Understanding ‘whole person impairment’ in your workers compensation claim
Published on August 9, 2023 by Scott Dougall
When you suffer a work-related injury or illness, you may be entitled to workers compensation benefits to help you recover and regain your quality of life. In NSW the compensation process involves several factors, one of which is determining your level of ‘whole person impairment’ (WPI). This article provides you with an overview of what it means in the context of your workers compensation claim in NSW.
What is whole person impairment?
WPI refers to the permanent loss or damage to your physical or mental function resulting from a work-related injury or illness. It is a measure used to assess the impact of the injury on your overall health and well-being.
What is a whole person impairment payment? And why is it so important?
A whole person impairment payment is a lump sum payment to compensate you for the overall effect your work injury or illness has had on your life. This lump sum payout is in addition to any weekly payments, medical and related expenses that you may receive.
How is whole person impairment assessed?
In NSW, the assessment of whole person impairment is conducted according to the guidelines outlined in the Workers Compensation Guidelines for the Evaluation of Permanent Impairment (Guidelines). The Guidelines provide detailed criteria for assessing impairments resulting from various body systems, such as the musculoskeletal, cardiovascular, respiratory, and nervous systems, among others. It covers both physical and psychological impairments.
The assessment of WPI must be carried out by a medical specialist that is trained as an assessor of permanent impairment. The medical specialist evaluates your condition, reviews medical records, and conducts a medical examination to determine the extent of the impairment. They then assign a percentage value to the WPI based on the Guidelines, reflecting the degree of impairment suffered by you as the worker.
To undergo assessment, your injury must have reached maximum medical improvement. This means that your condition is stable and is unlikely to change substantially in the next year with or without treatment.
Why should I make a claim for whole person impairment?
It is important to pursue a permanent impairment claim if you qualify. The length of time the insurer is required to pay for your treatment costs is dependent on your level of WPI. If your level of WPI hasn’t been assessed, the insurer will pay for treatment for at least two years from the date of your injury or two years from the last date you received weekly benefits (whichever is later).
The calculation of WPI plays a crucial role in determining the compensation benefits you as an injured worker are entitled to receive.
You must have 11% or more whole person impairment for a physical injury or 15% or more for a primary psychological injury to be entitled to receive a whole person impairment payout in NSW. For emergency services workers, the threshold reduces to 1% for physical injuries but is still 15% for psychological injuries.
In addition to receiving a tax free payment for the percentage of your impairment, there are 2 other benefits in bringing a claim for permanent impairment. These are:
- The percentage of your impairment can extend you coverage for weekly compensation benefits (potentially through to 1 year beyond retiring age) and medical coverage (potentially for the balance of your life);
- If you are found to have an impairment of 15% or greater you can bring a claim alleging negligence against your employer. This type of claim can allow you to recover payment for your past and future economic loss paid to you in a single tax free sum
How do I make a claim?
Only one claim for permanent impairment can be made in respect of your injury. You are required to complete a permanent impairment claim form which can be located on the State Insurance Regulatory Authority (SIRA) website.
If you receive a whole person impairment payout, it doesn’t mean an end to any weekly benefits you’re entitled to and these payments will continue as long as you qualify for them.
What happens if the insurer disputes my claim?
Once your claim is made, the insurer must, within certain timeframes, either accept liability and make a reasonable offer of settlement or dispute liability.
When the insurer agrees with your degree of whole person impairment the agreement must be made in writing by executing a complying agreement. You are required to obtain independent legal advice before you sign any complying agreement with the insurer regarding your entitlement to compensation for your permanent impairment.
In some cases, there may be a dispute between you and the insurer regarding the assessment of your WPI. If the insurer disputes the assessment, they must notify you in writing. This is called being issued with a section 78 Notice.
It is important to obtain legal advice regarding a section 78 Notice if you receive one. You can apply for a review of the insurer’s decision or proceed to the Personal Injury Commission for your dispute to be resolved but a lawyer will assist you to navigate the path forward.
You can contact us at Carroll & O’Dea Lawyers on 1800 059 278 or via our Contact Page if you have been injured in a workplace accident and one of our lawyers will assist you. You can also complete our Personal Injury Claim Check here.