•
Degree of insight
•
Life expectancy
•
Extent of physical
limitations
•
Extent of cognitive
limitations
•
Extent of sensory
limitation, for example, limitation of hearing or
sense of taste or smell
•
Level of function and
pre-existing function
•
Degree of independence
•
Ability to communicate
•
Behavioural or psychological
changes
•
Epilepsy or a high risk of
epilepsy
•
Presence of, and extent of,
secondary medical complications
Comment about appropriate
level of ISV
•
An ISV of 21 to 25 will be
appropriate if there is reduced concentration and
memory, or reduced mood control, and either or
both—
•
reduced capacity for
employment
•
a noticeable interference
with lifestyle and leisure.
•
An ISV of 26 to 40 will be
appropriate if there is an increased risk of
epilepsy and either or both—
•
a moderate cognitive
impairment
•
loss of, or greatly reduced
capacity for, employment.
•
An ISV of 41 to 55 will be
appropriate if there is no capacity for
employment, and 1 or more of the following—
•
moderate to severe cognitive
impairment
•
marked personality
change
•
dramatic effect on speech,
sight or other senses
•
epilepsy or a high risk of
epilepsy.
8
Minor
brain injury
Comment
6 to 20
The injured worker will make a
good recovery and be able to take part in normal
social life and to return to work. There may be
minor problems persisting that prevent a
restoration of normal function.
Examples of factors
affecting ISV assessment
•
Severity of any physical
injury causing the brain damage, having regard
to—
(a)
any medical assessment made
immediately after the injury was caused, for
example, CT or MRI scans, an ambulance officer’s
assessment or hospital emergency unit assessment;
and
(b)
any post-traumatic
amnesia.
•
Extent of any ongoing, and
possibly permanent, disability
•
Extent of any personality
changer
•
Depression
•
Degree of insight
•
Life expectancy
•
Extent of physical
limitations
•
Extent of cognitive
limitations
•
Extent of sensory
limitation, for example, limitation of hearing or
sense of taste or smell
•
Level of function and
pre-existing function
•
Degree of independence
•
Ability to communicate
•
Behavioural or psychological
changes
•
Epilepsy or a high risk of
epilepsy
•
Presence of, and extent of,
secondary medical complications
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if the injured
worker has—
•
an increased risk of
epilepsy; and
•
ongoing reduced
concentration and memory, or reduced mood control,
that does not significantly interfere with the
person’s ability to take part in normal social
life or return to work.
9
Minor
head injury, other than an injury mentioned in pt 3
Comment
0 to 5
Brain damage, if any, is
minimal.
Examples of the
injury
•
Uncomplicated skull
fracture
•
Concussion with transitory
loss of consciousness and no residual effect
Examples of factors
affecting ISV assessment
•
Severity of any physical
injury causing brain damage
•
Length of time to recover
from any symptoms
•
Extent of ongoing
symptoms
•
Presence of, or absence of,
headaches
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate for an injury
from which the injured worker fully recovers
within a few weeks.
•
An ISV at or near the top of
the range will be appropriate if there is an
uncomplicated skull fracture and there are
associated concussive symptoms of dizziness,
headache and memory loss persisting for less than
6 months.
Part 2
Mental
disorders
General comment for items
10 to 13
This part includes references
to ratings (PIRS ratings) on the
psychiatric impairment rating scale set out in
schedule 11. A PIRS rating is
capable of being accepted by a court only if it is
assessed by a medical expert as required under
schedules 10 and 11 and provided to the court in a PIRS
report.
Examples of factors
affecting ISV assessment for items 10 to
13
•
PIRS rating
•
Degree of insight
•
Age and life
expectancy
•
Pain and suffering
•
Loss of amenities of
life
•
Likelihood difficulties
would have emerged in any event
•
If there is extreme
psychological trauma, for example, intense
helplessness or horror, the immediate adverse
psychological reaction
10
Extreme mental disorder
Example of the
injury
41 to 65
A mental disorder with a PIRS
rating between 31% and 100%
Comment about appropriate
level of ISV
Despite a very high PIRS
rating, an ISV at or near the bottom of the range
may be appropriate if the injured worker has
reduced insight.
11
Serious mental disorder
Example of the
injury
11 to 40
A mental disorder with a PIRS
rating between 11% and 30%
12
Moderate mental disorder
Comment
2 to 10
There is generally only
moderate impairment.
Example of the
injury
A mental disorder with a PIRS
rating between 4% and 10%
13
Minor
mental disorder
Comment
0 to 1
For many persons who have
suffered the injury there will be little or no
impact on their lives.
Example of the
injury
A mental disorder with a PIRS
rating between 0% and 3%
Part 3
Facial
injuries
Division 1
Skeletal injuries of the facial area
Examples of factors
affecting ISV assessment for items 14 to
22
•
Extent of skeletal or
functional damage
•
Degree of cosmetic damage or
disfigurement
•
Adverse psychological
reaction
•
Availability of cosmetic
repair
14
Extreme facial injury
Comment
26 to 45
The injury will involve
severe traumatic injury to the face requiring
substantial reconstructive surgery.
Examples of the
injury
•
A Le Fort I fracture or Le
Fort II fracture if the degree of incapacity and
disfigurement after reconstructive surgery will be
very severe
•
A Le Fort III fracture
causing incapacity in daily activities
Additional example of
factor affecting ISV assessment
The extent of any
neurological impairment or effect on the
airway
Note—
Le Fort I fracture, Le Fort
II fracture and Le Fort III fracture are defined
in schedule 13.
15
Serious facial injury
Comment
14 to 25
The injury will involve
serious traumatic injury to the face requiring
reconstructive surgery that is not
substantial.
Examples of the
injury
•
A Le Fort I fracture or Le
Fort II fracture if the degree of incapacity and
disfigurement after reconstructive surgery will
not be very severe
•
A Le Fort III fracture if no
serious deformity will remain after reconstructive
surgery
•
A serious or multiple
fracture of the nasal complex either or
both—
(a)
requiring more than 1
operation; and
(b)
causing 1 or more of the
following—
•
permanent damage to the
airway
•
permanent damage to nerves
or tear ducts
•
facial deformity.
•
A serious cheekbone fracture
that will require surgery and cause serious
disfigurement and permanent effects despite
reconstructive surgery, for example,
hyperaesthesia or paraesthesia
•
A very serious multiple jaw
fracture that will—
(a)
require prolonged treatment;
and
(b)
despite reconstructive
surgery, cause permanent effects, for example,
severe pain, restriction in eating, paraesthesia
or a risk of arthritis in the joints.
•
A severed trunk of the
facial nerve (7th cranial nerve), causing total
paralysis of facial muscles on 1 side of the
face
Additional examples of
factors affecting ISV assessment
•
Any neurological impairment
or effect on the airway
•
Permanent cosmetic
deformity
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if the injury
causes permanent cosmetic deformity, asymmetry of
1 side of the face and limited adverse
psychological reaction.
•
An ISV at or near the top of
the range will be appropriate if the injury causes
serious bilateral deformity and significant
adverse psychological reaction.
16
Moderate facial injury
Examples of the
injury
6 to 13
•
A simple cheekbone fracture,
requiring minor reconstructive surgery, from which
the injured worker will fully recover with little
or no cosmetic damage
•
A fracture of the jaw
causing—
(a)
permanent effects, for
example, difficulty in opening the mouth or in
eating; or
(b)
hyperaesthesia or
paraesthesia in the area of the fracture.
•
A displaced fracture of the
nasal complex from which the injured worker will
almost fully recover after surgery
•
Severed branches of the
facial nerve (7th cranial nerve) with paralysis of
some of the facial muscles
•
A severed sensory nerve of
the face with minor permanent paraesthesia
17
Minor facial injury
Examples of the
injury
0 to 5
•
A simple cheekbone fracture,
for which surgery is not required and from which
the injured worker will recover fully
•
A simple jaw fracture,
requiring immobilisation and from which the
injured worker will fully recover
•
A stable fracture of the
joint process of the jaw
•
A displaced fracture of the
nasal complex requiring only manipulation
•
A simple undisplaced
fracture of the nasal complex, from which the
injured worker will fully recover
•
A severed sensory nerve of
the face, with good repair causing minimal or no
paraesthesia
18
Injury to teeth or gums
Comment
There will generally have
been a course of treatment as a result of the
injury.
Additional examples of
factors affecting ISV assessment
•
Extent and degree of
discomfort during treatment
•
Difficulty with eating
Comment about appropriate
level of ISV
If protracted dentistry
causes the injury, the ISV may be higher than the
ISV for the same injury caused by something
else.
18.1
Loss of or serious damage to
more than 3 teeth, serious gum injury or serious
gum infection
6 to 10
18.2
Loss of or serious damage to
2 or 3 teeth, moderate gum injury or moderate gum
infection
3 to 5
18.3
Loss of or serious damage to
1 tooth, minor gum injury or minor gum
infection
0 to 2
Division 2
Scarring to the face
General comment for items
19 to 22
This division will usually
apply to an injury involving skeletal damage only
if the skeletal damage is minor.
19
Extreme facial scarring
Examples of the
injury
21 to 45
•
Widespread area scarring,
for example, over the side of the face or another
whole area
•
Severe contour
deformity
•
Significant deformity of the
mouth or eyelids with muscle paralysis or
tic
Comment about appropriate
level of ISV
•
An ISV in the upper half of
the range may be appropriate if the injured worker
is relatively young, the cosmetic damage is very
disfiguring and the adverse psychological reaction
is severe.
•
An ISV at or near the top of
the range will be appropriate if the injury is
caused by burns that resulted in loss of the
entire nose, eyelids or ears.
20
Serious facial scarring
Examples of the
injury
11 to 20
•
Substantial disfigurement
and significant adverse psychological
reaction
•
Severe linear scarring
•
Discoloured hypertrophic
(keloid) scarring
•
Atrophic scarring
•
Serious contour
defects
21
Moderate facial scarring
Comment
6 to 10
Any adverse psychological
reaction is small, or having been considerable at
the outset, has greatly diminished.
Examples of the
injury
•
Scarring, the worst effects
of which will be reduced by plastic surgery that
will leave minor cosmetic damage
•
Scars crossing lines of
election with discoloured, indurated, hypertrophic
or atrophic scarring, of moderate severity
22
Minor facial scarring
Examples of the
injury
0 to 5
•
A single scar able to be
camouflaged
•
More than 1 very small scar
if the overall effect of the scars is to mar, but
not to markedly affect, appearance and adverse
psychological reaction is minor
•
Almost invisible linear
scarring, in lines of election, with normal
texture and elevation
Part 4
Injuries
affecting the senses
Division 1
General comment
General comment for items
23 to 33
Injuries mentioned in this
part are commonly symptoms of brain or nervous
system injury.
Division 2
Injuries affecting the eyes
23
Total sight and hearing impairment
Comment
90 to 100
The injury ranks with the
most devastating injuries.
Examples of factors
affecting ISV assessment
•
Degree of insight
•
Age and life
expectancy
24
Total sight impairment
Examples of factors
affecting ISV assessment
50 to 80
•
Degree of insight
•
Age and life
expectancy
25
Complete sight impairment in 1 eye with reduced vision in the other
eye
Comment about appropriate
level of ISV
25 to 50
An ISV at or near the top of
the range will be appropriate if there is serious
risk of further significant deterioration in the
remaining eye.
26
Complete sight impairment in 1 eye or total loss of 1 eye
Examples of factors
affecting ISV assessment
26 to 30
•
The extent to which the
injured worker’s activities are adversely affected
by the impairment or loss
•
Associated scarring or
cosmetic damage
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if there is a minor
risk of sympathetic ophthalmia.
27
Serious eye injury
Examples of the
injury
11 to 25
•
A serious but incomplete
loss of vision in 1 eye without significant risk
of loss or reduction of vision in the other
eye
•
An injury causing double
vision that is not minor and intermittent
28
Moderate eye injury
Example of the
injury
6 to 10
Minor but permanent
impairment of vision in one eye, including if
there is double vision that is minor and
intermittent
29
Minor eye injury
Example of the
injury
0 to 5
A minor injury, for example,
from being struck in the eye, exposed to smoke or
other fumes or being splashed by liquids—
(a)
causing initial pain and
temporary interference with vision; and
(b)
from which the injured
worker will fully recover within a relatively
short time
Division 3
Injuries affecting the ears
Comment for items 30 to
33
The injuries commonly, but
not always, involve hearing loss. If the injury is
to a single ear, the binaural loss must be
assessed.
