Whole person impairment

If you have sustained a workplace injury or illness that is permanent in nature, then you may be entitled to receive a lump sum payment.

This lump sum payment is in addition to weekly payments, medical and related expenses that your Claims Service Provider may be paying to you.

You are only able to make one claim for permanent impairment for your injury.

On this page

Process

Timeframes

Settlement

Beyond lump sum payments

Disputes

Exempt workers

Process

If you would like to make a claim for whole person impairment, you can do so by downloading and completing the permanent impairment claim form (PDF, 0.1MB).

You will also need to provide a report from a State Insurance Regulatory Authority (SIRA)-accredited permanent impairment assessor (who specialises in Psychiatry).

The report must include:

  • whether your condition has reached *Maximum Medical Improvement (MMI)
  • whether your compensable injury/condition has resulted in an impairment
  • whether the resultant impairment is permanent
  • the degree of permanent impairment that results from your injury
  • the amount of permanent impairment that is due to any previous injury, pre-existing condition or abnormality.

For psychological claims, the level of permanent impairment must be greater or equal to 15% for the (whole person impairment) claim to be accepted.

*Maximum Medical Improvement is considered to occur when your condition is well stabilised and is unlikely to change substantially in the next year, with or without medical treatment.

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Timeframes

When your Claims Service Provider has received the permanent impairment claim form and the report from a SIRA-accredited psychiatric assessor, the Claims Service Provider will objectively review the impairment assessment to ensure it is consistent with the information in the claim file.

If the Claims Service Provider determines that further information is required in the report they must, within two weeks from receipt of the permanent impairment claim, ask you to either:

  • provide this additional information, or
  • make arrangements for you to be assessed again by a psychiatrist who specialises in permanent impairment.

If the Claims Service Provider does not request additional information, arrange a further assessment or seek further clarification on the impairment assessment, the Claims Service Provider has two months from receipt of the claim for permanent impairment to determine the claim.

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Settlement

When the Claims Service Provider is satisfied that they have all the necessary information to make a decision, they will either make an offer, or dispute liability for your whole person impairment claim.

If the Claims Service Provider accepts, a complying agreement will be provided. This is a written agreement between yourself and the Claims Service Provider regarding the offer of settlement for a lump sum payment for permanent impairment.

In the event a SIRA-accredited psychiatric assessor considers that MMI has not been achieved, the assessment will be deferred, and comment made on the value of additional or different treatment and/or rehabilitation.

Prior to making the payment for permanent impairment, the Claims Service Provider must be satisfied that you have obtained independent legal advice or have waived the right to independent legal advice. The Claims Service Provider is required to record evidence that this advice has been obtained, or that you waive your right to obtain the advice, and the details of the agreement.

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Beyond lump sum payments

The level of whole person impairment accepted by the Claims Service Provider is also used to determine other timeframes such as:

  • how long you are entitled to receive weekly compensation payments
  • how long you are entitled to receive medical expenses.

For whole person impairments that fall between 15 per cent and 20 per cent, there is an entitlement to:

  • weekly payments of compensation up to five years
  • medical expenses up to five years after either the date the claim was made, or five years after the last date on which you received weekly payments of compensation, whichever is later.

For whole person impairments of 21 per cent or greater, there is an entitlement to:

  • weekly payments until 12 months after your retirement age, or subject to the Claims Service Provider conducting a work capacity decision every two years to assess your capacity to work
  • reasonably necessary medical expenses are payable for life.
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Disputes

If the Claims Service Provider disputes the level of whole person impairment claimed, you (or your legal representative) can make an application to the Workers Compensation Commission. The Commission will appoint an independent psychiatrist to complete a final assessment of your level of whole person impairment.

The decision from the Commission is final and will be provided to the Claims Service Provider.

Learn more in the Personal Injury Commission informational videos

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Exempt workers: Lump sum compensation payments

This information only applies if you are an exempt worker in the Treasury Managed Fund. Exempt workers are a class of worker that can include police officers, paramedics and firefighters. They are not subject to most of the amendments made to the workers compensation acts in 2012 and 2015.

Permanent impairment

At a stage during your claim you may be eligible for a lump sum compensation payment.

Lump sum payments may include:

  • permanent impairment sustained as a result of a work-related injury or illness
  • pain and suffering arising from the impairment.

If you have suffered a primary psychological injury a claim for lump sum compensation can only be made when your impairment is assessed by an accredited independent medical examiner as 15 per cent or more.

When your claim service provider receives the claim for lump sum compensation they will acknowledge receipt of it, accept liability and make a reasonable offer of settlement, or they will dispute liability.

In the event a SIRA-accredited psychiatric assessor considers that Maximum Medical Improvement* has not been achieved, the assessment will be deferred, and comment made on the value of additional or different treatment and/or rehabilitation.

*Maximum Medical Improvement is considered to occur when your condition is well stabilised and is unlikely to change substantially in the next year, with or without medical treatment.

If the Claims Service Provider requires more information, they must make this request within two weeks of receiving the claim. They can still request the information after two weeks but, if this happens, they must make a decision on the claim within two months from claim lodgement. They may ask you to supply further information, and/or attend a permanent impairment assessor.

You also may be eligible to claim more than once for lump sum compensation.

Pain and suffering

You may be eligible for lump sum compensation for any pain and suffering you have due to your permanent impairment.

To be eligible to claim you must have a permanent impairment of 10 per cent or more to have access to a pain and suffering payment.

Please note the eligibility criteria for permanent impairment and pain and suffering payments can vary depending on the date of injury. Please consult your claim service provider for further detail.

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