Part 5—Injuries to internal organs
Division 1—Chest injuries
Example of factors affecting ISV assessment for items 36 to 39
The level of any reduction in the capacity for employment and enjoyment of life
Extreme chest injury
The injury will involve severe traumatic injury to the chest, or a large majority of the organs in the chest cavity, causing a high level of disability and ongoing medical problems.
An ISV at or near the top of the range will be appropriate if there will be total removal of 1 lung or serious heart damage, or both, with serious and prolonged pain and suffering and significant permanent scarring.
Serious chest injury
The injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing serious disability and ongoing medical problems.
A trauma to 1 or more of the following, causing permanent damage, physical disability and impairment of function—
• the chest (eg the chest wall mechanics with consequent restrictive ventilatory impairment)
• the heart
• 1 or both of the lungs (eg scarring or restrictive pleural disease)
• the diaphragm (eg rupture or phrenic nerve injury)
• an injury that causes the need for oxygen therapy for about 16 to 18 hours a day
Example of factors affecting ISV scale
The need for a permanent tracheostomy
An ISV at or near the top of the range will be appropriate if, after recovery, there are both of the following—
(a) serious impairment to cardio‑pulmonary function;
(b) whole person impairment for the injury of, or of nearly, 40%.
Moderate chest injury
The injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing moderate disability and ongoing medical problems
• Duration and intensity of pain and suffering (eg chronic inter costal neuralgia)
• The degree of permanent impairment of lung or cardiac function, as evidenced by objective test results
• The need for a temporary tracheostomy for short‑term airway management
An ISV at or near the top of the range will be applicable if there are multiple rib fractures causing—
(a) a flail segment (flail chest) requiring mechanical ventilation in the acute stage; and
(b) moderate permanent impairment of cardio‑pulmonary function.
An ISV at near the bottom of the range will be appropriate if there will be a partial loss of a breast without significant consequential mental harm.
An ISV in the lower half of the range will be appropriate if there was a pneumothorax, or haemothorax, requiring intercostal catheter insertion.
Minor chest injury
Examples of factors affecting ISV scale for items 39.1 and 39.2
• complexity of any fractures
• extent of injury to underlying organs
• extent of any disability
• duration and intensity of pain and suffering
39.1
Complicated or significant fracture, or internal organ injury, that substantially resolves
The injury will involve significant or complicated fractures, or internal injuries, that cause some tissue damage but no significant long‑term effect on organ function.
• Multiple fractures of the ribs or sternum, or both, that may cause cardio‑pulmonary contusion
• Internal injuries that cause some tissue damage but no significant long‑term effect on organ function
• An ISV at or near the bottom of the range will be appropriate if there is a fractured sternum that substantially resolves, and there is some ongoing pain and activity restriction
• An ISV at or near the top of the range will be appropriate if the injury causes significant persisting pain and significant activity restriction.
39.2
Soft tissue injury, minor fracture or minor internal organ injury
• The injury will involve a soft tissue injury, minor fracture, or minor and non‑permanent injury to internal organs
• There may be persistent pain from the chest, for example, from the chest wall or sternochondral or costochondral joints.
• A single penetrating wound, causing some tissue damage but no long‑term effect on lung function
• An injury to the lungs caused by the inhalation of toxic fumes or smoke that will not permanently interfere with lung function
• A soft tissue injury to the chest wall, for example, a laceration or serious seatbelt bruising
• Fractured ribs or a minor fracture of the sternum causing serious pain and disability for weeks, without internal organ damage or permanent disability
An ISV at or near the bottom of the range will be appropriate if there is a soft tissue injury from which the injured person will fully recover.
Division 2—Lung injury other than asthma
The level of an ISV for lung disease often reflects the fact that the disease is worsening and there is a risk of the development of secondary medical conditions.