Examples of factors
affecting ISV assessment for item 30 to 33
injuries
•
Whether the injury has an
immediate effect, allowing the injured worker no
opportunity to adapt, or whether it occurred over
a period of time, for example, from exposure to
noise
•
Whether the injury was
suffered at an early age so that it has affected
or will affect speech
•
Whether the injury will
affect balance
•
The extent to which former
activities will be affected
•
Presence of tinnitus
30
Extreme ear injury
Definition of
injury
36 to 55
The injury involves a
binaural hearing loss of at least 80%.
Additional examples of
factors affecting ISV assessment
•
Associated problems, for
example, severe tinnitus, moderate vertigo, a
moderate vestibular disturbance or headaches
•
Availability of hearing aids
or other devices that may reduce the hearing
loss
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if the injury
happened at an early age so as to prevent or to
seriously affect the development of normal
speech.
31
Serious ear injury
Definition of
injury
26 to 35
The injury involves—
(a)
a binaural hearing loss of
at least 50% but less than 80%; or
(b)
severe permanent vestibular
disturbance.
Comment about appropriate
level of ISV
An ISV in the lower half of
the range will be appropriate if there is no
speech impairment or tinnitus.
An ISV in the upper half of
the range will be appropriate if there is speech
impairment and tinnitus.
32
Moderate ear injury
Definition of
injury
11 to 25
The injury involves—
(a)
a binaural hearing loss of
at least 20% but less than 50%; or
(b)
significant permanent
vestibular disturbance.
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if there are
problems associated with the injury, for example,
severe tinnitus, moderate vertigo, a moderate
vestibular disturbance or headaches.
33
Minor ear injury
Definition of
injury
The injury involves a
binaural hearing loss of less than 20%.
Comment
•
This item covers the bulk of
hearing impairment cases.
•
The injury is not to be
judged simply by the degree of hearing loss.
•
There will often be a degree
of tinnitus present.
•
There may also be minor
vertigo or a minor vestibular disturbance causing
loss of balance.
•
A vestibular disturbance may
increase the level of ISV.
33.1
Moderate tinnitus or hearing
loss, or both
6 to 10
33.2
Mild tinnitus with some
hearing loss
4 to 5
33.3
Slight or occasional
tinnitus with slight hearing loss or an occasional
vestibular disturbance, or both
0 to 3
Division 4
Impairment of taste or smell
34
Total loss of taste or smell, or both
Comment about appropriate
level of ISV
6 to 9
•
An ISV at or near the bottom
of the range will be appropriate if there will be
a total loss of either taste or smell
•
An ISV at or near the top of
the range will be appropriate if there will be a
total loss of both taste and smell.
35
Partial loss of taste or smell, or both
Comment about appropriate
level of ISV
0 to 5
•
An ISV at or near the bottom
of the range will be appropriate if there will be
a partial loss of either taste or smell.
•
An ISV at or near the top of
the range will be appropriate if there will be a
partial loss of both taste and smell.
Part 5
Injuries to
internal organs
Division 1
Chest injuries
Example of factor
affecting ISV assessment for items 36 to
39
The level of any reduction
in the capacity for employment and enjoyment of
life
36
Extreme chest injury
Comment
46 to 65
The injury will involve
severe traumatic injury to the chest, or a large
majority of the organs in the chest cavity,
causing a high level of disability and ongoing
medical problems.
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if there will be
total removal of 1 lung or serious heart damage,
or both, with serious and prolonged pain and
suffering and significant permanent
scarring.
37
Serious chest injury
Comment
21 to 45
The injury will involve
serious traumatic injury to the chest or organs in
the chest cavity, causing serious disability and
ongoing medical problems.
Examples of the
injury
•
A trauma to 1 or more of the
following, causing permanent damage, physical
disability and impairment of function—
•
the chest
•
the heart
•
1 or both of the lungs
•
the diaphragm.
•
An injury that causes the
need for oxygen therapy for about 16 to 18 hours a
day
Example of factors
affecting ISV assessment
The need for a permanent
tracheostomy
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if, after recovery,
there are both of the following—
(a)
serious impairment to
cardio-pulmonary function;
(b)
a DPI for the injury of, or
of nearly, 40%.
38
Moderate chest injury
Example of the
injury
11 to 20
The injury will involve
serious traumatic injury to the chest or organs in
the chest cavity, causing moderate disability and
ongoing medical problems
Examples of factors
affecting ISV assessment
•
Duration and intensity of
pain and suffering
•
The DPI of lung or cardiac
function, as evidenced by objective test
results
•
The need for a temporary
tracheostomy for short-term airway
management
Comment about appropriate
level of ISV
An ISV at or near the bottom
of the range will be appropriate if there will be
the loss of a breast without significant adverse
psychological reaction.
An ISV in the lower half of
the range will be appropriate if there was a
pneumothorax, or haemothorax, requiring
intercostal catheter insertion.
An ISV at or near the top of
the range will be appropriate if there are
multiple rib fractures causing—
(a)
a flail segment (flail
chest) requiring mechanical ventilation in the
acute stage; and
(b)
moderate permanent
impairment of cardio-pulmonary function.
39
Minor chest injury
Examples of factors
affecting ISV assessment for items 39.1 and
39.2
•
complexity of any
fractures
•
extent of injury to
underlying organs
•
extent of any
disability
•
duration and intensity of
pain and suffering
39.1
Complicated or
significant fracture, or internal organ injury,
that substantially resolves
5 to 10
Comment
The injury will involve
significant or complicated fractures, or internal
injuries, that cause some tissue damage but no
significant long-term effect on organ
function.
Examples of the
injury
•
Multiple fractures of the
ribs or sternum, or both, that may cause
cardio-pulmonary contusion
•
Internal injuries that cause
some tissue damage but no significant long-term
effect on organ function
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a
fractured sternum that substantially resolves, and
there is some ongoing pain and activity
restriction.
•
An ISV at or near the top of
the range will be appropriate if the injury causes
significant persisting pain and significant
activity restriction.
39.2
Soft tissue injury,
minor fracture or minor internal organ
injury
0 to 4
Comment
•
The injury will involve a
soft tissue injury, minor fracture, or minor and
non-permanent injury to internal organs.
•
There may be persistent pain
from the chest, for example, from the chest wall
or sternocostal or costochondral joints.
Examples of the
injury
•
A single penetrating wound,
causing some tissue damage but no long-term effect
on lung function
•
An injury to the lungs
caused by the inhalation of toxic fumes or smoke
that will not permanently interfere with lung
function
•
A soft tissue injury to the
chest wall, for example, a laceration or serious
seatbelt bruising
•
Fractured ribs or a minor
fracture of the sternum causing serious pain and
disability for weeks, without internal organ
damage or permanent disability
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a
soft tissue injury from which the injured worker
will fully recover.
•
An ISV at or near the top of
the range will be appropriate if there is an
injury causing a small pneumothorax that does not
require intercostal catheter insertion, and from
which the injured worker will fully recover.
Division 2
Lung injuries other than asthma
General comment for items
40 to 43
The level of an ISV for lung
disease often reflects the fact that the disease
is worsening and there is a risk of the
development of secondary medical
consequences.
Examples of factors
affecting ISV assessment for items 40 to
43
•
A history of smoking tobacco
will reduce the level of ISV
•
Adverse psychological
reaction may increase the level of ISV
40
Extreme lung injury
Examples of the
injury
46 to 65
•
Diagnosed lung cancer
•
Lung disease involving
serious disability causing severe pain and
dramatic impairment of function and quality of
life
•
A recurrent pulmonary
embolism resulting in failure of the right side of
the heart requiring a lung transplant, heart
transplant or both
Additional examples of
factors affecting ISV assessment
•
Age
•
Likelihood of progressive
worsening
•
Duration and intensity of
pain and suffering
41
Serious lung injury
41.1
Serious lung injury if
progressive worsening of lung function
25 to 45
Example of item
41.1
Lung disease, for example,
emphysema, causing—
•
significantly reduced and
worsening lung function
•
prolonged and frequent
coughing
•
disturbance of sleep
•
restriction of physical
activity, employment and enjoyment of life.
Additional examples of
factors affecting ISV assessment for item
41.1
•
The possibility of lung
cancer developing may increase the level of
ISV
•
The need for continuous
oxygen therapy
41.2
Serious lung injury if
no progressive worsening of lung
function
11 to 24
Examples of item
41.2
•
Lung disease causing
breathing difficulties, short of disabling
breathlessness, requiring frequent use of an
inhaler
•
Lung disease causing a
significant effect on employment and social life,
including inability to tolerate a smoky
environment, with an uncertain prognosis
•
A recurrent pulmonary
embolism causing pulmonary hypertension and cor
pulmonale
42
Moderate lung injury
Examples of the
injury
6 to 10
•
Bronchitis that does not
cause serious symptoms, with little or no serious
or permanent effect on employment or social
life
•
A pulmonary embolism
requiring anticoagulant therapy for at least 1
year or pulmonary endarterectomy
43
Minor lung injury
Examples of the
injury
0 to 5
•
Lung disease causing slight
breathlessness, with—
(a)
no effect on employment;
and
(b)
the likelihood of
substantial and permanent recovery within a few
years after the injury is caused
•
A pulmonary embolism
requiring anticoagulant therapy for less than 1
year
Comment about appropriate
level of ISV
An ISV at or near the bottom
of the range will be appropriate if there is lung
disease causing temporary aggravation of
bronchitis, or other chest problems, that will
resolve within a few months.
Division 3
Asthma
44
Extreme asthma
Comment
31 to 55
The most serious cases may
confine a person to the home and destroy capacity
for employment.
Example of the
injury
Severe and permanent
disabling asthma causing—
•
prolonged and frequent
coughing
•
disturbance of sleep
•
severe restriction of
physical activity and enjoyment of life
•
gross reduction of capacity
for employment
45
Severe asthma
Example of the
injury
11 to 30
Chronic asthma, with a poor
prognosis, causing—
•
breathing difficulties
•
the need to frequently use
an inhaler
•
significantly reduced
capacity for employment.
46
Moderate asthma
Example of the
injury
6 to 10
Asthma, with symptoms that
include bronchitis and wheezing, affecting
employment or social life
47
Minor asthma
Example of the
injury
0 to 5
Asthma with minor symptoms
that has no effect on employment or social
life
Comment about appropriate
level of ISV
An ISV at or near the bottom
of the range will be appropriate if there is
asthma treated by a general practitioner that will
resolve within 1 year after the injury is
caused.
Division 4
Injuries to male reproductive system
General comment for items
48 to 51
•
This division applies to
injuries caused by physical trauma rather than as
a secondary result of a mental disorder
•
For a mental disorder that
causes loss of reproductive system function, see
part 2 (Mental disorders).
•
Sterility is usually
either—
(a)
caused by surgery, chemicals
or disease; or
(b)
caused by a traumatic injury
that is often aggravated by scarring.
Examples of factors
affecting ISV assessment for items 48 to
51
•
Adverse psychological
reaction
•
Effect on social and
domestic life
48
Impotence and sterility
Additional examples of
factors affecting ISV assessment
5 to 37
•
Age
•
Whether the injured worker
has children
•
Whether the injured worker
intended to have children or more children
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if the sterility
has little impact.
•
An ISV in the lower half of
the range will be appropriate if an injured worker
with children may have intended to have more
children and has uncomplicated sterility, without
impotence or any aggravating features.
•
An ISV in the upper half of
the range will be appropriate if a young injured
worker without children has uncomplicated
sterility, without impotence or any aggravating
features.
•
An ISV at or near the middle
of the range will be appropriate if a middle-aged
injured worker with children has sterility and
permanent impotence.
•
An ISV at or near the top of
the range will be appropriate if a young injured
worker has total impotence and loss of sexual
function and sterility.
