Impairment Protocols
Explanatory Memorandum
1. Supporting medical material:
The explanatory memorandum in the AMA Guides to the Evaluation of Permanent Impairment (4th
Edition) (“AMA4”) requires that a worker’s medical history is available to the Independent
Impairment Assessor. As a result, the existing claims manual and guidelines require that WorkSafe
Victoria (WorkSafe) collects and submits treating medical reports to the Independent Impairment
Assessor.
Workers’ legal representatives are complaining that WorkSafe is not obtaining any or adequate
treating practitioner reports.
2. Legally Represented Workers
The solution proposed is that workers’ legal representatives will provide medical reports and records
if requested to do so by the agent. This medical information will comprise all records and reports
arising from the treatment of the body part injured, including details and treatment of all prior
injuries to the body part claimed. The treating doctor should also be asked to confirm in the body of
their report the frequency and the extent of treatment, provide their diagnosis of the injury or
condition, and provide their advice as to the level of any pre-existing impairment or disability of the
affected body part.
This is consistent with AMA4 requirements that the IMP has access to a full medical history of the
worker.
Knowledge of the course of an individual’s medical condition over time is essential in reaching an
understanding of the individual’s health status. Thus, within legal constraints, copies of existing
medical office and hospital records should be attached to the evaluation report even if the report
itself discusses the medical history and course of the condition.
According to the Guides the first step in assessing an individual’s impairment is gathering thorough
and complete historical information on the medical condition(s) and then carrying out a medical
evaluation supported by appropriate tests and diagnostic procedures.
Guides to the Evaluation of Permanent Impairment (4th Edition) Page 2/8
To avoid duplication of enquiry the legal representative may request a list and copies of all treating
doctor reports in the possession of WorkSafe in respect of a claim. When the Impairment claim is
lodged the agent will request the legal representative to complete an enquiry form. The purpose of
the enquiry form is to confirm the worker has been asked about prior or subsequent injuries or
disease to the claimed body part or other body parts affecting the injury and which medical
practitioners treated these condition(s). The solicitor will be requested to disclose the names of the
treaters and confirm whether inquiries have been made to collect reports from those treaters.
Completion of this form will be one of the triggers for payment to the legal representative of legal
costs by WorkSafe.
This policy does not derogate from WorkSafe’s responsibility to collect additional reports or records
to complete the treatment medical history to ensure appropriate compensation is paid.
Any communication with a legally represented worker will include his or her legal representative.
This includes, but is not limited to, letters regarding medical appointments, liability determinations
and the notice of entitlement. To enable the legal representative to properly advise his or her client
on the notice of entitlement, the Agent will provide the legal representative with the notice of
entitlement along with the Independent Impairment Assessor’s report and any supplementary
reports.
3. No Legal Representation
Where the worker is not legally represented WorkSafe or its agent will collect reports and records of
the worker’s prior medical history. This will include obtaining reports and records from the worker’s
treating medical practitioners, and collection of medical material from earlier injuries/incidents to
the body part claimed. It is proposed that the claim form will be amended to require that the
worker disclose the names of treaters of previous injuries to the same body parts or affecting the
body parts claimed.
An Independent Impairment Assessor’s report, and any supplementary reports, will be made
available to a worker who is not legally represented via his or her treating practitioner and upon
request by the worker.
4. Material Sent to Independent Impairment Assessor
In addition to the expertise applied to claims by agents, standard letters will be provided to
authorised agents to assist with instructions to Independent Impairment Assessors to perform
assessments. A copy of the letter of instructions will be sent to the worker’s representative prior to
the assessment. Any request by the worker’s representative that the Independent Impairment
Assessor receives additional material should be submitted to the agent. The standard letter will
specifically request that the Independent Impairment Assessor consider whether he/she will be
assisted by any absent background medical information. If so, this information will be collected by
the agent before the assessment proceeds.
The Independent Impairment Assessor will also be asked whether all injuries have been identified
and additional injuries will be referred back to the agent for liability determination. Identification of
additional injuries will stall the final assessment of other injuries until all liability issues have been
finally determined in accordance with the legislation.
Medical reports and records from treating doctors will be sent to the Independent Impairment
Assessor (or the independent medical examiner if appropriate) in assessing the claim. The examiner
will assess the relevance and importance of the material submitted and determine the level of
impairment pursuant to the AMA Guides.
5. Impairment Benefit Managers
To improve claims management each of WorkSafe's authorised agents has appointed dedicated
Impairment Benefit Managers. The Impairment Benefit Managers will improve the level of technical
knowledge within WorkSafe’s operational arm; they will be responsible for implementing strategies
to ensure that assessments are being carried out in accordance with the guidelines and will raise the
standard of analysis being applied to claims.
WorkSafe will provide authorised agents with ongoing support and training in use of the AMA 4th
Edition Guides until further notice.
