2.7.7 Independent Impairment Assessments

An independent impairment assessment is conducted by an Independent Impairment Assessor (IIA). Typically, each injury or illness will be assessed once, and only when they are stable. The assessment determines a worker’s degree of permanent impairment (expressed as a whole person percentage) and is used to determine, where applicable, a worker’s entitlement to:

an impairment benefit
voluntary settlements
weekly payments post the second entitlement period (for pre 12 November 1997 claims, and claims where 130 weeks has been reached on or after 31 March 2024)
leave to seek common law damages

See: Impairments Benefits | Common Law | ICRP settlements | Review of entitlement approaching end of the second entitlement period | Pre 12 November 1997 claims – weekly payments

Agents and self-insurers should consider:

the purpose of an assessment prior to selecting an IIA
whether it is appropriate to refer the worker for a multi-purpose assessment – see Arrange an assessment for multiple purposes.
whether it is appropriate to refer the worker for an assessment under the AMA American Medical Association 2nd Edition Guides – see Pre 12 November 1997 claims – weekly payments

For multiple injuries see: Arranging assessments for multiple injuries.

Agents should email WorkSafe’s Central Booking Team at bssc_ime@worksafe.vic.gov.au for IIA appointments relating to impairment benefit claims and weekly payment (excluding Pre 12 November 1997 claims).

2.7.7.1 Who can be an IIA, or HLA

Independent Impairment Assessors (IIA)

An IIA is a medical practitioner who has successfully completed a training course approved by the Minister responsible for WorkSafe and may conduct impairment assessments in line with:

the AMA 4th Edition Guides
any operational guidelines as to the use of those Guides or methods issued by the Minister.

AMA4 Training modules for IIA examiners

Eligible assessors must have both the medical speciality relevant to the referred injury and AMA4 training to assess the impairment of particular types of injuries. IIA examiners must have completed the following:

the Core module of the Ministerially approved training course and

the training module specific to the injury and/or impairment to be assessed.

For example, If an impairment assessment is required in line with ‘Chapter 8 The Visual System’ of the AMA Guides Fourth Edition, the IIA must have completed both the Core and Visual Systems modules of the training course.

Hearing loss assessors (HLA)

Hearing loss assessors are medical practitioners who are approved by the Minister of WorkSafe to assess hearing loss.

A list of approved specialists is provided by the Minister every three years.

Schedule of fees for IIAs & HLAs

See: Fee schedules

2.7.7.2 Arrange an assessment for multiple purposes

Where appropriate, Impairment Specialists should arrange a medical examination with a medical practitioner who is both a:

WorkSafe acknowledged independent impairment assessor (IIA) who has successfully completed the Ministerially approved training course in the application of the AMA 4th Edition Guides and is listed by WorkSafe as an IIA; and
WorkSafe approved independent medical examiner (IME Independent Medical Examiner / Independent Medical Examination).

For IB Impairment Benefits claims, a “dual purpose” examiner may provide:

a medical opinion about the specific questions of liability posed to the examiner and
an assessment of whole person impairment made in line with the AMA 4th Edition Guides and operational guidelines (if any) as to the use of those Guides or methods issued by the Minister of the accepted injuries.

For weekly payment claims, a “combined medical” examiner may provide:

a medical opinion about the worker’s capacity for suitable employment; and
an assessment of whole person impairment made in line with the AMA 4th Edition Guides and operational guidelines (if any) as to the use of those Guides or methods issued by the Minister of the accepted injuries.

Agents and self-insurers are encouraged to seek advice from WorkSafe’s Impairment Benefit Team and/or the Agent Medical Advisor in relation to clinical or medical issues affecting the impairment assessment process.

2.7.7.3 Arrange an assessment for multiple inurjies

If the worker’s claim is for multiple injuries, the Impairment Specialist A suitably qualified person at the agent or self-insurer, such as an IB Specialist or WPI specialist, who is responsible for managing the end-to-end impairment determination process for workers in accordance with the requirements of the legislation. Suitably qualified means at a minimum, having completed AMA4 Guides training and applied those Guides at an operational level may need to arrange more than one IIA examination.

Where the assessor is a specialist in one field and is also accredited in other modules of the AMA4 Guides, the Impairment Specialist can request the IIA combine the impairments, reducing the need for the worker to attend one less examination.

For example, if a worker has traumatic injuries to the neck and the head, the Impairment Specialist may have accepted these as the anatomical loss to the cervical spine, organic brain injury and a psychological stress reaction. In this situation the worker may be assessed by:

an orthopaedic surgeon to assess the neck
a psychiatrist to assess psychiatric injury and provide assistance in distinguishing brain injury
a neurologist to assess any brain damage.

If the neurologist assessing the worker’s head injury is also AMA4 accredited in the spine module, the worker may only need to attend two IIA examinations.

If the assessor combines impairments with their speciality/accredited modules, they must provide a breakdown of individual impairments.

See: Multiple injuries – impairment assessment

2.7.7.4 Provide information to IIA

Impairment Specialists should ensure treating practitioner reports are collected before arranging an independent impairment assessment.

