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During Part 1 of this series, we explained what WPI is and the key principles that all Medical Assessors are required to consider and assess on the day of the assessment. We will now continue to examine further common questions and how they play a role in the assessment of your level of WPI.
What if I sustained injury to multiple body parts from one single accident?
Often, an injured worker would sustain injuries to more than one single body part from a workplace accident. The NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment (revised 4th edition) stipulates that multiple impairments arising from the same injury are to be combined and assessed together to calculate the final degree of WPI of the Claimant. The ‘formula’ used by the Medical Assessor is not the simple mathematical calculation of 1 + 2 = 3, but they must use the Combined Values Chart found in the AMA5 to derive a final WPI percentage that arises from the multiple impairments.
The only exception to this rule is when an injured worker also sustained psychiatric or psychological injuries. Despite suffering from both physical and psychological injuries arising from the same accident, the two assessments cannot be combined and must be assessed separately.
As an example, we had a client who fell off a faulty ladder at work, firstly landing on his buttocks and lower back before hitting his right shoulder on the concrete floor. His doctors ordered an MRI scan of the lumbar spine (lower back) which revealed an impingement nerve causing radiating pain into his lower left leg and an ultrasound on his shoulder which revealed a rotator cuff tear, causing him to have restricted range of shoulder motion. Our client was then prescribed with analgesics for pain management and due to developed reliance, he took the analgesics for prolonged causing the development of symptoms to his upper digestive tract.
We arranged for our client to be assessed by an Surgeon for his lumbar spine and right shoulder injury, and then a Gastroenterologist for the symptoms to his upper digestive tract. The Surgeon assessed the lumbar spine at 12% WPI, right shoulder at 9% WPI whilst the Gastroenterologist assessed 7% WPI for the upper digestive tract. Using the Combined Value Chart, our client’s combined final level of permanent impairment was 26% WPI and a lump sum compensation claim for 26% WPI was subsequently made to the insurer.
Am I still entitled to make a lump sum permanent impairment claim if I suffer from pre-existing condition?
There is no simple answer to this question, as it depends on how severe your pre-existing condition/injuries were. When it comes to assessment of permanent impairment, the degree of permanent impairment resulting from the pre-existing condition/injuries will be deducted from the final level of permanent impairment. There is a general rule called the ‘deductible proportion’ and that the deduction for pre-existing condition is generally 1/10th of the assessed impairment, unless that is at odds with the available evidence. What this means is that, if there is a pre-existing condition, the Medical Assessor will most likely make a 1/10th deduction unless through his/her clinical judgment, the history taken, available relevant material, he/she is convinced that the pre-existing is more severe then he/she is at discretion to make a larger apportionment for the pre-existing condition.
To make it easier to understand, for example, a Claimant is assessed at 24% WPI for her psychological injury however she suffered from depression five (5) years prior to the subject workplace incident and did not require any ongoing treatment or medication. The Medical Assessor in this incident will most likely make a 1/10th deduction (2.4% WPI), and therefore her final level of WPI will be 22% WPI (after rounding up).
Another example, a Claimant is also assessed at 24% WPI for her psychological injury however she suffered from ongoing depression two (2) years prior to the subject workplace incident and had undergone counselling and was prescribed with anti-depressants. The Claimant was taking the anti-depressant at the time of the subject incident. In this case, the Medical Assessor will most likely make a larger deduction than 1/10th, as there is compelling evidence to suggest so. If the Assessor makes a 1/3rd deduction (8% WPI), then her final level of WPI will be 16% WPI.
The NSW Workers Compensation Scheme is a complex system and therefore we highly recommend you seek legal advice. The Head of our NSW team, Jessica Cheung is an Accredited Specialist in Personal Injury Law specializing in workplace injuries. If you believe you have sustained a work-related injury and would like professional legal, reach out to Jessica and her team for a confidential discussion at no costs to you.