6. Independent Impairment Assessor Referral
The agent will appoint the Independent Impairment Assessor (or Independent Impairment Assessors
where multiple specialties are required) and arrange the assessment.
One of the benefits of the AMA4 Guides is said to be that “two physicians following the methods of
the Guides to evaluate the same patient, should report similar results and reach similar conclusion.
Moreover, if the clinical findings are fully described, any knowledgeable observer may check the
findings with the Guides’ criteria” (AMA4 pg 2/7).
This is designed to deliver assessments conducted in accordance with AMA4, performed by
appropriately qualified, AMA4 proficient, well-instructed and conscientious examiners. The
Independent Impairment Assessors nominated by agents will be selected on account of objective
criteria including the Independent Impairment Assessor’s proficiency in conducting AMA4
assessments in accordance with the Guides, current teaching and hospital appointments, current
clinical practice, quality of reporting etc.
If a worker’s representative is not satisfied the assessment made by the selected Independent
Impairment Assessor has been performed correctly according to the Guides’ procedure, the worker
has a right of referral to the Medical Panel.
WorkSafe is committed to providing feedback to Independent Impairment Assessor from Medical
Panel reasons and where possible judicial comment, to improve the consistency of application of
AMA4. We will be promoting the AMA4 Ministerially approved training course to expand the
number of medical practitioners qualified to perform assessments. We will be reviewing the need
for AMA4 “refresher” courses for Independent Impairment Assessors.
7. Material prior to Medical Panel referral
Consistent with WorkSafe’s aim to achieve assessments conducted in accordance with the methods
prescribed in the legislation, WorkSafe may seek clarification of an Independent Impairment
Assessor's report prior to notification of the entitlement.
If additional injuries are identified prior to acceptance of an assessment, or the Medical Panel
determination as the case may be, WorkSafe will withdraw the notice of entitlement until any
dispute in relation to additional injuries has been determined. A revised notice of entitlement will
then be issued.
If a worker requests clarification of an assessment before he/she advises whether he/she accepts or
disputes the assessments, the notice of entitlement may be withdrawn and a revised notice of
entitlement may be sent to the worker’s representative after the issues requiring clarification have
been dealt with. If a worker remains dissatisfied with assessment it is appropriate to refer the
assessment to the Medical Panel. WorkSafe will forward to the Medical Panel all of the documents
in its possession relating to the assessment, including correspondence from any party seeking
clarification of an assessment.
If the submissions relate to the method of calculation of the benefit, WorkSafe will review the
calculation and a dispute as to the amount of compensation payable may be referred to Conciliation.
8. Disbursements
If treater reports or records are obtained and submitted with the Impairment claim form, WorkSafe
will generally reimburse those expenses in accordance with the legislation unless previously
obtained from the treating practitioner by the agents. There is no requirement that medico-legal
reports be submitted. These disbursements will not be reimbursed if the treater reports or records
are not provided at least 2 weeks prior to the independent impairment Assessor unless expressly
authorised by WorkSafe. Each medical report and invoice, and any covering letter, should be clearly
identified as being submitted for the purpose of the impairment benefit claim, or marked to the
attention of the impairment benefit team.
9. Legal fees (other than disbursements)
The impairment process was designed to be conducted as an administrative process and it remains
largely so. The process is simplified into easy steps, which are manageable by a worker without
representation.
The Authority recognises the legal consequences arising from a worker’s decision to accept a
payment for impairment, especially where the injury arose on or after 20 October 1999.
The worker’s legal representative, at the request of the agent, may participate in the process with a
view to streamlining procedures and assisting in the delivery of the benefit in a timely manner. As
the agent’s ability and capacity to collect the background medical material improves the need to
request this information from the worker’s legal representative will decrease. WorkSafe considers
the contribution to the worker’s legal fees for the legal representative’s contribution to the
impairment claims management process to be an interim measure. The contribution to legal fees
will be reviewed from time to time and may not continue once agents develop further impairment
capability.
In order to qualify for the fee the worker’s representative must be requested to participate in the
process and also to complete the enquiry statement referred to on page one of this document. The
entitlement to legal costs is only achieved in claims where a worker reaches the minimum
impairment threshold giving rise to entitlement to compensation and the legal representative
provides WorkSafe with tax invoice for the amount in relation to the appropriate protocol fee on
WorkSafe’s website.
Collection of background medical material represents a significant part of a worker’s
representative’s contribution to the impairment process. It is acknowledged that the legal
representative may also study the assessments, advise regarding Medical Panel appeals.
Hearing loss claims will attract no fee to reflect the level of input required by lawyers in these types
of claims.
WorkSafe Victoria (WorkSafe) is a trading name of the Victorian WorkCover Authority. 8 September
2015.