Examples of factors affecting ISV assessment for items 40 to 43
Consequential mental harm may increase the level of ISV
Extreme lung injury
• Lung disease involving serious disability causing severe pain and dramatic impairment of function and quality of life
• A recurrent pulmonary embolism resulting in failure of the right side of the heart requiring a lung transplant, heart transplant or both
• Likelihood of progressive worsening
• Duration and intensity of pain and suffering
Serious lung injury
41.1
Serious lung injury if progressive worsening of lung function
Example of item 41.1
Lung disease, causing—
• significantly reduced and worsening lung function
• prolonged and frequent coughing
• restriction of physical activity, employment and enjoyment of life.
Additional examples of factors affecting ISV scale for item 41.1
• The possibility of lung cancer developing may increase the level of ISV
• The need for continuous oxygen therapy
41.2
Serious lung injury if no progressive worsening of lung function
Examples of item 41.2
• Lung disease causing breathing difficulties, short disabling breathlessness, requiring frequent use of inhaler
• Lung disease causing a significant effect on employment and social life, including inability to tolerate a smoky environment, with an uncertain prognosis
• A recurrent pulmonary embolism causing pulmonary hypertension and cor pulmonale
Moderate lung injury
A pulmonary embolism requiring anticoagulant therapy for at least 1 year or pulmonary endarterectomy
Minor lung injury
• Lung disease causing slight breathlessness, with—
(a) no effect on employment; and
(b) the likelihood of substantial and permanent recovery within a few years after the injury is caused
• A pulmonary embolism requiring anticoagulant therapy for less than 1 year
An ISV under this item will also will be appropriate if there is lung disease causing temporary aggravation of bronchitis, or other chest problems, that will resolve within a few months.
Division 4—Injuries to male reproductive system
• This Division applies to injuries caused by physical trauma rather than as a secondary result of psychiatric impairment
• For psychiatric impairment that causes loss of reproductive system function, (see psychiatric impairment)
• Sterility is usually either—
(a) caused by surgery, chemicals or disease; or
(b) caused by a traumatic injury that is often aggravated by scarring.
Examples of factors affecting ISV assessment for items 44 to 47
• Effect on social and domestic life
Impotence and sterility
• Whether the injured person has children
• Whether the injured person intended to have children or more children
44.1
• An ISV at or near the top of the range will be appropriate if a young injured person has total impotence and loss of sexual function and sterility
• An ISV in the upper half of the range will be appropriate if a young injured person without children has uncomplicated sterility, without impotence or any aggravating features
• An ISV near the middle of the range will be appropriate if a middle‑aged injured person with children has sterility and permanent impotence
• An ISV in lower half of the range will be appropriate if an injured person with children may have intended to have more children and has uncomplicated sterility, without impotence or any aggravating features
• An ISV at or near the bottom of the range will be applicable if the sterility has little impact.
Loss of part or all of the penis
• Extent of penis remaining
• Availability of prosthesis
• Extent to which sexual activity will be possible
Loss of both testicles
See item 44 where sterility results
Loss of 1 testicle
Additional example of factors affecting ISV scale
Age, cosmetic damage or scarring
An ISV at or near the bottom of the range will be appropriate if the injury does not reduce reproductive capacity.
Division 5—Injuries to female reproductive system
• This Division applies to injuries caused by physical trauma rather than as a secondary result of psychiatric impairment
• For psychiatric impairment that causes loss of reproductive system function, (see psychiatric impairment).
Examples of factors affecting ISV assessment for items 48 to 49
• Extent of any physical trauma
• Whether the injured person has children
• Whether the injured person intended to have children or more children
• Scarring
• Depression or consequential mental harm
• Effect on social and domestic life
Infertility
48.1
Infertility causing severe effects
Infertility with severe depression, anxiety and pain
48.2
Infertility causing moderate effects
Infertility without any medical complication if the injured person has children
An injury under this item is applicable even if there is consequential mental harm
48.3
Infertility causing minor effects
Infertility if—
(a) the injured person was unlikely to have had children, for example, because of age; and
(b) there is little or no consequential mental harm
Any other injury to the female reproductive system
49.1
Injury to female genitalia or reproductive organs, or both
• An ISV at or near the top of the range will be appropriate if the injury causes the early onset of menopause or irregular hormonal activity
• An ISV at or near the middle of the range will be appropriate if the injury causes:
• development of a prolapse or fistula
• a laceration or tear with good repair.
