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Workers Compensation Entitlements Explained Lump Sum Compensation

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Workers Compensation Entitlements Explained Lump Sum Compensation

A worker who suffers an injury arising out of or in the course of employment may be entitled to a lump sum payment as compensation.

Lump sum compensation for permanent impairment is in addition to weekly payments, medical and related expenses that may generally be available through the workers compensation system, as discussed in our previous articles.

Am I Eligible for a Lump Sum Claim?

Claims for lump sum compensation for injuries that occurred on and from 1 January 2002 are based on an assessment of your permanent impairment.

The degree of permanent impairment that results from an injury is to be assessed by reference to the NSW Workers Compensation Guidelines For The Evaluation Of Permanent Impairment as a whole person impairment percentage (WPI). The methodology in the Guidelines is largely based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th Edition (AMA5).

These guidelines include detailed tables and methods for evaluating the percentage whole person impairment. The doctor uses these guidelines to assess the percentage of whole person impairment based on the injuries sustained as a result of your workplace injury.

For claims made on or after 19 June 2012, a minimum level of WPI must be assessed to be eligible for lump sum compensation as follows:

  • For physical injuries, you must have 11% or more permanent impairment.
  • For psychological injuries, you must have 15% or more permanent impairment.

You are only entitled to make one lump sum claim, and there is no time limit to making this claim so it is important that you are satisfied your condition will not significantly deteriorate in future.

How do I get my permanent impairment assessed?

The degree of impairment must be assessed by an accredited independent medico-legal assessor who is approved by SIRA (State Insurance Regulation Authority) to undertake permanent impairment assessments.

To undergo an assessment, your injury must have reached “maximum medical improvement”.

This means your condition has stabilised and is unlikely to change substantially in the next year with or without treatment. If you are unsure if you have reached maximum medical improvement, it is best to speak with your treating doctor and specialists.

What happens at a permanent impairment assessment?

The medico-legal doctor who conducts your WPI assessment will look at the following criteria, among other things:

  • Has your condition reached maximum medical improvement (MMI)? Or in other words, has your injury stabilised, and is your condition unlikely to improve?
  • Do you have an impairment because of your injury?
  • If so, it this impairment permanent?
  • To what degree are you permanently impaired?
  • Is your permanent impairment partly due to a previous injury or condition? If so, should a deduction be made?

After completing your assessment and answering these questions, the doctor will determine your whole person impairment percentage using the tables, graphs and methodology given in the guidelines and prepare a report based on their findings and expertise.

My treating specialist has recommended a form of treatment that I do not wish to undertake, will this affect whether I am at “maximum medical improvement”?

If you have been offered, but do not wish to undergo the recommended, additional or alternative treatment which may improve your condition, the medical assessor will make an assessment on your current condition without considering the potential effect of the proposed treatment.

The medical assessor may comment on the potential for improvement in your condition if you were to undergo the prescribed treatment, and note your rejection of this treatment, but this will not be considered in your assessment of whole person impairment.

Making a claim

The experienced compensation team at Brazel Moore Lawyers are able to seek funding from the Independent Review Office (IRO) to cover the costs of the independent medico-legal assessment and report as well as obtaining the required clinical notes etc. to enable this assessment to be completed.

We can arrange an examination by an appropriately qualified independent specialist to assess your degree of permanent impairment and thereafter advise whether you can make a claim for lump sum compensation. If you exceed the relevant threshold, the compensation team at Brazel Moore Lawyers can assist you in making the claim. If the insurer disputes your claim, we can also assist with challenging this dispute.

IRO also fund our professional costs also meaning you will not be responsible for any of our legal fees in investigating or assisting you with your claim for lump sum compensation.

We hope that you are able to follow our tips to understand your workers compensation entitlements. If, however, you have a query relating to any of the information in this article, or you require advice about your own matter, please don’t hesitate to get in touch with the Compensation Team of Brazel Moore Lawyers on (02) 4324 7699.