49
Loss of part or all of penis
Additional examples of
factors affecting ISV assessment
5 to 25
•
Extent of the penis
remaining
•
Availability of a
prosthesis
•
Extent to which sexual
activity will be possible
50
Loss of both testicles
Comment
See item 48 because
sterility results.
Additional example of
factor affecting ISV assessment
Level of any pain or
residual scarring
51
Loss of 1 testicle
Additional example of
factors affecting ISV assessment
2 to 10
Age, cosmetic damage or
scarring
Comment about appropriate
level of ISV
An ISV at or near the bottom
of the range will be appropriate if the injury
does not reduce reproductive capacity.
Division 5
Injuries to female reproductive system
General comment for items
52 to 53.5
•
This division applies to
injuries caused by physical trauma rather than as
a secondary result of a mental disorder.
•
For a mental disorder that
causes loss of reproductive system function, see
part 2.
Examples of factors
affecting ISV assessment for items 52 to
53.5
•
Extent of any physical
trauma
•
Whether the injured worker
has children
•
Whether the injured worker
intended to have children or more children
•
Age
•
Scarring
•
Depression or adverse
psychological reaction
•
Effect on social and
domestic life
52
Infertility
52.1
Infertility causing
severe effects
16 to 35
Example of item
52.1
Infertility with severe
depression, anxiety and pain
52.2
Infertility causing
moderate effects
9 to 15
Example of item
52.2
Infertility without any
medical complication if the injured worker has a
child or children
Comment about appropriate
level of ISV for item 52.2
An ISV at or near the top of
the range will be appropriate if there is
significant adverse psychological reaction.
52.3
Infertility causing minor
effects
0 to 8
Example of item
52.3
Infertility if—
(a)
the injured worker was
unlikely to have had children, for example,
because of age; and
(b)
there is little or no
adverse psychological reaction
53
Any other injury to the female reproductive system
53.1
Post-menopausal
hysterectomy
5 to 15
53.2
Female
impotence
5 to 15
Comment for item
53.2
The injury may be
correctable by surgery.
Additional examples of
factors affecting ISV assessment for item
53.2
The level of sexual function
or the extent of any corrective surgery
53.3
An injury causing an
inability to give birth by normal vaginal
delivery, for example, because of pelvic ring
disruption or deformity
4 to 15
Comment for item
53.3
The injury may be
correctable by surgery.
53.4
Injury to female
genitalia or reproductive organs, or
both
3 to 25
Comment about appropriate
level of ISV for item 53.4
•
An ISV at or near the bottom
of the range will be appropriate if there is a
laceration or tear with good repair.
•
An ISV at or near the middle
of the range will be appropriate if the injury
causes development of a prolapse or fistula.
•
An ISV at or near the top of
the range will be appropriate if the injury causes
the early onset of menopause or irregular hormonal
activity.
53.5
Reduced fertility,
caused by, for example, trauma to ovaries or
fallopian tubes
3 to 8
Comment about appropriate
level of ISV for item 53.5
An ISV in the lower half of
the range will be appropriate if the injury is
caused by a delay in diagnosis of an ectopic
pregnancy.
Division 6
Injuries to digestive system
Subdivision 1
Injuries caused by
trauma
54
Extreme injury to the
digestive system caused by trauma
Examples of the
injury
19 to 40
Severe permanent damage to
the digestive system, with ongoing debilitating
pain and discomfort, diarrhoea, nausea and
vomiting that—
(a)
are not controllable by
drugs; and
(b)
cause weight loss of at
least 20%.
Note—
Digestive system is
defined in schedule 13.
•
An injury to the throat
requiring a permanent gastrostomy
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is an
injury to the throat requiring a temporary
gastrostomy for more than 1 year and permanent
dietary changes, for example, a requirement for a
soft food diet.
•
An ISV at or near the top of
the range will be appropriate if there is an
injury to the throat requiring a permanent
gastrostomy, with significant ongoing
symptoms.
Examples of factors
affecting ISV assessment
•
the extent of any voice or
speech impairment
•
need for ongoing endoscopic
procedures
55
Serious injury to the
digestive system caused by trauma
Examples of the
injury
11 to 18
•
A serious injury causing
long-term complications aggravated by physical
strain
•
An injury requiring a
feeding tube for between 3 and 12 months
Examples of factors
affecting ISV assessment
•
The extent of any ongoing
voice or speech impairment
•
Whether a feeding tube was
required, and if so, for how long it was
required
56
Moderate injury to the
digestive system caused by trauma
Examples of the
injury
6 to 10
•
A simple penetrating stab
wound, causing some permanent tissue damage, but
with no significant long-term effect on digestive
function
•
An injury requiring a
feeding tube for less than 3 months
Example of factors
affecting ISV assessment
•
Whether a feeding tube was
required, and if so, for how long it was
required
•
Whether dietary changes are
required to reduce the risk of aspiration because
of impaired swallowing
57
Minor injury to the
digestive system caused by trauma
Examples of the
injury
0 to 5
•
A soft tissue injury to the
abdomen wall, for example, a laceration or serious
seatbelt bruising to the abdomen or flank, or
both
•
A minor injury to the throat
or tongue causing temporary difficulties with
swallowing or speech
•
A laceration of the tongue
requiring suturing
Subdivision 2
Injuries not caused by
trauma
General comment for items
58 to 61
There is a marked difference
between those comparatively rare cases having a
long-term or even permanent effect on quality of
life and cases in which the only ongoing symptom
is an allergy, for example, to specific foods,
that may cause short-term illness.
58
Extreme injury to the
digestive system not caused by trauma
Examples of the
injury
13 to 35
Severe toxicosis—
(a)
causing serious acute pain,
vomiting, diarrhoea and fever, requiring
hospitalisation for days or weeks; and
(b)
also causing 1 or more of
the following—
•
ongoing incontinence
•
haemorrhoids
•
irritable bowel syndrome;
and
(c)
having a significant impact
on the capacity for employment and enjoyment of
life
Comment about appropriate
level of ISV
An ISV in the lower half of
the range will be appropriate if the injury causes
a chronic infection, that requires prolonged
hospitalisation, that will not resolve after
antibiotic treatment for 1 year.
59
Serious injury to the
digestive system not caused by trauma
Examples of the
injury
6 to 12
•
Serious but short-term food
poisoning causing diarrhoea and vomiting—
(a)
that requires admission to
an intensive care unit; and
(b)
with some remaining
discomfort and disturbance of bowel function and
impact on sex life and enjoyment of food, over a
few years
•
Constant abdominal pain,
causing significant discomfort, for up to 18
months caused by a delay in diagnosis of an injury
to the digestive system
Comment about appropriate
level of ISV
•
An ISV at or near the top of
the range will be appropriate if there is an
adverse response to the administration of a drug
that—
(a)
requires admission to an
intensive care unit; and
(b)
does not cause any permanent
impairment; and
(c)
causes the need for ongoing
drug therapy for life.
•
An ISV in the upper half of
the range will be appropriate if a chronic
infection—
(a)
requires prolonged
hospitalisation and additional treatment;
and
(b)
will be resolved by
antibiotic treatment within 1 year.
•
An ISV at or near the bottom
of the range will be appropriate if there is an
adverse response to the administration of a drug
that—
(a)
requires admission to an
intensive care unit; and
(b)
does not cause any permanent
impairment; and
(c)
does not cause the need for
ongoing drug therapy for life.
60
Moderate injury to the
digestive system not caused by trauma
Examples of the
injury
3 to 5
•
Food poisoning—
(a)
causing significant
discomfort, stomach cramps, change of bowel
function and fatigue; and
(b)
requiring hospitalisation
for days; and
(c)
with symptoms lasting a few
weeks; and
(d)
from which the injured
worker will fully recover within 1 or 2
years
•
An infection that is
resolved by antibiotic treatment, with or without
additional treatment in hospital, within 3 months
after the injury is caused
•
An adverse response to the
administration of a drug, causing any of the
following continuing over a period of more than 7
days, and requiring hospitalisation—
(a)
vomiting;
(b)
shortness of breath;
(c)
hypertension;
(d)
skin irritation
61
Minor injury to the
digestive system not caused by trauma
Examples of the
injury
0 to 2
•
Disabling pain, cramps and
diarrhoea, ongoing for days or weeks
•
A localised infection,
requiring antibiotic treatment, that heals within
6 weeks after the start of treatment
•
An adverse response to the
administration of a drug, causing any of the
following continuing over a period of not more
than 7 days, and not requiring
hospitalisation—
(a)
vomiting;
(b)
shortness of breath;
(c)
hypertension;
(d)
skin irritation
•
Intermittent abdominal pain
for up to 6 months caused by a delay in diagnosis
of an injury to the digestive system
Division 7
Kidney or ureter injuries
General comment for items
62 to 65
An injury to a ureter or the
ureters alone, without loss of, or serious damage
to, a kidney will generally be assessed under item
64 or 65.
Examples of factor
affecting ISV assessment for items 62 to
65
•
Age
•
Risk of ongoing kidney or
ureter problems, complications or symptoms
•
Need for future medical
procedures
62
Extreme injury to kidneys or ureters
62.1
Loss of both kidneys
causing loss of renal function and requiring
permanent dialysis or transplant
56 to 75
62.2
Serious damage to both
kidneys, requiring temporary or intermittent
dialysis
31 to 55
Examples of factors
affecting ISV assessment
•
The effect of dialysis and
loss of kidney function on activities of daily
living
•
The length of time for which
dialysis was required or the frequency of
intermittent dialysis
•
Ongoing requirement for
medication, for example, to control blood
pressure
•
Whether the injury caused
the need for dietary changes, and if so, for how
long
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if dialysis was
required for an initial 3-month period, with
intermittent dialysis required after that.
•
An ISV at or near the top of
the range will be appropriate if the injury
required dialysis for about 1 year and ongoing
dietary changes and medication.
63
Serious injury to kidneys or ureters
Comment
19 to 30
The injury may require
temporary dialysis for less than 3 months.
Example of the
injury
Loss of 1 kidney if there is
severe damage to, and a risk of loss of function
of, the other kidney
Comment about appropriate
level of ISV
The higher the risk of loss
of function of the other kidney, the higher the
ISV.
64
Moderate injury to kidneys or ureters
Examples of the
injury
11 to 18
•
Loss of 1 kidney, with no
damage to the other kidney
•
An injury to a ureter or the
ureters that requires surgery or placement of
stents
65
Minor injury to kidneys or ureters
Examples of the
injury
0 to 10
A laceration or contusion to
1 or both of the kidneys
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is an
injury to a kidney causing a contusion.
•
An ISV at or near the top of
the range will be appropriate if a partial removal
of a kidney is required.
Division 8
Liver, gall bladder or biliary tract injuries
Examples of factors
affecting ISV assessment for items 66 to
69
•
Whether there are recurrent
episodes of infection or obstruction
•
Whether there is a risk of
developing biliary cirrhosis
66
Extreme injury to liver, gall bladder or biliary tract
Examples of the
injury
51 to 70
Loss, or injury causing
effective loss, of liver function, requiring
constant substitutional therapy
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there are
recurrent episodes of liver failure that require
hospital admission and medical management but do
not require liver transplantation.
•
An ISV at or near the top of
the range will be appropriate if the injury
requires liver transplantation.
67
Serious injury to liver, gall bladder or biliary tract
Examples of the
injury
36 to 50
Serious damage causing loss
of over 30% of the tissue of the liver, but with
some functional capacity of the liver
remaining
68
Moderate injury to liver, gall bladder or biliary tract
Examples of the
injury
16 to 35
A laceration or contusion to
the liver, with a moderate effect on liver
function
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if the injury
causes impaired liver function with symptoms of
intermittent nausea and vomiting.
•
An ISV at or near the bottom
of the range will also be appropriate if there is
a gall bladder injury with recurrent infection or
symptomatic stone disease, the symptoms of which
may include, for example, pain or jaundice.
•
An ISV at or near the middle
of the range will be appropriate if the injury
involves removal of the gall bladder causing a
bile duct injury.
•
An ISV at or near the top of
the range will be appropriate if—
(a)
surgery is required to
remove not more than 30% of the liver; or
(b)
bile ducts require repair,
for example, placement of stents.