49.2
Female impotence
The injury may be correctable by surgery.
The level of sexual function or the extent of any corrective surgery
49.3
An injury causing an inability to give birth by normal vaginal delivery, for example, because of pelvic ring disruption or deformity
The injury may be correctable by surgery.
49.4
Reduced fertility, caused by, for example, trauma to ovaries or fallopian tubes
Division 6—Injuries to digestive system
Subdivision 1—Upper digestive tract
Extreme injury to the digestive system caused by trauma
• Severe permanent damage to the upper digestive system, with ongoing debilitating pain and discomfort, diarrhoea, nausea and vomiting that—
(a) are not controllable by drugs; and
(b) causes weight loss of at least 15%.
• An injury to the throat requiring a permanent gastrostomy
• An ISV at or near the bottom of the range will be appropriate if there is an injury to the oropharynx/oesophagus (throat) requiring a temporary gastrostomy for more than 1 year and permanent dietary changes, for example, a requirement for a soft food diet
• An ISV at or near the top of the range will be appropriate if there is an injury to the oropharynx/oesophagus (throat) requiring a permanent gastrostomy, with significant ongoing symptoms.
• the extent of any voice or speech impairment
• need for ongoing endoscopic procedure
Serious injury to the digestive system caused by trauma
A serious injury causing long‑term complications and requiring continuous medication
• The extent of any ongoing voice or speech impairment
• Whether a feeding tube was required, and if so, for how long it was required
• Urgent and/or uncontrolled bowel use
An ISV under this item is applicable if a feeding tube is required for between 3 and 12 months
Moderate injury to the digestive system caused by trauma
• A blunt trauma or a penetrating stab wound, causing some permanent tissue damage, but with no significant long‑term effect on digestive function
• An injury requiring a feeding tube for less than 3 months
Example of factors affecting ISV scale
• Whether a feeding tube was required, and if so, for how long it was required
• Whether dietary changes are required to reduce the risk of aspiration because of impaired swallowing
Minor injury to the digestive system caused by trauma
• A soft tissue injury to the abdomen wall, for example, a laceration or serious seatbelt bruising to the abdomen or flank, or both
• A minor injury to the throat or tongue causing temporary difficulties with swallowing or speech
• A laceration of the tongue requiring suturing
Subdivision 2—Injuries to the digestive system not caused by trauma
There is a marked difference between those comparatively rare cases having a long term or even permanent effect on quality of life and cases in which the only ongoing symptom is an allergy, for example, to specific foods, that may cause short‑term illness.
Extreme injury to the digestive system not caused by trauma
Severe toxicosis—
(a) causing serious acute pain, vomiting, diarrhoea and fever, requiring hospitalisation for days or weeks; and
(b) also causing 1 or more of the following:
• ongoing incontinence
• haemorrhoids
• irritable bowel syndrome; and
(c) having a significant impact on the capacity for employment and enjoyment of life.
An ISV in the lower half of the range will be appropriate if the injury causes a chronic infection that requires prolonged hospitalisation that will not resolve after antibiotic treatment for a year.
Serious injury to the digestive system not caused by trauma
Constant abdominal pain, causing significant discomfort, for up to 18 months caused by a delay in diagnosis of an injury to the digestive system
• An ISV at or near the top of the range will be appropriate if there is an adverse response to the administration of a drug that—
(a) requires admission to an intensive care unit; and
(b) does not cause any permanent impairment; and
(c) causes the need for ongoing drug therapy for life.
• An ISV in the upper half of the range will be appropriate if a chronic infection—
(a) requires prolonged hospitalisation and additional treatment; and
(b) will be resolved by antibiotic treatment within 1 year.
