6.2.2.1 Guidelines to determine liability

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 should consider the following guidelines when making a decision about the worker’s claimed injuries:

  1. Did the worker sustain an injury to the body part claimed, as defined in the Act?

  2. Did the worker’s injury arise out of or in the course of employment?

  3. Is there a requirement that employment be a ‘significant contributing factor’ to the claimed injury?

  4. Was the claimed injury sustained on or after 12 November 1997?

  5. Is the worker a worker under the Act?

  6. Are there any other grounds for rejecting initial liability, for example the worker’s injury was due to serious and wilful misconduct?

If the answer is no to any of these questions (except the last question), the Impairment Specialist must not accept liability for the claimed injury. In short, the focus should be on injuries for which initial liability was appropriately accepted. Where initial liability for an injury was appropriately accepted, liability for that injury should be accepted for the purposes of an IB Impairment Benefits claim, even if that injury or work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. aggravation has since resolved.

Agent to review all reports received

The Impairment Specialist must review treating medical practitioner reports, forms and accident circumstance reports on its claim file and any other documentation submitted by the worker.

See: Impairment Benefit Protocols

Liability to be assessed for the injury, not the symptoms

The Impairment Specialist must ensure that liability is only accepted for anatomic dysfunction of a body part, organ or system caused by the claimed injuries and not for the symptoms for which treatment may be sought.

The Impairment Specialist should analyse the medical reports of the worker’s claimed injuries and make clear reference to the accepted injuries in its letter of liability.

If the worker questions the Agent’s decision about liability the Impairment Specialist must explain the assessment of impairment and how the assessment is based upon the permanent impairment to the body part and not the symptoms which may stem from its dysfunction.

See: AMA Guides to the Evaluation of Permanent Impairment Fourth Edition

Back to top

Agent to carefully assess injuries not included on the primary claim

The Impairment Specialist needs to carefully assess liability for injuries claimed on the Worker’s Claim for Impairment Benefits form.

These injuries may differ from those listed on the Worker’s Claim for Compensation Form (the primary claim), because they were not apparent at that time or had not yet developed.

Agent can use authority to obtain treating practitioner reports

The Impairment Specialist may use the authority on the claim form to obtain reports from the worker’s treating practitioners. The reports are used to:

Dual purpose examination

If liability is undetermined when arranging impairment examinations and an independent medical examination opinion is required to assist in the liability determination. Impairment Specialists are recommended to arrange a ‘dual purpose’ examination with an appropriate medical practitioner (i.e. a ‘dual purpose examiner’).

A ‘dual purpose’ examiner is 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 American Medical Association 4th Edition Guides and is listed by WorkSafe as an IIA and
  • WorkSafe approved independent medical examiner

A ‘dual purpose’ examiner may only provide:

  • a medical opinion about IB claims specific questions of liability and
  • an assessment of impairment made in line with the AMA of those Guides and operational guidelines (if any) as to the use of those Guides or methods issued by the Minister of the accepted injuries.

The dual purpose examination may be used to help determine liability:

  • whether a claimed injury resulted from the deemed date of injury
  • to clarify any inconsistencies in the workers medical history
  • to confirm stabilisation

See: Arrange an assessment for multiple purposes

Liability & stabilisation of injuries

The Impairment Specialist should determine liability for injuries despite evidence that the injuries are currently not stable. If the Agent cannot determine liability and/or the workers entitlement to compensation for non-economic loss, the Agent may advise the worker in writing within 90 days from the date of receipt of the IB claim, suspend the workers claim for impairment benefits if:

  • the Impairment Specialist has insufficient medical information to determine liability or impairment or
  • the workers condition of the injury is not stabilised.

Ensure that documentation on file substantiates that the workers condition has not stabilised (e.g. worker to undergo further surgery or treatment).

See: Suspend impairment process

Next | Back to top