Form P36
STANDARD FORM OF ORDER - WHOLE PERSON
IMPAIRMENT (WPI) (RETURN TO WORK)
Case Number
PARTIES
Applicant
Respondent
Other Party
ORDERS
With the consent of the parties I make the following orders: 1.
The decision of the Respondent dated ###, assessing lump sum compensation pursuant to Section 43
of the Act is varied to reflect the following entitlement for permanent impairment.
###% loss of function and impairment of the ###
1.
The decision of the Respondent dated ### assessing lump sum compensation pursuant to Section 43
of the Act is varied to assess the worker’s degree of Whole Person Impairment at ##
2.
The Applicant is entitled to the sum of $### (in accordance with Regulation 25 and the relevant
prescribed sum(s) as applicable).
3.
The Applicant is entitled to costs of the proceedings fixed at $### and reasonable disbursements, to be
agreed or taxed.
3.
The Applicant is entitled to costs of the proceedings and reasonable disbursements, to be agreed or
taxed.
Name
Signature
Date
Tribunal member
Applicant
representative
Respondent
representative
Other party
representative
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
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