• An ISV at or near the bottom of the range will be appropriate if there is an adverse response to the administration of a drug that—
(a) requires admission to an intensive care unit; and
(b) does not cause any permanent impairment; and
(c) does not cause the need for ongoing drug therapy for life.
Moderate injury to the digestive system not caused by trauma
• An infection that is resolved by antibiotic treatment, with or without additional treatment in hospital, within 3 months after the injury is caused
• An adverse response to the administration of a drug, causing any of the following continuing over a period of more than 7 days, and requiring hospitalisation:
(a) vomiting;
(b) shortness of breath;
(c) hypertension;
(d) skin irritation
Minor injury to the digestive system not caused by trauma
• Disabling pain, cramps and diarrhoea, ongoing for days or weeks
• A localised infection, requiring antibiotic treatment, that heals within 6 weeks after the start of treatment
• An adverse response to the administration of a drug, causing any of the following continuing over a period of not more than 7 days, and not requiring hospitalisation:
(a) vomiting;
(b) shortness of breath;
(c) hypertension;
(d) skin irritation
• Intermittent abdominal pain for up to 6 months caused by a delay in diagnosis of an injury to the digestive system
Division 7—Kidney or ureter injuries
An injury to a ureter or the ureters alone, without loss of, or serious damage to, a kidney will generally be assessed under items 60 or 61.
Examples of factor affecting ISV assessment for items 58 to 61
• Risk of ongoing kidney or ureter problems, complications or symptoms
• Need for future medical procedures
Extreme injury to kidneys or ureters
58.1
Loss of both kidneys causing loss of renal function and requiring permanent dialysis or transplant
58.2
Serious damage to both kidneys, requiring temporary or intermittent dialysis
• The effect of dialysis and loss of kidney function on activities of daily living
• The length of time for which dialysis was required or the frequency of intermittent dialysis
• Ongoing requirement for medication, for example, to control blood pressure
• Whether the injury caused the need for dietary changes
• An ISV at or near the bottom of the range will be appropriate if dialysis was required for an initial 3 months period, with intermittent dialysis required after that
• An ISV at or near the top of the range will be appropriate if the injury required dialysis for about 1 year and ongoing dietary changes and medication.
Serious injury to kidneys or ureters
The injury may require temporary dialysis for less than 3 months.
Loss of 1 kidney if there is severe damage to, and a risk of loss of function of, the other kidney
The higher the risk of loss of function of the other kidney, the higher the ISV.
Moderate injury to kidneys or ureters
• Loss of 1 kidney, with no damage to the other kidney
• An injury to a ureter or the ureters that requires surgery or placement of stents
Minor injury to kidneys or ureters
A laceration or contusion to 1 or both of the kidneys confirmed by imaging
• An ISV at or near the bottom of the range will be appropriate if there is an injury to a kidney causing a contusion
• An ISV at or near the top of the range will be appropriate if a partial removal of a kidney is required
Division 8—Liver, gall bladder or biliary tract injuries
• Whether there are recurrent episodes of infection or obstruction
• Whether there is a risk of developing biliary cirrhosis
Extreme injury to liver, gall bladder or biliary tract
Loss, or injury causing effective loss of liver function
• An ISV at or near the bottom of the range will be appropriate if there are recurrent episodes of liver failure that require hospital admission and medical management but do not require liver transplantation
• An ISV at or near the top of the range will be appropriate if the injury requires liver transplantation
Serious injury to liver, gall bladder or biliary tract
Serious damage causing physical loss of over 30% of the tissue of the liver, but with some functional capacity of the liver remaining
Moderate injury to liver, gall bladder or biliary tract
A laceration, contusion or trauma damage to the liver, with a moderate permanent effect on liver function, confirmed from imaging
The removal of the gall bladder that causes ongoing symptoms
• An ISV at or near the bottom of the range will be appropriate if the injury causes impaired liver function with symptoms of intermittent nausea and vomiting and weight loss
• An ISV at or near the bottom of the range will also be appropriate if there is a gall bladder injury with recurrent infection or symptomatic stone disease, the symptoms of which may include, for example, pain or jaundice
• An ISV at or near the middle of the range will be appropriate if the injury involves removal of the gall bladder causing a bile duct injury
(a) surgery is required to remove not more than 30% of the liver; or
(b) bile ducts require repair, for example, placement of stents.