The Impairment Specialist is required to provide the IIA (or dual/130 wk all-purpose examiner) full background information and detailed instructions.

Information could include:

treating doctor reports and clinical records
hospital reports
diagnostic investigation reports, and where possible imaging
test results
claim form
incident/accident reports
Independent examiner reports
capacity information, such as Certificates of Capacity and vocational assessment reports.

An itemised list of material provided must be included in the correspondence to the IIA.

The Impairment Specialist must also provide the IIA specific instructions including:

a request to examine only accepted injuries
identify rejected injuries
instructions to consider aggravation, apportionment and unrelated condition/s to the impairment claim (where relevant) including medical information describing this unrelated impairment brought about by separate incidents
a synopsis of issues to consider
a request for the following information to be addressed in the impairment assessment report:
- a whole person impairment for each accepted injury (for all relevant chapters of the AMA4 Guides)
- if applicable for injuries which occurred on or after 3/12/03, a separate whole person impairment for any accepted injuries assessable under Chapter 3 of the AMA4 Guides
- details of any accepted injury that results in a total loss injury set out in the no disadvantage compensation table
- details of any injury arising out of the accepted incident/cause for which compensation has not been claimed
- advice if a further specialist opinion is needed about the injuries
- where necessary, an apportionment of impairments brought about by separate incidents (whether work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. or unrelated to the claim)
- confirmation that the accepted injury/injuries are stable.

Information to be requested from multiple purpose examiners

WorkSafe suggests that in some circumstances it is appropriate to provide the IIA:

an identification of accepted injuries, rejected injuries and those injuries where liability is undetermined
a request to provide an impairment assessment of the accepted injuries
a request for the ‘dual purpose’ examiner’s medical opinion in relation to those claimed injuries with undetermined liability
purpose request for the ‘dual purpose’ or ‘130 wk all-purpose’ examiner’s opinion that the claimed injury is related to the claimed incident and request for an impairment assessment of the injury/injuries and
a request for the ‘130 wk all-purpose’ examiner’s medical opinion on the worker’s capacity for suitable employment

2.7.7.5 IIA assesses impairment

For claims lodged on or after 18 November 2004 the following methods must be used to determine impairment:

Physical impairment

For physical impairment (excluding psychiatric and hearing loss), the AMA Guides to the Evaluation of Permanent Impairment (4th Edition) – substituting chapter 14 Mental and Behavioural Disorders and excluding chapter 15 Pain.

Hearing loss

For hearing loss, The Improved Procedures for Determination of Percentage Loss of Hearing (1988 Edition or a later prescribed Edition), published by the National Acoustics Laboratory.

Psychiatric impairment

The Guide to the Evaluation of Psychiatric Impairment for Clinicians, prepared by MWN. Epstein, G Mendelson, NHM Strauss and published in the Government Gazette (No. G30 Thursday 27 July 2006).

To avoid doubt, the definition of mental injury in section 3 of the WIRC Act Workplace Injury Rehabilitation & Compensation Act 2013 does not apply for the purposes of assessing the degree of psychiatric impairment.

For dates of injury from 12/11/1997 to 02/12/2003

The IIA:

examines the worker and provides an IIA report for the agent or self-insurer
must provide in the report:
- a percentage whole person impairment for injuries referred to the examiner
- an opinion as to whether the worker has a total loss injury mentioned in the no disadvantage compensation table
- a calculation of whole person impairment that includes the impairment value for any injury which the doctor considers is a total loss injury and excludes the impairment value for the injury that is a total loss injury
- should disregard any impairment from pre-existing or unrelated injuries or causes.

For dates of injury on or after 03/12/2003

The IIA:

examines the worker and provides an IIA report for the agent or self-insurer
must provide in the report:
- a percentage whole person impairment for the injuries referred to the examiner
- an opinion as to whether the worker has suffered a total loss injury mentioned in the no disadvantage compensation table
- a combined whole person impairment for AMA4 Chapter 3 musculoskeletal injuries assessed, excluding the injuries which are considered a total loss mentioned in the no disadvantage compensation table
- a combined whole person impairment for AMA4 Chapter 3 musculoskeletal injuries assessed, including the injuries which are considered a total loss mentioned in the no disadvantage compensation table
- a combined whole person impairment for physical injuries assessed including the injuries which are considered a total loss mentioned in the no disadvantage compensation table
- a combined whole person impairment for physical injuries assessed excluding the injuries which are considered a total loss mentioned in the no disadvantage compensation table
- any psychiatric impairment has been assessed in accordance with The Guide to the Evaluation of Psychiatric Impairment for Clinicians
- should disregard any impairment from pre-existing or unrelated injuries or causes.

For claims lodged on or after 18/11/2004

The IIA who has been selected as a ‘dual purpose examiner’ or a ‘130 week all-purpose examiner’ must:

examine the worker and provide an IIA report for the agent or self-insurer (as requested above)
only address requests for medical opinion about specific issues as provided to them in the letter of instruction from the agent or self-insurer.

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