If you have suffered an injury at work, you may have an entitlement to potentially two lump sum payments of compensation related to permanent impairment.
The first category of lump sum payment is called “non-economic loss” which compensates you for pain and suffering, loss of amenities of life, loss of expectation of life, disfigurement, and any other loss or detriment of a non-economic nature.
The second category of lump sum payment is called “economic loss” which is intended to compensate the injured worker for the fact that their ability to earn income may be affected or diminished because of their work injury.
There are specific criteria that must be met in order to qualify for either category of lump sum compensation.
Lump sum compensation can only be paid for physical injuries. People who suffer from purely psychological or psychiatric injuries are not entitled to lump sum compensation. However, in some cases, if a psychological or psychiatric injury produces physical effects, it is possible that lump sum compensation can be paid for those physical effects.
Maximum Medical Improvement
In order to proceed with a claim for lump sum compensation, you must have reached “maximum medical improvement” (MMI) which means that your condition has been medically stable for the previous three months and is unlikely to change in the forseeable future, with or without medical treatment. With MMI, further recovery or deterioration is not anticipated however it can include temporary fluctuations – the expectation is neurological damage (e.g peripheral nerve injury) which should not be assessed until symptoms have persisted for 12 months. Depending upon your circumstances, MMI might be reached after 6 months but more often approximately 12 months post-injury. If you have had, or need to have surgery, it is unlikely that you will reach MMI until at least six months after surgery but again most likely longer. Sometimes a work injury might affect numerous different body parts – e.g. a back injury might cause symptoms in legs as well as the back. A work injury might also lead to “secondary injuries” – e.g. medication taken for pain might cause digestive problems. It is important to note that MMI also needs to be reached in relation to these other body regions.
To qualify for lump sum compensation, you must have sustained a “permanent impairment” which means an injury that does not resolve or improve with treatment loss of function of the relevant body part which is permanent. The question of whether you have sustained a permanent impairment is determined by medical practitioners that are accredited under the Accreditation Scheme established by the Minister for Industrial Relations. The assessor must conduct the assessment in accordance with the legislation and the Impairment Assessment Guidelines to determine whether the injury has reached MMI, whether the injury has resulted in an impairment, whether the impairment is permanent and the degree of whole person impairment resulting from the work injury. If your claim relates to more than one body part or condition, it may be necessary for more than one assessor to become involved. You have the right to choose the doctor (from a set list of accredited doctors) who conduct this assessment and most claimants will seek the advice of their lawyer when selecting the most appropriate assessor.
5% whole person impairment
You are only entitled to receive lump sum compensation if you are assessed as having at least 5% impairment of the whole person (“whole person impairment”). If you have a permanent impairment which is less than 5% whole person impairment, you are not entitled to receive lump sum compensation. If you reach or exceed the relevant threshold, a mathematical formula applies to determine the amount of compensation you are entitled to receive.
One assessment only
An injured worker is only entitled to have one assessment of permanent impairment conducted in relation to each work injury. It is therefore extremely important to select the right medical practitioner to conduct the assessment. This criteria means that you should only proceed with your claim for lump sum compensation for permanent impairment when all body parts or conditions arising from your work injury have reached MMI.
Additional criteria for economic loss
Eligibility for lump sum compensation for economic loss only applies to impairments of between 5% and 29% WPI – i.e the economic loss lump sum is not available to a seriously injured worker as they have greater entitlements to weekly payments to offset the economic loss that results from a serious injury. The economic loss lump sum also does not apply to psychiatric injury or consequential mental harm or noise induced hearing loss claims.
Rudall & Rudall Lawyers have an experienced team of lawyers in Gawler, Tanunda and Adelaide to assist you. Please Call us on 8523 8400 (Gawler) 8523 8444 (Tanunda) or 8211 6500 (Adelaide) to arrange an obligation free first appointment, or alternatively send an email to email@example.com and we will contact you.