•
An ISV at or near the top of
the range will also be appropriate if there is an
injury to the gall bladder, that despite biliary
surgery, causes ongoing symptoms, infection or the
need for further endoscopic surgery.
69
Minor injury to liver, gall bladder or biliary tract
Comment
3 to 15
An injury within this item
should not require surgery to the liver.
Example of the
injury
A laceration or contusion to
the liver, with a minor effect on liver
function
Comment about appropriate
level of ISV
An ISV in the lower half of
the range will be appropriate if there is an
uncomplicated removal of the gall bladder with no
ongoing symptoms.
Division 9
Bowel injuries
Examples of factors
affecting ISV assessment for items 70 to
73
•
Age
•
Risk of ongoing bowel
problems, complications or symptoms
•
Need for future
surgery
•
The degree to which dietary
changes are required to manage chronic pain or
diarrhoea caused by the injury
70
Extreme bowel injury
Example of the
injury
41 to 60
An injury causing a total
loss of natural bowel function and dependence on
colostomy
71
Serious bowel injury
Example of the
injury
19 to 40
A serious abdominal injury
causing either or both of the following—
(a)
impairment of bowel function
(which often requires permanent or long-term
colostomy, leaving disfiguring scars);
(b)
restrictions on employment
and diet
72
Moderate bowel injury
Comment about appropriate
level of ISV
7 to 18
•
An ISV at or near the bottom
of the range will be appropriate if—
(a)
the injury requires an
ileostomy or colostomy for less than 3 months;
and
(b)
bowel function returns to
normal; and
(c)
there are no ongoing
symptoms.
•
An ISV at or near the top of
the range will be appropriate if—
(a)
the injury requires
temporary surgical diversion of the bowel, for
example, an ileostomy or colostomy; and
(b)
there is ongoing
intermittent abnormal bowel function requiring
medication.
73
Minor bowel injury
Example of the
injury
3 to 6
An injury causing tears to
the bowel, with minimal ongoing bowel
problems
Division 10
Bladder, prostate or urethra injuries
Examples of factors
affecting ISV assessment for items 74 to
77
•
Age
•
Risk of ongoing bladder,
prostate or urethra problems, complications or
symptoms
•
Need for future
surgery
74
Extreme bladder, prostate or urethra injury
Example of the
injury
40 to 60
An injury causing a complete
loss of bladder function and control, with
permanent dependence on urostomy
75
Serious bladder, prostate or urethra injury
Example of the
injury
19 to 39
An injury causing serious
impairment of bladder control, with some
incontinence
Comment about appropriate
level of ISV
An ISV in the upper half of
the range will be appropriate if there is serious
ongoing pain.
76
Moderate bladder, prostate or urethra injury
Example of the
injury
7 to 18
An injury causing continued
impairment of bladder control, with minimal
incontinence and minimal pain
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a
laceration of the urethra, that required surgical
repair and caused intermittent infection or
bladder dysfunction.
•
An ISV at or near the top of
the range will be appropriate if there is—
(a)
increased urinary frequency
of more than once every 2 hours throughout the day
and more than 3 times at night that is
unresponsive to treatment; or
(b)
an ongoing requirement for
minor surgery, for example, cystoscopy or urethral
dilation.
77
Minor bladder, prostate or urethra injury
Example of the
injury
3 to 6
A bladder injury, from which
the injured worker will fully recover, with some
relatively long-term interference with natural
bladder function
Division 11
Pancreas and spleen injuries
78
Injury to the pancreas
Comment about appropriate
level of ISV
10 to 35
•
An ISV at or near the bottom
of the range will be appropriate if there is a
contusion to the pancreas that heals.
•
An ISV at or near the middle
of the range will be appropriate if there are
chronic symptoms, for example, pain or
diarrhoea.
•
An ISV at or near the top of
the range will be appropriate if—
(a)
there are chronic symptoms
with significant weight loss of between 10% and
20% of body weight, and pancreatic enzyme
replacement is required; or
(b)
an injury to the pancreas
causes diabetes.
Examples of factors
affecting ISV assessment
•
The extent of any ongoing
risk of internal infection and disorders, for
example, diabetes
•
The need for, and outcome
of, further surgery, for example, surgery to
manage pain caused by stone disease, infection or
an expanding pseudocyst
79
Loss of spleen (complicated)
Example of the
injury
8 to 20
Loss of spleen if there will
be a risk, that is not minor, of ongoing internal
infection and disorders caused by the loss
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if the injury
leads to a splenectomy, with intermittent symptoms
of pain, nausea and vomiting that settle.
•
An ISV at or near the middle
of the range will be appropriate if—
(a)
the injury leads to a
splenectomy, with serious infection after the
splenectomy; and
(b)
the infection requires
surgical or radiological intervention.
•
An ISV at or near the top of
the range will be appropriate if the injury leads
to a splenectomy, with portal vein thrombosis
after the splenectomy.
80
Injury to the spleen or uncomplicated loss of spleen
Example of the
injury
0 to 7
Laceration or contusion to
the spleen that—
(a)
has been radiologically
confirmed; and
(b)
has no ongoing bleeding;
and
(c)
is managed conservatively;
and
(d)
resolves fully.
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if there has been
removal of the spleen (splenectomy), with little
or no risk of ongoing infections and disorders
caused by the loss of the spleen.
Division 12
Hernia injuries
81
Severe hernia
Example of the
injury
11 to 20
A hernia if after repair
there is either or both—
(a)
ongoing pain; or
(b)
a restriction on physical
activities, sport or employment
82
Moderate hernia
Example of the
injury
6 to 10
A hernia that after repair
has some real risk of recurring in the
short-term
83
Minor hernia
Example of the
injury
0 to 5
An uncomplicated inguinal
hernia, whether or not repaired
Part 6
Orthopaedic
injuries
Division 1
Cervical spine injuries
General comment for items
84 to 88
•
This division does not apply
to the following injuries (that are dealt with in
items 1 to 3)—
•
quadriplegia
•
paraplegia
•
hemiplegia or severe
paralysis of more than 1 limb.
•
Cervical spine injuries,
other than those dealt with in items 1 to 3, range
from cases of very severe disability to cases of a
minor strain, with no time off work and symptoms
only suffered for 2 or 3 weeks.
•
Symptoms associated with
nerve root compression or damage can not be taken
into account in assessing an ISV under item 84, 85
or 86 unless objective signs are present of nerve
root compression or damage, for example—
•
CT or MRI scans or other
radiological evidence
•
muscle wasting
•
clinical findings of deep
tendon reflex loss, motor weakness and loss of
sensation.
84
Extreme cervical spine injury
Comment
41 to 75
These are extremely severe
injuries that cause gross limitation of movement
and serious interference with performance of daily
activities.
The injury will involve
significant upper or lower extremity impairment
and may require the use of an adaptive device or
prosthesis.
Examples of the
injury
•
A total neurological loss at
a single level
•
Severe multilevel
neurological dysfunction
•
Structural compromise of the
spinal canal with extreme upper or lower extremity
motor and sensory impairments
•
Fractures involving more
than 50% compression of a vertebral body with
neural compromise
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
of about 29%.
•
An ISV at or near the top of
the range will be appropriate if there is a
cervical spine injury causing monoplegia of the
dominant upper limb and a DPI of at least
60%.
85
Serious cervical spine injury
Comment
16 to 40
•
The injury will cause
serious upper extremity impairment or serious
permanent impairment of the cervical spine.
•
The injury may
involve—
(a)
a change of motion segment
integrity; or
(b)
bilateral or multilevel
nerve root compression or damage.
Examples of the
injury
•
Loss of motion in a motion
segment because of a surgical or post-traumatic
fusion
•
A fracture involving more
than 25% compression of 1 vertebral body
•
An injury showing objective
signs of nerve root damage after surgery
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if—
(a)
the injured worker has had
surgery and symptoms persist; or
(b)
there is a fracture
involving 25% compression of 1 vertebral
body.
•
An ISV in the middle of the
range will be appropriate if there is a fracture
involving about 50% compression of a vertebral
body, with ongoing pain.
•
An ISV at or near the top of
the range will be appropriate if—
(a)
the injured worker has had a
fusion of vertebral bodies that has failed,
leaving objective signs of significant residual
nerve root damage and ongoing pain, affecting 1
side of the body; and
(b)
there is a DPI of about
28%.
86
Moderate cervical spine injury—fracture, disc prolapse or nerve root
compression or damage
Comment about appropriate
level of ISV
5 to 15
•
An ISV at or near the top of
the range will be appropriate if—
(a)
there is a disc prolapse for
which there is radiological evidence at an
anatomically correct level; and
(b)
there are symptoms of pain
and 3 or more of the following objective signs
that are anatomically localised to an appropriate
spinal nerve root distribution—
(i)
sensory loss;
(ii)
loss of muscle
strength;
(iii)
loss of reflexes;
(iv)
unilateral atrophy;
and
(c)
the impairment has not
improved after non-operative treatment.
•
An ISV of about 10 will be
appropriate if there is a fracture of a vertebral
body with up to 25% compression, and ongoing
pain.
•
An ISV at or near the bottom
of the range will be appropriate for an
uncomplicated fracture of a posterior element of 1
or more of the vertebral segments, for example,
spinous or transverse processes, without
neurological impairment.
87
Moderate cervical spine injury—soft tissue injury
Comment
5 to 10
The injury will cause
moderate permanent impairment, for which there is
objective evidence, of the cervical spine.
Comment about appropriate
level of ISV
An ISV of not more than 10
will be appropriate if there is a DPI of 8% caused
by a soft tissue injury for which there is no
radiological evidence.
88
Minor cervical spine injury
Comment
0 to 4
•
Injuries within this item
include a whiplash injury with no ongoing
symptoms, other than symptoms that are merely a
nuisance, remaining more than 18 months after the
injury is caused.
•
There will be no objective
signs of neurological impairment
Example of the
injury
A soft tissue or whiplash
injury if symptoms are minor and the injured
worker recovers, or is expected to recover, from
the injury to a level where the injury is merely a
nuisance within 18 months after the injury is
caused
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if the injury
will resolve without any ongoing symptoms within
months after the injury is caused.
•
An ISV at or near the top of
the range will be appropriate if the injury,
despite improvement, causes headaches and some
ongoing pain.
Division 2
Thoracic or lumbar spine injuries
General comment for items
89 to 93
•
This division does not apply
to the following injuries (that are dealt with in
items 1 to 3)—
•
quadriplegia
•
paraplegia
•
hemiplegia or severe
paralysis of more than 1 limb.
•
Thoracic or lumbar spine
injuries, other than those dealt with in items 1
to 3, range from cases of very severe disability
to cases of a minor strain, with no time off work
and symptoms suffered only for 2 or 3 weeks.
•
Symptoms associated with
nerve root compression or damage can not be taken
into account in assessing an ISV under item 89, 90
or 91 unless objective signs are present of nerve
root compression or damage, for example—
•
CT or MRI scans or other
radiological evidence
•
muscle wasting
•
clinical findings of deep
tendon reflex loss, motor weakness and loss of
sensation.
89
Extreme thoracic or lumbar spine injury
Comment
36 to 60
These are extremely severe
injuries causing gross limitation of movement and
serious interference with performance of daily
activities. There may be some motor or sensory
loss, and some impairment of bladder, ano-rectal
or sexual function.
Example of the
injury
A fracture involving
compression of a thoracic or lumbar vertebral body
of more than 50%, with neurological
impairment
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 25%.
•
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of at least 45%.
90
Serious thoracic or lumbar spine injury
Comment
16 to 35
•
The injury will cause
serious permanent impairment in the thoracic or
lumbar spine.
•
The injury may
involve—
(a)
bilateral or multilevel
nerve root damage; or
(b)
a change in motion segment
integrity, for example, because of surgery.
Example of the
injury
A fracture involving at
least 25% compression of 1 thoracic or lumbar
vertebral body
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if—
(a)
the injured worker has had
surgery and symptoms persist; or
(b)
there is a fracture
involving 25% compression of 1 vertebral
body.
•
An ISV in the middle of the
range will be appropriate if there is a fracture
involving 50% compression of a vertebral body,
with ongoing pain.
