Impairment Claims and WorkCover < Back
The following information is prepared for the assistance of persons who wish to undertake their own impairment claim under the WorkCover legislation. This information is prepared for claimants who have contacted Workforce Legal but who wish to avoid the cost of submitting a claim and who have not instructed Workforce Legal to act on their behalf.

This information is specifically provided on the basis that it is general information only and does not purport to be specific legal advice in respect of the claimant's individual entitlement.

Each impairment claim is different and in some circumstances an impairment assessment can have very significant effects. Where an injury is a result of negligence and a claim for common law damages is possible, it is important to be aware that the final impairment score can have a significant effect on an entitlement to damages. We recommend that any claimant in this category should seek legal advice and not submit a claim themselves.

Remember there is a strict 6 year time limit that applies to common law claims. This six year period can be extended by the processing period of an impairment claim. The processing period is calculated from the date of lodging the claim until 30 days after the final assessment of the impairment - refer to attached Fact Sheet.

Assessment Methods
Most physical injuries are assessed under the American Medical Association Guides for the Evaluation of Permanent Impairment (Usually the Fourth Edition). Separate guidelines apply for industrial asthma, some infectious diseases and psychological injuries.

Injury Details
Some assessments for impairment can be extraordinarily complex particularly where an injury has an effect on other body systems or on other medical conditions. It is extremely important that all the effects of an injury are claimed on the form as it is usually only possible to make one claim. (If there is not enough room on the form a separate sheet can be attached), For example, a physical injury may have some effect on a person's hypertensive condition. The effect can be included in a claim for permanent impairment but it will raise complicated issues about its assessment and whether the worsening of the condition is permanent. Where there are complex interactions between injuries and other medical conditions, it is recommended that you obtain legal advice in preparation of the claim.

Total Loss
For some injuries, it is possible to claim an additional or alternative payment for 'a total loss' of a body part. This obviously applies if there is an anatomical loss such as e.g. the amputation of the finger. A total loss can also apply even though there is no amputation of the body part but that part is totally useless. When in doubt, it should be claimed as a "total loss". E.g. "total loss of ring finger".

Psychological Injury
An impairment from a psychological injury can be claimed if the impairment is directly related to a traumatic incident or a work stress. This is called a primary impairment. Unfortunately, a psychological condition that results from physical injury (sometimes called a secondary psychological condition), cannot be included in a psychological assessment. The physical injuries can of course be claimed. This provision in the legislation is quite complex and illogical but, nonetheless, each assessment for a psychological impairment is divided into these components where appropriate and only the primary impairment is assessable.

Impairment Thresholds and Values
The value of an impairment payment and the necessary percentage threshold for an injury can vary according to the date of an injury. The value of injuries is set out in the 'Claims Manual' section of the Worksafe web site www.worksafe.vic.gov.au.
  • Then Click to Injuries and Claims;
  • Then select Online Claims Manual;
  • Then Select 'Chapter 12' Benefits - Impairment;
Claims Process

Submitting a claim involves the following steps;
  1. Usually it is necessary to wait 12 months from the date of injury and until the condition is stable.

  2. A claim for permanent impairment should be completed and submitted to your employer. The form is a 'Workers claim for impairment benefits form'. The form can be obtained by ringing Workforce Legal, contacting your Claims Agent or the Victorian WorkCover Authority on 9641 444.

  3. A photocopy should be sent to your Claims Agent. If you have written medical information (including written scan reports) about your condition it should be included with this. (Do not send any xrays or scan films).

  4. The claim form should be completed as accurately as possible. All the effects of injury should be included. For example, where there is a psychological condition and physical injuries both should be specifically mentioned. In some cases, people who take medication for physical injuries may have gastric problems which can form part of the impairment claim.The gastric problems must be specifically mentioned on the claim form. If the injury or surgery has resulted in a scar, 'scarring' should also be claimed.

  5. Once the claim is submitted, the Claims Agent will arrange medical appointments. These appointment dates will be notified to you direct. Usually, a medical examination is necessary for each type of body system for which you have claimed an impairment.

  6. The medical examiner will assess your level of impairment in accordance with the appropriate scale.

  7. When the medical assessments are received by the WorkCover agent, it will issue a notice of entitlement within 120 days. The notice will indicate which injuries WorkCover accepts and which it does not. If it rejects injuries, it is possible to refer the dispute to the Accident Compensation Conciliation Service within 60 days of the notice. A form for conciliation can be requested from the Accident Compensation Conciliation Service by telephoning 99401111.

  8. If you dispute the assessment of your impairment, you can refer the dispute about the extent of your impairment to the Medical Panel. You can choose to dispute the assessment of your physical impairment, your psychological impairment or both. Great care is needed in deciding to dispute an assessment if you have been offered money, as it is important to be aware that the Medical Panel can not only increase, but decrease the assessment.

  9. The decision of the Medical Panel is final and the Claims Agent is obliged to adopt that assessment. A claims agent will not re-offer a payment on the basis of the original assessment. A decision of a Medical Panel can only be appealed in very rare circumstances where the Panel has failed to conduct its examination procedures properly and fairly or has made an error in legal interpretation.

  10. In the event that the Medical Panel decreases the assessment, the insurer will not re offer the previous amount. A matter should only be referred to the Medical Panel if there is a reasonable prospect of concerning or increasing the assessment.

 
 

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