What is whole person impairment compensation?

Whole Person Impairment (WPI) compensation addresses situations where an individual, due to physical or mental conditions, struggles with or cannot perform daily activities that most people manage without difficulty. This is often referred to as having a disability, and PK Simpson can guide you through understanding your entitlements.

Whole person impairment vs permanent disability

When someone has no ability, whether physically or mentally, or has difficulty doing the usual activities of life that most people have no trouble performing, then they are deemed as having a disability. A disabled person might not be able to do their own shopping, bathe or shower themselves, and may need some help. Disability is a non-medical, generic term. Impairment is a specific medical term for an abnormality in the function or structure of a limb or organ.

Whole person impairment guidelines

When someone is whole person impaired, it can be defined as an injury that impairs a person’s physical or mental abilities, or both. The level of permanent impairment from an injury is assessed by referencing the NSW Compensation Guidelines for Evaluation of Permanent Impairment.

A medical doctor trained to assess impairment will clinically assess the injured party and review their history, including relevant medical information, in deciding how much whole person impairment is a result of the injury. Combining psychological and physical injuries to increase whole person impairment is not allowed. The primary injury is the only one that is compensable. The guidelines are calculated by the answers to the following questions:

• Has the condition reached maximum medical improvement (MMI)?
• Has the injury resulted in an impairment?
• Is the impairment permanent?
• Does the degree of permanent impairment result from the injury?
• Is any proportion of the permanent impairment caused by any pre-existing abnormality, condition or injury?

How to make a claim for whole person impairment compensation payments

To claim a lump sum compensation or weekly compensation payments for a permanent impairment you must have lawyers who are accredited specialists in personal injury law. At PK Simpson, our lawyers have accreditation and will not only arrange appointments but pay for a medical specialist to assess your injuries using the impairment guidelines.

The following conditions must be established before you can receive a lump sum compensation for permanent impairment:

• You must have an assessment carried out by a doctor who is a medico-legal expert approved by WorkCover to determine the percentage of your whole person impairment.
• The doctor has to follow the guidelines for the permanent impairment assessment. The guidelines let the doctor judge what percentage of impairment ought to be allowed in your case.
• Your condition must be stabilised, with no likely future improvement or deterioration. This assessment is usually done about 12 months after your injury and is termed MMI or ’reaching maximum medical improvement’.
• The medico-legal assessor relies on the examination and the relevant scans, x-rays and other medical reports.
• E.g., a lumbar spinal injury is established using the categories of impairment and the other categories are as follows:

Category 1 –  where there is no evidence of injury, is 0 per cent impairment.

Category 2 –  where there is evidence of injury but without neurological involvement is 5-8 per cent impairment.

Category 3 – where there is evidence of injury and neurological symptoms on examination is 10-13 per cent whole person impairment.

Category 4 – where fusion surgery has been performed is 20-24 per cent whole person impairment.

What is whole person impairment rating?

The Workers Compensation Act has a rating system for the different levels of impairment to assess a person’s eligibility for lump-sum compensation for permanent impairment and weekly payments.

If your assessment of whole person impairment is 10 per cent or less, you may receive weekly compensation payments for at most, five years. Payment of your medical bills ends after two years which is either from the date of your claim or the last date on which you received weekly compensation, whichever is latest.

Between an 11-20 per cent assessment, weekly payments are made for five years and medical bill payments also end after five years either from the time you claimed to the last date on which you received a weekly payment, whichever is the latest to occur.

An impairment of 21 per cent or more entitles you to receive weekly payments until 12 months after your retirement age providing your insurer conducts work capacity decisions every two years.

Assessment of whole person impairment of 31 per cent or more entitles you to weekly compensation payments up until 12 months after your retirement age medical expenses for life.

Only one whole person impairment claim permitted

If you are deemed eligible for whole person impairment compensation, be aware that you are allowed only one claim, which means that if your condition worsens in the future you cannot go back and claim a larger amount of lump-sum compensation.

Whole Person impairment and hearing loss

If you are worried about your hearing or feel you are losing some level of hearing ability due to your working conditions, you must report it to your manager. Then consult your GP for a referral to an Ear Nose and Throat (ENT) specialist for a proper assessment to determine whether you need appropriate treatment.

The specialist assessment should also show whether you have lost some of your ability to hear, whether or not it is a work injury, and if there’s a need for you to have hearing aids. If your hearing loss is work-related, you may be eligible for whole person impairment workers compensation and will need to reach out to a law firm such as PK Simpson.

If you need to make a claim for whole person impairment workers compensation for hearing loss, our lawyers can help you to provide your insurer or employer with:

• Your report from the EN specialist
• A binaural hearing loss assessment
• A copy of the audiogram.
• Your permanent impairment claim form properly completed.