•
An ISV at or near the top of
the range will be appropriate if the injured
worker has had a fusion of vertebral bodies that
has failed—
(a)
leaving objective signs of
significant residual nerve root damage and ongoing
pain, affecting 1 side of the body; and
(b)
causing a DPI of 24%.
91
Moderate thoracic or lumbar spine injury—fracture, disc prolapse or
nerve root compression or damage
Comment about appropriate
level of ISV
5 to 15
•
An ISV at or near the top of
the range will be appropriate if—
(a)
there is a disc prolapse for
which there is radiological evidence at an
anatomically correct level; and
(b)
there are symptoms of pain
and 3 or more of the following objective signs,
that are anatomically localised to an appropriate
spinal nerve root distribution—
(i)
sensory loss;
(ii)
loss of muscle
strength;
(iii)
loss of reflexes;
(iv)
unilateral atrophy;
and
(c)
the impairment has not
improved after non-operative treatment.
•
An ISV of about 10 will be
appropriate if there is a fracture of a vertebral
body with up to 25% compression, and ongoing
pain.
•
An ISV at or near the bottom
of the range will be appropriate for an
uncomplicated fracture of a posterior element of 1
or more of the vertebral segments, for example
spinous or transverse processes, without
neurological impairment.
92
Moderate thoracic or lumbar spine injury—soft tissue injury
Comment
5 to 10
The injury will cause
moderate permanent impairment, for which there is
objective evidence, of the thoracic or lumbar
spine.
Comment about appropriate
level of ISV
An ISV of not more than 10
will be appropriate if there is a DPI of 8% caused
by a soft tissue injury for which there is no
radiological evidence.
93
Minor thoracic or lumbar spine injury
Example of the
injury
0 to 4
A soft tissue injury of the
thoracic or lumbar spine with no—
•
significant clinical
findings
•
fractures
•
documented neurological
impairment
•
significant loss of motion
segment integrity
•
other objective signs of
impairment relating to the injury
Comment about appropriate
level of ISV
•
An ISV at or near the top of
the range will be appropriate, whether or not the
injured worker continues to suffer some ongoing
pain, if the injury will substantially reach
maximum medical improvement, with only minor
symptoms, within about 18 months after the injury
is caused.
•
An ISV at or near the bottom
of the range will be appropriate if the injury
will resolve without any ongoing symptoms within
months after the injury is caused.
Division 3
Shoulder injuries
General comment for items
94 to 97
•
Injuries under items 94 to
97 include subluxations or dislocations of the
sternoclavicular joint, acromioclavicular joint or
glenohumeral joint.
•
Soft tissue injuries may
involve the musculoligamentous supporting
structures of the joints.
•
Fractures may involve the
clavicle, the scapula (shoulder blade) and the
humerus.
Comment about appropriate
level of ISV for items 94 to 97
An ISV at or near the top of
the range will generally only be appropriate if
the injury is to the shoulder of the dominant
upper limb.
94
Extreme shoulder injury
Comment
31 to 50
These are the most severe
traumatic injuries causing gross permanent
impairment.
Examples of the
injury
•
A severe fracture or
dislocation, with secondary medical
complications
•
Joint disruption with poor
outcome after surgery
•
Degloving
•
Permanent nerve
palsies
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI of
45% and complete loss of all shoulder function of
the dominant upper limb.
95
Serious shoulder injury
Comment
16 to 30
The 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 worker 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 impairment
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 25% and the injury is to the
dominant upper limb.
96
Moderate shoulder injury
Examples of the
injury
6 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 worker has made a reasonable recovery,
requiring open reduction and internal
fixation
•
Nerve palsies from which the
injured worker has made a good recovery
•
Painful persisting
dislocation of the acromioclavicular joint
•
An injury to the
sternoclavicular joint causing permanent, painful
instability
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 6%.
•
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 12% and the injury is to the
dominant upper limb.
97
Minor shoulder injury
Examples of the
injury
0 to 5
•
Soft tissue injury with
considerable pain from which the injured worker
makes an almost full recovery in less than 18
months
•
Fracture from which the
injured worker has made an uncomplicated
recovery
•
Strain injury of the
acromioclavicular joint or sternoclavicular
joint
Division 4
Amputation of upper limbs
Comment about appropriate
level of ISV for items 98 to 99.3
An ISV at or near the top of
the range will generally only be appropriate if
the amputation is of the dominant upper
limb.
98
Loss of both upper limbs, or loss of 1 arm and extreme injury to the
other arm
Comment
55 to 85
The effect of the injury is
to reduce the injured worker 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
pains
Additional 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 a DPI 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 a DPI 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 a DPI of 54%.
99
Loss of 1 upper limb
Examples 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 arm
99.1
An upper limb amputation
at the shoulder
50 to 65
99.2
An upper limb amputation
through the elbow or above the elbow but below the
shoulder
40 to 65
Additional comment about
appropriate level of ISV for item 99.2
•
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.
99.3
An upper limb amputation
below the elbow
35 to 60
Additional comment about
appropriate level of ISV for item 99.3
An 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 5
Elbow injuries
Comment about appropriate
level of ISV for items 100 to 103
An 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.
100
Extreme elbow injury
Comment
26 to 50
The injury will involve an
extremely severe elbow injury, falling short of
amputation, leaving little effective use of the
elbow joint.
Examples of the
injury
•
A DPI 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 position
101
Serious elbow injury
Comment
13 to 25
The 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 worker will partially recover
•
Permanent, poor restriction
of range of motion with the elbow constrained in a
satisfactory functional position
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 23% and the injury is to the
elbow of the dominant upper limb.
102
Moderate elbow injury
Comment
6 to 12
The 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 worker has made a reasonable recovery,
requiring open reduction and internal
fixation
•
Nerve palsies from which the
injured worker has made a good recovery
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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 a DPI of 10%.
103
Minor elbow injury
Comment
0 to 5
The 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
laceration
Division 6
Wrist injuries
Comment about appropriate
level of ISV for items 104 to 107
An 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.
104
Extreme wrist injury
Comment
25 to 40
The 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
palsies
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 36% and the injury is to the
wrist of the dominant upper limb.
105
Serious wrist injury
Examples of the
injury
16 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
instability
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 20% and the injury is to the
wrist of the dominant upper limb.
106
Moderate wrist injury
Examples of the
injury
6 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 entrapment
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 6%.
•
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 12%.
107
Minor wrist injury
Examples of the
injury
0 to 5
•
A fracture from which the
injured worker almost fully recovers
•
A soft tissue injury, for
example, severe bruising
•
Continued pain following
carpal tunnel release
Division 7
Hand injuries
General comment for items
108 to 119
Hands are cosmetically and
functionally the most important part of the upper
limbs.
Comment about appropriate
level of ISV for items 108 to 119
•
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.
108
Total or effective loss of both hands
Examples of the
injury
51 to 75
A serious injury causing
extensive damage to both hands making them little
more than useless
Examples 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
amputations
Additional 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.
109
Serious injury to both hands
Comment
40 to 50
The injury will involve
significant loss of function in both hands, for
example, loss of 50% or more of the use of each
hand.
110
Total or effective loss of 1 hand
Examples of the
injury
35 to 60
•
A crushed hand that has been
surgically amputated
•
Traumatic amputation of all
fingers and most of the palm
Example of factor
affecting ISV assessment
Severity of any phantom pain
if there has been an amputation
Additional 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 a DPI 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.
111
Amputation of the thumb or part of the thumb
Examples of factors
affecting ISV assessment
15 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 fingers
Additional 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 a DPI 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.
112
Amputation of index, middle and ring fingers, or any 2 of
them
Comment
15 to 30
The 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 assessment
The level of the amputation,
for example, whether the hand has been made to be
of very little use and any remaining grip is very
weak
Additional 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 a DPI
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
a DPI for the injury of at least 27%; and
(b)
the injury is to the
dominant hand.
113
Amputation of individual fingers
Examples of factors
affecting ISV assessment
5 to 20
•
Whether the amputation was
of the index or middle finger
•
The level of the
amputation
•
Any damage to other fingers
short of amputation
Additional 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 a DPI 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 a DPI 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 a DPI of at least 15%.
114
Amputation of thumb and all fingers
Comment
As the injury will cause
effective loss of the hand, see item 110.
115
Any other injury to 1 or more of the fingers or the thumb
Comment about appropriate
level of ISV for items 115.1 to 115.4
An 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 hand
115.1
Extreme injury to 1 or
more of the fingers or the thumb
16 to 25
Example of the
injury
Total loss of function of 1
or more of the fingers, with the joints ankylosed
in non-functional positions
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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.
115.2
Serious injury to 1 or
more of the fingers or the thumb
11 to 15
Examples 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 repair
115.3
Moderate injury to 1 or
more of the fingers or the thumb
6 to 10
Comment
There 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 repair
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 8% and the injury is to the
dominant hand.
115.4
Minor injury to 1 or more
of the fingers or the thumb
0 to 5
Example of the
injury
An uncomplicated fracture or
soft tissue injury that has healed with minimal
residual symptoms
Additional 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.
116
Extreme hand injury
Comment
31 to 45
•
The injury will involve a
severe traumatic injury to the hand, that may
include amputation of part of the hand, causing
gross impairment of the hand.
•
A hand injury causing a DPI
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
disfigurement
Additional 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.
117
Serious hand injury
Examples of the
injury
16 to 30
•
A severe crush injury
causing significantly impaired function despite
surgery
•
Serious permanent tendon
damage
Additional comment about
appropriate level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 20%.
118
Moderate hand injury
Examples of the
injury
6 to 15
•
A crush injury, penetrating
wound or deep laceration, requiring surgery
•
Moderately serious tendon
damage
•
A hand injury causing a DPI
for the injury of between 5% and 12%
119
Minor hand injury
Examples of the
injury
0 to 5
A soft tissue injury, or an
injury that does not require surgery, with nearly
full recovery of hand function
Division 8
Upper limb injuries, other than injuries mentioned in divisions 3 to 7
Comment about appropriate
level of ISV for items 120 to 123
An ISV at or near the top of
the range will generally only be appropriate if
the injury is to the dominant upper limb.
120
Extreme upper limb injury, other than an injury mentioned in divisions 3 to 7
Comment
36 to 65
The injury will involve an
extremely serious upper limb injury, falling short
of amputation, leaving the injured worker 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 useless
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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 a DPI for the
injury of 55%.
121
Serious upper limb injury, other than an injury mentioned in divisions 3 to 7
Examples of the
injury
21 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
function
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 16%.
•
An ISV at or near the top of
the range will be appropriate if there is an
injury to the dominant limb causing a DPI of
30%.
122
Moderate upper limb injury, other than an injury mentioned in divisions 3 to 7
Examples of the
injury
6 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
ulna
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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
worker 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 a
DPI for the injury of 15%.
123
Minor upper limb injury, other than an injury mentioned in divisions 3 to 7
Example of the
injury
0 to 5
An uncomplicated fracture of
the humerus, radius or ulna, or any combination of
the humerus, radius and ulna, from which the
injured worker has fully recovered within a short
time
Additional 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 worker 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
worker has substantially recovered within a few
weeks, leaving some minor functional
impairment.
Division 9
Pelvis or hip injuries
General comment for items
124 to 127
•
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 124 to
127
•
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
•
Age
124
Extreme pelvis or hip injury
Examples of the
injury
46 to 65
•
An extensive pelvis
fracture
•
Degloving
•
Permanent nerve
palsies
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 40%.
•
An ISV at or near the top of
the range will be appropriate if the injured
worker is not able to mobilise without a
wheelchair and is relatively young.
125
Serious pelvis or hip injury
Comment
26 to 45
There 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 surgery
Comment about appropriate
level of ISV
An ISV at or near the bottom
of the range will be appropriate for an injury
causing a DPI for the injury of 20%.
126
Moderate pelvis or hip injury
Examples of the
injury
11 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 a DPI 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 a DPI
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.
127
Minor pelvis or hip injury
Examples of the
injury
0 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 successful.
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a
soft tissue injury from which the injured worker
fully recovers.
•
An ISV at or near the middle
of the range will be appropriate if there is a DPI
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 10
Amputation of lower limbs
Subdivision 1
Amputation of both lower
limbs
Examples of factors
affecting ISV assessment for items 128 and
129
•
The level of each
amputation
•
Severity of any phantom
pain
•
Pain in the stumps
•
Extent of any ongoing
symptoms
128
Loss of both lower
limbs above or through the knee
Comment about appropriate
level of ISV
55 to 70
An 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.
129
Below the knee
amputation of both lower limbs
Comment about appropriate
level of ISV
50 to 65
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
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 2
Amputation of 1 lower
limb
Examples of factors
affecting ISV assessment for items 130 and
131
•
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 stump
130
Above or through the
knee amputation of 1 lower limb
Comment about appropriate
level of ISV
35 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.
131
Below the knee
amputation of 1 lower limb
Comment about appropriate
level of ISV
31 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 11
Lower limb injuries, other than injuries mentioned in division 9 or 10 or divisions 12 to 15
132
Extreme lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15
Comment
31 to 55
These are the most severe
injuries short of amputation, leaving the injured
worker 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
a DPI of 40%
133
Serious lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15
Comment
21 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
injury
Multiple complex fractures
of the lower limb that are expected to take years
to heal and cause serious deformity and serious
limitation of mobility
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 16%.
•
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 25%.
134
Moderate lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15
Examples of the
injury
11 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
fibula
Examples 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 damage
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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 a DPI
for the injury of 15%.
135
Minor lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15
Example of the
injury
0 to 10
An uncomplicated fracture of
the femur, tibia or fibula, from which the injured
worker has fully recovered
Comment 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 worker 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 worker 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
worker 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 a
DPI for the injury of 9%.
Division 12
Knee injuries
General comment for items
136 to 139
The availability of
remedies, for example, a total knee replacement is
an important factor in assessing an ISV under this
division.
136
Extreme knee injury
Example of the
injury
25 to 40
A severe knee injury if
there is a disruption of the joint, gross
ligamentous damage, loss of function after
unsuccessful surgery, lengthy treatment and
considerable pain
Comment about appropriate
level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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 a DPI for the injury
of more than 30%.
137
Serious knee injury
Comment
11 to 24
The 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
injury
A leg fracture extending
into the knee joint, causing pain that is
constant, permanent and limits movement or impairs
agility
Comment about appropriate
level of ISV
An ISV at or near the middle
of the range will be appropriate if there is a
ligamentous injury, that required surgery and
prolonged rehabilitation, causing a DPI of 15% and
functional limitation.
138
Moderate knee injury
Examples of the
injury
6 to 10
A dislocation or torn
cartilage or meniscus causing ongoing minor
instability, wasting and weakness
Comment about appropriate
level of ISV
An ISV at or near the top of
the range will be appropriate if there is a DPI
for the injury of 8%.
139
Minor knee injury
Examples of the
injury
0 to 5
•
A partial cartilage,
meniscal or ligamentous tear
•
A laceration
•
A twisting or bruising
injury
Division 13
Ankle injuries
Comment about appropriate
level of ISV for items 140 to 143
The appropriate ISV for the
vast majority of ankle injuries is 1 or 2.
140
Extreme ankle injury
Examples of the
injury
21 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
•
A DPI 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 walking
141
Serious ankle injury
Example of the
injury
11 to 20
An 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 basis
Examples 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 activity
Additional comment about
appropriate level of ISV
•
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 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.
142
Moderate ankle injury
Example of the
injury
6 to 10
A 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 scarring
Additional comment about
appropriate level of ISV
An ISV at or near the bottom
of the range will be appropriate if there is a DPI
for the injury of 6%.
143
Minor ankle injury
Example of the
injury
0 to 5
A sprain, ligamentous or
soft tissue injury or minor or undisplaced
fracture
Examples of factors
affecting ISV assessment
•
Whether the injured worker
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 discomfort
Division 14
Foot injuries
Subdivision 1
Amputations
144
Amputation of both
feet
Examples of factors
affecting ISV assessment
32 to 65
•
Severity of any phantom
pain
•
Pain in the stumps
•
Extent of any ongoing
symptoms
Comment 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.
145
Amputation of 1
foot
Examples of factors
affecting ISV assessment
20 to 35
•
Severity of any phantom
pain
•
Pain in the stump
•
Extent of any ongoing
symptoms
Comment 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 2
Other foot
injuries
146
Extreme foot injury
that is not an amputation
Comment
13 to 25
There will be permanent and
severe pain or very serious permanent
disability.
Example of the
injury
An unusually severe foot
injury causing a DPI of 15% or more, for example,
a heel fusion or loss of the tibia-calcaneum
angle
Comment about appropriate
level of ISV
An 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 a DPI for the injury of
24%.
147
Serious foot
injury
Examples of the
injury
9 to 12
•
A severe midfoot deformity
causing a DPI of 8%
•
A lower level loss of the
tibia-calcaneum angler
148
Moderate foot
injury
Example of the
injury
4 to 8
A displaced metatarsal
fracture causing permanent deformity, with ongoing
symptoms of minor severity, for example, a limp
that does not prevent the injured worker engaging
in most daily activities
149
Minor foot
injury
Examples of the
injury
0 to 3
A simple metatarsal
fracture, ruptured ligament, puncture wound or
similar injury
Comment about appropriate
level of ISV
An 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 worker will
fully recover.
Division 15
Toe injuries
150
Extreme toe injury
Examples of factors
affecting ISV assessment for items 150.1 to
150.3
•
Whether the amputation was
traumatic or surgical
•
Extent of the loss of the
forefoot
•
Residual effects on
mobility
150.1
Amputation of all
toes
8 to 20
Comment 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.
150.2
Amputation of the great
toe
6 to 12
Example of factor
affecting ISV assessment for item 150.2
The level at which the
amputation happens or any ongoing symptoms
Comment about appropriate
level of ISV
An 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.
150.3
Amputation of individual
lesser toes
3 to 5
Example of factor
affecting ISV assessment for item 150.3
The level at which the
amputation happens or any ongoing symptoms
Comment 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.
151
Serious toe injury
Comment
8 to 12
The 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
symptoms
152
Moderate toe injury
Comment
4 to 7
There 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 toes
Comment about appropriate
level of ISV
An 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.
153
Minor toe injury
Examples of the
injury
0 to 3
A relatively straightforward
fracture or soft tissue injury
Comment about appropriate
level of ISV
An 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 16
Limb disorders
General comment
The 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 thrombosis
Examples 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 limb
Part 7
Scarring to
parts of the body other than the face
General 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 154.1 to
154.4
•
Location of a scar
•
Age
•
Adverse psychological
reaction
•
Likelihood of a scar fading
or becoming less noticeable over time
154
Scarring to a part of the body other than the face
154.1
Extreme scarring to a part
of the body other than the face
14 to 25
Comment 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.
154.2
Serious scarring to a part
of the body other than the face
9 to 13
Comment
There 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 irritation.
154.3
Moderate scarring to a part
of the body other than the face
4 to 8
Examples 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 neck
154.4
Minor scarring to a part of
the body other than the face
0 to 3
Examples 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
damage.
Part 8
Burn
injuries
General 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 9
Injuries
affecting hair
155
Extreme injury affecting head hair
Example of the
injury
11 to 15
Total permanent loss of head
hair
156
Serious injury affecting head hair
Example of the
injury
4 to 10
Damage 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 life
Comment about appropriate
level of ISV
An 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.
157
Moderate injury affecting head hair or loss of body hair
Examples of the
injury
0 to 3
•
Hair that has been pulled
out leaving bald patches
•
The same example applies as
for item 156 but with fewer or only moderate
symptoms
Example of factor affecting
ISV assessment
Length of time before
regrowth
Part 10
Dermatitis
158
Extreme dermatitis
Examples of the
injury
11 to 20
Permanent dermatitis having a
severe effect on employment and domestic
capability, with some mental disorder
159
Serious dermatitis
Example of the
injury
8 to 10
Dermatitis 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 reaction
160
Moderate dermatitis
Example of the
injury
3 to 7
Dermatitis lasting for a
significant period, but settling with treatment or
a change of personal conduct, or both
161
Minor dermatitis
Examples of the
injury
0 to 2
Itching, skin irritation or a
rash, alone or in combination, that resolves with
treatment within a few months of the start of
treatment
Schedule 10
Matters relevant to
PIRS assessment by medical expert
section 129(d)
Part 1
Explanation of the PIRS
1
PIRS
rates permanent impairment caused by mental disorder
The PIRS set out in schedule 11 rates permanent impairment caused by a
mental disorder.
Note—
PIRS ratings are referred to in schedule 9, part 2. A PIRS rating is capable of being
accepted by a court under schedule 8, section 6 only if it is—
(a)
assessed by a medical expert as
required under this schedule and schedule 11; and
(b)
provided to the court in a PIRS
report as required under section 12.
2
Areas
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 2
Assessment
of PIRS rating
3
Medical expert must comply with requirements
(1)
A medical expert must comply with this schedule
and schedule 11 in assessing a PIRS rating for a
mental disorder of an injured worker.
(2)
The medical expert may give an assessment only if
the medical expert has examined the injured worker.
4
How
to assess a PIRS rating
(1)
To assess a PIRS rating for a mental disorder of
an injured worker, 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 worker; 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 worker’s
level of impairment, including, for example, the
injured worker’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 worker.
5
Assessment if pre-existing mental disorder
(1)
If an injured worker 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 worker.
Editor’s
note—
See also section 11.
6
How
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.
Note—
A median class score, as opposed to a mean
class score or average class score, has the advantage of not
being too influenced by 1 extreme score.
7
Conversion table
This section sets out the conversion table for use
under section 4.
Conversion table for
percentage impairment
Median class
score
1
2
3
4
5
6
0%
Total class score
7
0%
8
1%
9
1%
4%
10
2%
5%
11
2%
5%
12
2%
6%
13
3%
7%
11%
14
3%
7%
13%
15
8%
15%
16
9%
17%
17
9%
19%
31%
18
10%
22%
34%
19
24%
37%
20
26%
41%
21
28%
44%
61%
22
30%
47%
65%
23
50%
70%
24
54%
74%
25
57%
78%
26
60%
83%
27
87%
28
91%
29
96%
30
100%
8
Example worksheet
This 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
impairment
Class
1
Self care and personal
hygiene
1
2
Social and recreational
activities
2
3
Travel
3
4
Social
functioning
5
5
Concentration,
persistence and pace
5
6
Adaptation
5
List of class numbers in
ascending order:
1
2
3
5
5
5
Median class score (using
section 6):
4
Total class score:
21
Percentage impairment (using
conversion table in section 7):
44%
PIRS rating (if no
pre-existing mental disorder):
44%
Part 3
Particular
cases
9
Refusal of treatment
(1)
This section applies if an injured worker refuses
treatment that could lead to a significant improvement in the level
of permanent impairment caused by a mental disorder of the injured
worker.
(2)
Despite the injured worker’s refusal of treatment,
a medical expert may assess a PIRS rating for the mental disorder of
the injured worker.
(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 worker refuses treatment that could
lead to a significant improvement in the level of permanent
impairment caused by the mental disorder of the injured
worker.
(6)
The court may, in assessing the ISV for an injury
or multiple injuries of the injured worker, 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.
10
Cognitive impairment
If a medical expert assessing a PIRS rating for a
mental disorder of an injured worker suspects the injured worker has a
cognitive impairment, the medical expert must take into account the
following factors—
(a)
the relevant medical history of the
injured worker;
(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.
11
Pre-existing mental disorder
If a medical expert assessing a PIRS rating for a
mental disorder of an injured worker considers the injured worker 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 4
Report of
PIRS rating
12
Court 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 worker.
(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
worker;
(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 worker; 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 worker 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 worker.
Schedule 11
Psychiatric
impairment rating scale
section 129(c)
Area of
functional impairment: self-care and personal hygiene
Class
Level of
impairment
Examples of indicators of level
of impairment
Note—
These must be had regard to
under schedule 10, section 4(3)(a)(i).
Percentage impairment
ranges
Note—
These may be had regard to
under schedule 10, section 4(3)(b).
Class 1
Little or no impairment
0 to 3%
Class 2
Mild impairment
4 to 10%
•
can live independently
•
looks after himself or
herself adequately, although may look unkempt
occasionally
•
sometimes misses a meal or
relies on takeaway food
Class 3
Moderate impairment
11 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 nutrition
Class 4
Severe impairment
31 to 60%
•
needs supervised residential
care
•
if unsupervised, may
accidentally or deliberately hurt himself or
herself
Class 5
Totally impaired
more than 60%
•
needs assistance with basic
functions, for example, feeding or toileting
Area of functional impairment: social and recreational activities
Class
Level of
impairment
Examples of indicators of level
of impairment
Note—
These must be had regard to
under schedule 10, section 4(3)(a)(i).
Percentage impairment
ranges
Note—
These may be had regard to
under schedule 10, section 4(3)(b).
Class 1
Little or no impairment
0 to 3%
•
regularly goes to cinemas,
restaurants or other recreational venues
•
belongs to clubs or
associations and is actively involved in
them
Class 2
Mild impairment
4 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 team
Class 3
Moderate impairment
11 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
withdrawn
Class 4
Severe impairment
31 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 residence
Class 5
Totally impaired
more than 60%
•
can not tolerate living with
anybody
•
extremely uncomfortable when
visited by a close family member
Area of functional impairment: travel
Class
Level of
impairment
Examples of indicators of level
of impairment
Note—
These must be had regard to
under schedule 10, section 4(3)(a)(i).
Percentage impairment
ranges
Note—
These may be had regard to
under schedule 10, section 4(3)(b).
Class 1
Little or no impairment
0 to 3%
•
can travel to new
environments without supervision
Class 2
Mild impairment
4 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
neighbour
Class 3
Moderate impairment
11 to 30%
•
can not travel away from own
residence without a support person
•
there may be problems
resulting from excessive anxiety or cognitive
impairment
Class 4
Severe impairment
31 to 60%
•
finds it extremely
uncomfortable to leave his or her own residence
even with a trusted person
Class 5
Totally impaired
more than 60%
•
can not be left
unsupervised, even at own residence
•
may require 2 or more
persons to supervise him or her when
travelling
Area of functional impairment: social functioning
Class
Level of
impairment
Examples of indicators of level
of impairment
Note—
These must be had regard to
under schedule 10, section 4(3)(a)(i).
Percentage impairment
ranges
Note—
These may be had regard to
under schedule 10, section 4(3)(b).
Class 1
Little or no impairment
0 to 3%
•
has no difficulty in forming
and sustaining relationships, for example, with a
spouse or close friend lasting years
Class 2
Mild impairment
4 to 10%
•
existing relationships are
strained
•
tension and arguments
between the injured worker and a spouse or close
family member
•
some friendships are
lost
Class 3
Moderate impairment
11 to 30%
•
established relationships
are severely strained, as is shown by periods of
separation or domestic violence
•
if the injured worker has
children, then a spouse, family members or
community services are providing most of the care
for the children
Class 4
Severe impairment
31 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 parent
Class 5
Totally impaired
more than 60%
•
can not function within
society
•
lives away from populated
areas
•
actively avoids social
contact
Area of functional impairment: concentration, persistence and
pace
Class
Level of
impairment
Examples of indicators of level
of impairment
Note—
These must be had regard to
under schedule 10, section 4(3)(a)(i).
Percentage impairment
ranges
Note—
These may be had regard to
under schedule 10, section 4(3)(b).
Class 1
Little or no impairment
0 to 3%
•
can complete vocational
education and training or a university course
within a normal time frame
Class 2
Mild impairment
4 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 headaches
Class 3
Moderate impairment
11 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 knitting
Class 4
Severe impairment
31 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 services
Class 5
Totally impaired
more than 60%
•
needs constant supervision
and assistance within an institutional
environment
Area of functional impairment: adaptation
Note—
This area of functional
impairment deals with employability.
Class
Level of impairment
Examples of indicators of level of
impairment
Note—
These must be had regard to
under schedule 10, section 4(3)(a)(i).
Percentage impairment
ranges
Note—
These may be had regard to
under schedule 10, section 4(3)(b).
Class 1
Little or no impairment
0 to 3%
•
can work full-time in the
position (the pre-injury position)
in which the injured worker worked immediately
before the injury
•
the injured worker’s duties
at work and performance of the duties are
consistent with the worker’s education and
training
•
can cope with the normal
demands of the job
Class 2
Mild impairment
4 to 10%
•
can work in the pre-injury
position, but for no more than 20 hours a week,
for example, because the injured worker 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 position
Class 3
Moderate impairment
11 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 stressful
Class 4
Severe impairment
31 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
erratic
Class 5
Totally impaired
more than 60%
•
needs constant supervision
and assistance within an institutional
environment
Schedule 12
General damages
calculation provisions
section 130
Table 1—For an injury sustained from 1
July 2010 to 30 June 2011 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,180
2
10 or less but more than 5
$5,900
(Injury scale value - 5) x
$1,410
3
15 or less but more than 10
$12,950
(Injury scale value - 10) x
$1,650
4
20 or less but more than 15
$21,200
(Injury scale value - 15) x
$1,880
5
25 or less but more than 20
$30,600
(Injury scale value - 20) x
$2,120
6
30 or less but more than 25
$41,200
(Injury scale value - 25) x
$2,360
7
35 or less but more than 30
$53,000
(Injury scale value - 30) x
$2,590
8
40 or less but more than 35
$65,950
(Injury scale value - 35) x
$2,830
9
50 or less but more than 40
$80,100
(Injury scale value - 40) x
$3,040
10
60 or less but more than 50
$110,500
(Injury scale value - 50) x
$3,250
11
70 or less but more than 60
$143,000
(Injury scale value - 60) x
$3,460
12
80 or less but more than 70
$177,600
(Injury scale value - 70) x
$3,680
13
90 or less but more than 80
$214,400
(Injury scale value - 80) x
$3,890
14
100 or less but more than 90
$253,300
(Injury scale value - 90) x
$4,120
Table 2—For an injury sustained from 1
July 2011 to 30 June 2012 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,210
2
10 or less but more than 5
$6,050
(Injury scale value - 5) x
$1,450
3
15 or less but more than 10
$13,300
(Injury scale value - 10) x
$1,700
4
20 or less but more than 15
$21,800
(Injury scale value - 15) x
$1,930
5
25 or less but more than 20
$31,450
(Injury scale value - 20) x
$2,180
6
30 or less but more than 25
$42,350
(Injury scale value - 25) x
$2,430
7
35 or less but more than 30
$54,500
(Injury scale value - 30) x
$2,660
8
40 or less but more than 35
$67,800
(Injury scale value - 35) x
$2,910
9
50 or less but more than 40
$82,350
(Injury scale value - 40) x
$3,130
10
60 or less but more than 50
$113,650
(Injury scale value - 50) x
$3,340
11
70 or less but more than 60
$147,050
(Injury scale value - 60) x
$3,560
12
80 or less but more than 70
$182,650
(Injury scale value - 70) x
$3,780
13
90 or less but more than 80
$220,450
(Injury scale value - 80) x
$4,000
14
100 or less but more than 90
$260,450
(Injury scale value - 90) x
$4,240
Table 3—For an injury sustained from 1
July 2012 to 30 June 2013 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1270
2
10 or less but more than 5
$6,350
(Injury scale value - 5) x
$1,530
3
15 or less but more than 10
$14,000
(Injury scale value - 10) x
$1,790
4
20 or less but more than 15
$22,950
(Injury scale value - 15) x
$2,030
5
25 or less but more than 20
$33,100
(Injury scale value - 20) x
$2,300
6
30 or less but more than 25
$44,600
(Injury scale value - 25) x
$2,560
7
35 or less but more than 30
$57,400
(Injury scale value - 30) x
$2,800
8
40 or less but more than 35
$71,400
(Injury scale value - 35) x
$3,070
9
50 or less but more than 40
$86,750
(Injury scale value - 40) x
$3,300
10
60 or less but more than 50
$119,750
(Injury scale value - 50) x
$3,520
11
70 or less but more than 60
$154,950
(Injury scale value - 60) x
$3,750
12
80 or less but more than 70
$192,450
(Injury scale value - 70) x
$3,980
13
90 or less but more than 80
$232,250
(Injury scale value - 80) x
$4,210
14
100 or less but more than 90
$274,350
(Injury scale value - 90) x
$4,470
Table 4—For an injury sustained from 1
July 2013 to 30 June 2014 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,310
2
10 or less but more than 5
$6,550
(Injury scale value - 5) x
$1,580
3
15 or less but more than 10
$14,450
(Injury scale value - 10) x
$1,840
4
20 or less but more than 15
$23,650
(Injury scale value - 15) x
$2,090
5
25 or less but more than 20
$34,100
(Injury scale value - 20) x
$2,370
6
30 or less but more than 25
$45,950
(Injury scale value - 25) x
$2,640
7
35 or less but more than 30
$59,150
(Injury scale value - 30) x
$2,880
8
40 or less but more than 35
$73,550
(Injury scale value - 35) x
$3,160
9
50 or less but more than 40
$89,350
(Injury scale value - 40) x
$3,400
10
60 or less but more than 50
$123,350
(Injury scale value - 50) x
$3,620
11
70 or less but more than 60
$159,550
(Injury scale value - 60) x
$3,860
12
80 or less but more than 70
$198,150
(Injury scale value - 70) x
$4,100
13
90 or less but more than 80
$239,150
(Injury scale value - 80) x
$4,340
14
100 or less but more than 90
$282,550
(Injury scale value - 90) x
$4,600
Table 5—For an injury sustained from 1
July 2014 to 30 June 2015 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,360
2
10 or less but more than 5
$6,800
(Injury scale value - 5) x
$1,640
3
15 or less but more than 10
$15,000
(Injury scale value - 10) x
$1,910
4
20 or less but more than 15
$24,550
(Injury scale value - 15) x
$2,170
5
25 or less but more than 20
$35,400
(Injury scale value - 20) x
$2,460
6
30 or less but more than 25
$47,700
(Injury scale value - 25) x
$2,740
7
35 or less but more than 30
$61,400
(Injury scale value - 30) x
$2,990
8
40 or less but more than 35
$76,350
(Injury scale value - 35) x
$3,280
9
50 or less but more than 40
$92,750
(Injury scale value - 40) x
$3,530
10
60 or less but more than 50
$128,050
(Injury scale value - 50) x
$3,760
11
70 or less but more than 60
$165,650
(Injury scale value - 60) x
$4,010
12
80 or less but more than 70
$205,750
(Injury scale value - 70) x
$4,260
13
90 or less but more than 80
$248,350
(Injury scale value - 80) x
$4,500
14
100 or less but more than 90
$293,350
(Injury scale value - 90) x
$4,770
Table 6—For an injury sustained from 1
July 2015 to 30 June 2017 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,390
2
10 or less but more than 5
$6,950
(Injury scale value - 5) x
$1,680
3
15 or less but more than 10
$15,350
(Injury scale value - 10) x
$1,960
4
20 or less but more than 15
$25,150
(Injury scale value - 15) x
$2,220
5
25 or less but more than 20
$36,250
(Injury scale value - 20) x
$2,520
6
30 or less but more than 25
$48,850
(Injury scale value - 25) x
$2,810
7
35 or less but more than 30
$62,900
(Injury scale value - 30) x
$3,060
8
40 or less but more than 35
$78,200
(Injury scale value - 35) x
$3,360
9
50 or less but more than 40
$95,000
(Injury scale value - 40) x
$3,620
10
60 or less but more than 50
$131,200
(Injury scale value - 50) x
$3,850
11
70 or less but more than 60
$169,700
(Injury scale value - 60) x
$4,110
12
80 or less but more than 70
$210,800
(Injury scale value - 70) x
$4,360
13
90 or less but more than 80
$254,400
(Injury scale value - 80) x
$4,610
14
100 or less but more than 90
$300,500
(Injury scale value - 90) x
$4,890
Table 7—For an injury sustained from 1
July 2017 to 30 June 2018 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,410
2
10 or less but more than 5
$7,050
(Injury scale value - 5) x
$1,710
3
15 or less but more than 10
$15,600
(Injury scale value - 10) x
$1,990
4
20 or less but more than 15
$25,550
(Injury scale value - 15) x
$2,260
5
25 or less but more than 20
$36,850
(Injury scale value - 20) x
$2,560
6
30 or less but more than 25
$49,650
(Injury scale value - 25) x
$2,860
7
35 or less but more than 30
$63,950
(Injury scale value - 30) x
$3,110
8
40 or less but more than 35
$79,500
(Injury scale value - 35) x
$3,420
9
50 or less but more than 40
$96,600
(Injury scale value - 40) x
$3,680
10
60 or less but more than 50
$133,400
(Injury scale value - 50) x
$3,920
11
70 or less but more than 60
$172,600
(Injury scale value - 60) x
$4,180
12
80 or less but more than 70
$214,400
(Injury scale value - 70) x
$4,440
13
90 or less but more than 80
$258,800
(Injury scale value - 80) x
$4,690
14
100 or less but more than 90
$305,700
(Injury scale value - 90) x
$4,970
Table 8—For an injury sustained from 1
July 2018 to 30 June 2019 (dates inclusive)
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,450
2
10 or less but more than 5
$7,250
(Injury scale value - 5) x
$1,760
3
15 or less but more than 10
$16,050
(Injury scale value - 10) x
$2,050
4
20 or less but more than 15
$26,300
(Injury scale value - 15) x
$2,330
5
25 or less but more than 20
$37,950
(Injury scale value - 20) x
$2,640
6
30 or less but more than 25
$51,150
(Injury scale value - 25) x
$2,950
7
35 or less but more than 30
$65,900
(Injury scale value - 30) x
$3,210
8
40 or less but more than 35
$81,950
(Injury scale value - 35) x
$3,530
9
50 or less but more than 40
$99,600
(Injury scale value - 40) x
$3,790
10
60 or less but more than 50
$137,500
(Injury scale value - 50) x
$4,040
11
70 or less but more than 60
$177,900
(Injury scale value - 60) x
$4,310
12
80 or less but more than 70
$221,000
(Injury scale value - 70) x
$4,580
13
90 or less but more than 80
$266,800
(Injury scale value - 80) x
$4,830
14
100 or less but more than 90
$315,100
(Injury scale value - 90) x
$5,120
Table 9—For an injury sustained on or
after 1 July 2019
Item
Injury scale value
Base amount
Variable amount
1
5 or less
—
Injury scale value x $1,490
2
10 or less but more than 5
$7,450
(Injury scale value - 5) x
$1,810
3
15 or less but more than 10
$16,500
(Injury scale value - 10) x
$2,110
4
20 or less but more than 15
$27,050
(Injury scale value - 15) x
$2,400
5
25 or less but more than 20
$39,050
(Injury scale value - 20) x
$2,720
6
30 or less but more than 25
$52,650
(Injury scale value - 25) x
$3,040
7
35 or less but more than 30
$67,850
(Injury scale value - 30) x
$3,310
8
40 or less but more than 35
$84,400
(Injury scale value - 35) x
$3,640
9
50 or less but more than 40
$102,600
(Injury scale value - 40) x
$3,900
10
60 or less but more than 50
$141,600
(Injury scale value - 50) x
$4,160
11
70 or less but more than 60
$183,200
(Injury scale value - 60) x
$4,440
12
80 or less but more than 70
$227,600
(Injury scale value - 70) x
$4,720
13
90 or less but more than 80
$274,800
(Injury scale value - 80) x
$4,980
14
100 or less but more than 90
$324,600
(Injury scale value - 90) x
$5,270
sch 12 sub 2015 SL No. 47
s 14
amd 2017
SL No. 110
s 14;
2018
SL No. 82
s 12;
2019
SL No. 113
s
12
Schedule 13
Dictionary
section 3
actuarial standard means ‘Professional Standard
300—Actuarial reports and advice on outstanding claims in general
insurance’ issued by the Institute of Actuaries of Australia (ACN 000
423 656).
Editor’s
note—
A copy of the standard may be inspected at the
Regulator’s office.
actuary means an actuary approved by the Regulator.
adverse psychological reaction does not include a mental
disorder.
AMA
4 means the ‘Guides to the Evaluation of Permanent
Impairment’ (4th edition) published by the American Medical
Association.
AMA
5 means the ‘Guides to the Evaluation of Permanent
Impairment’ (5th edition) published by the American Medical
Association.
ankylosis means fixation of a joint in a specific
position.
appointed actuary means—
(a)
for part 3, division 3—an actuary appointed under
section 49; and
(b)
for part 3, division 4—an actuary approved by the
Regulator under section 84(4) of
the Act to
assess the self-insurer’s estimated claims liability.
def appointed actuary amd 2016 Act No. 44
s 53
sch 1
arbiter means the actuarial arbiter appointed under
section 93.
AS/NZS means a standard published jointly by Standards
Australia and Standards New Zealand.
assessed premium, for an employer, means premium
calculated using the employer’s wages for a period of insurance.
assessment day means—
(a)
for part 3, division 1—the last day of the financial
quarter immediately before the day the application for
self-insurance is lodged; and
(b)
for part 3, division 2—the last day of the financial
quarter immediately before the day the self-insurer applies
to the Regulator under section 89 of the Act for a change in the group membership on
the licence; and
(c)
for part 3, division 3—last day of the financial
quarter immediately before the cancellation day; and
(d)
for part 3, division 5—the last day of the financial
quarter immediately before the cancellation day; and
(e)
for part 3, division 6—the last day of the financial
quarter immediately before the final day.
binaural tables means the binaural tables recommended and
published by National Acoustic Laboratories.
cancellation day means—
(a)
for part 3, division 3—the day the former
self-insurer’s licence is cancelled; and
(b)
for part 3, division 5—the day the non-scheme
employer’s continued licence is cancelled under section 105E of the Act.
category, for schedule 4B, see schedule 4B, section 2(1)(b).
def category ins 2017 Act No. 27
s 37
central estimate has the meaning given by the actuarial
standard, section 10.
childrens functional independence measure instrument, for
part 5A, division 1, see section 117A.
def childrens functional independence measure instrument
ins 2016 Act No. 44
s 52
claim means—
(a)
an application for compensation; or
(b)
a claim for damages.
consecutive categories, for schedule 4B, see schedule 4B, section 3.
def consecutive categories ins 2017 Act No. 27
s 37
consent day means the day the Regulator approves the
application for the change in the self-insurer’s membership.
continued licence, for a non-scheme employer, see section 105B(2) of the Act.
corresponding score, for a category, for schedule 4B, see schedule 4B, section 1.
def corresponding score ins 2017 Act No. 27
s 37
decision, of an insurer, for part 4, division 3A, subdivision 4, see section 112L.
def decision ins 2015 SL No. 135
s 13
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 9.
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 as a dominant injury of a
particular 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.
DPI
amount, for schedule 4A, see schedule 4A, section 1(a).
def DPI
amount ins 2015 SL No. 135
s 13
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.
estimated claims liability has the same meaning as in
section 84(8) of the Act.
def estimated claims liability amd 2016 Act No. 44
s 53
sch 1
estimated claims liability amount, for part 3, division 3 means the amount of a self-insurer’s
estimated claims liability as calculated under division 4.
final
day means the day a non-scheme member stops being a member
of the old insurer under section 105M of the Act.
finalised non-scheme employer’s liability amount for
part 3, division 5 means the finalised amount of a non-scheme
employer’s liability as calculated under subdivision 3.
financial quarter means a period of 3 months beginning on
1 January, 1 April, 1 July or 1 October.
former self-insurer’s liability amount, for part 3, division 3, means the amount of the former
self-insurer’s liability calculated under this division.
functional independence measure instrument, for part 5A, division 1, see section 117A.
def functional independence measure instrument ins
2016 Act No. 44
s 52
further premium, for an employer, means an amount, other
than assessed premium or provisional premium, payable by an employer to
WorkCover under the Act, and includes
the following—
(a)
arrears of premium;
(b)
additional premium under section 8(4);
(c)
interest on premium under section 10(2);
(d)
an amount of unpaid premium or a payment
or penalty payable under section 57(2) of
the Act;
(e)
additional premium for late payment under
section 61 or 62 of the Act;
(f)
additional premium under section 63 of the Act.
hearing loss tables means Report No. 118—Improved
Procedure for Determining Percentage Loss of Hearing (1988) published by
National Acoustic Laboratories.
highest range means the range of ISVs having the highest
maximum ISV.
household worker means a person employed solely in and
about, or in connection with, a private dwelling house or the grounds of
the dwelling house.
injured worker means a worker who sustained an
injury.
injury, for part 4, division 3A and schedule 4A, see section 112A.
def injury ins 2015 SL No. 135
s 13
ISV means injury scale value.
last
employment period see section 13(3)(b)(ii).
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.
legal
cost amount, for schedule 4A, see schedule 4A, section 1(b).
def legal cost amount ins 2015 SL No. 135
s 13
lower
extremity see AMA 4.
medical expert, for an assessment of a PIRS rating, means
a person—
(a)
who is appropriately qualified to perform
the assessment, including a psychologist, neuropsychologist
or psychiatrist; and
(b)
who has had appropriate training in the
use of the PIRS.
medical specialty means the branch of medicine that is a
recognised specialty under the Health Practitioner Regulation National
Law that is relevant to the matters referred to the Tribunal for
decision.
mental disorder means a mental disorder recognised under
DSM 4.
modified barthel index means the guidelines and modified
scoring of the barthel index stated in the article Improving the
Sensitivity of the Barthel Index for Stroke Rehabilitation by S Shah, F
Vanclay and B Cooper published in the Journal of Clinical Epidemiology,
1989, vol 42 no 8, pp 703-709.
new
insurer means the party assuming the liability.
non-scheme employer’s liability amount means an amount
for a non-scheme employer’s liability.
old
insurer means—
(a)
for part 3, division 2—the party with whom the
liability currently resides;
(b)
for part 3, division 6—the self-insurer of which the
non-scheme member was a member.
ophthalmologists guide means the publication Percentage
Incapacity—A Guide for Members published by the Royal Australian College
of Ophthalmologists in 1992.
Editor’s
note—
A copy of the ophthalmologists guide may be
obtained at the Regulator’s office.
outstanding liability amount, for part 3, division 1, means the amount of the self-insurer’s
outstanding liability calculated under this division.
panel see section 112A.
def panel ins 2015 SL No. 135
s 13
PIRS means the psychiatric impairment rating scale set
out in schedule 11.
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.
premium includes assessed premium, provisional premium
and further premium.
presbycusis correction table means the presbycusis
correction table recommended and published by Hearing Australia.
provisional annual levy see section 18.
provisional premium, for an employer, means premium
calculated using a reasonable estimate of wages for a period of
insurance.
prudential margin has the meaning given by the actuarial
standard, section 12.
qualifying condition see section 112A.
def qualifying condition ins 2015 SL No. 135
s 13
range, in relation to an ISV for an injury, means the
range of ISVs for the injury set out in schedule 9.
reading, of a chest x-ray, for schedule 4B, see schedule 4B, section 2.
def reading ins 2017 Act No. 27
s 37
registered training organisation see the Vocational Education, Training
and Employment Act 2000, schedule 3.
Regulator’s actuary means an actuary asked by the
Regulator to give a report under section 61.
relevant parties, for part 3, division 2, means the old insurer and the new
insurer.
risk
free rate of return has the meaning given by the actuarial
standard, section 13.
section 193A compensation, for an injury, see
section 112A.
def section 193A compensation ins 2015 SL No. 135
s 13
section 193A notice, for part 4, division 3A, see section 112G(1).
def section 193A notice ins 2015 SL No. 135
s 13
specified worker see section 112A.
def specified worker ins 2015 SL No. 135
s 13
self-insurer’s data, for part 3, division 4, means data that will enable the actuary
to calculate the self-insurer’s estimated claims liability and prepare
and give to the Regulator and the self-insurer an actuarial report on
the calculation.
specialty medical assessment tribunal see section 138(1)(b).
total
liability amount, means the amount of the total liability
after a change in the self-insurer’s membership.
total
liability amount means—
(a)
for part 3, division 2—an amount of liability after a
change in the self-insurer’s membership; and
(b)
for part 3, division 6—an amount of liability after a
change in the self-insurer’s membership.
upper
extremity see AMA 4.