• An ISV at or near the top of the range will also be appropriate if there is an injury to the gall bladder, that despite biliary surgery, causes ongoing symptoms, infection or the need for further endoscopic surgery
Minor injury to liver, gall bladder or biliary duct
An injury within this item should not require surgery to the liver.
A laceration or contusion to the liver, with a minor effect on liver function and confirmed from imaging
An ISV in the lower half of the range will be appropriate if there is an uncomplicated removal of the gall bladder with no ongoing symptoms.
Division 9—Bowel injuries
Examples of factors affecting ISV assessment for items 66 to 69
• Risk of ongoing bowel problems, complications or symptoms
• Need for future surgery
• The degree to which dietary changes are required to manage chronic pain or diarrhoea caused by the injury
Extreme bowel injury
An injury causing a total loss of natural bowel function and dependence on colostomy
Serious bowel injury
A serious abdominal injury causing either or both of the following:
(a) impairment of bowel function (which often requires permanent or long‑term colostomy, leaving disfiguring scars);
(b) permanent restrictions on employment and diet and/or requiring nutritional supplements
Moderate bowel injury
(a) the injury requires temporary surgical diversion of the bowel, for example, an ileostomy or colostomy; and
(b) there is ongoing intermittent abnormal bowel function requiring medication; and
(c) some loss of bowel, weight loss and permanent restriction on diet and/or requiring nutritional supplements
Minor bowel injury
An injury causing tears to the bowel, with minimal ongoing bowel problems
Division 10—Bladder, prostate or urethra injuries
Examples of factors affecting ISV assessment for items 70 to 73
• Risk of ongoing bladder, prostate or urethra problems, complications or symptoms
• Need for future surgery
Extreme bladder, prostate or urethra injury
An injury causing a complete loss of bladder function and control, with permanent dependence on urostomy
Serious bladder, prostate or urethra injury
An injury causing serious impairment of bladder control, with some incontinence
An ISV in the upper half of the range will be appropriate if there is serious ongoing pain.
Moderate bladder, prostate or urethra injury
An injury causing continued impairment of bladder control, with minimal incontinence and minimal pain
An ISV at or near the top of the range will be applicable if—
• an ongoing requirement for minor surgery, for example, cystoscopy or urethral dilation; or
• other surgery due to being unresponsive to treatment
Minor bladder, prostate or urethra injury
A bladder injury that may require conservative intermittent medical treatment for which surgery is not required and from which the injured person will fully recover
Division 11—Spleen and pancreas injuries
Injuries to the pancreas
• The extent of any ongoing risk of internal infection and disorders, for example, diabetes
• The need for, and outcome of, further surgery, for example, surgery to manage pain caused by stone disease, infection or an expanding pseudocyst
• An ISV at or near the middle of the range will be appropriate if there are chronic symptoms, for example, pain or diarrhoea, and weight loss
(a) there are chronic symptoms with significant weight loss of between 10% and 20% of body weight, and pancreatic enzyme replacement is required; or
(b) an injury to the pancreas causes diabetes.
Loss of spleen (complicated)
Loss of spleen if there will be a risk, that is not minor, of ongoing internal infection and disorders caused by the loss
• An ISV at or near the top of the range will be appropriate if the injury leads to a splenectomy, with portal vein thrombosis after the splenectomy
• An ISV at or near the middle of the range will be appropriate if—
(a) the injury leads to a splenectomy, with serious infection after the splenectomy; and
(b) the infection requires surgical or radiological intervention
Injury to the spleen or uncomplicated loss of spleen
Laceration or contusion to the spleen that—
(a) has been radiologically confirmed;
(b) has no ongoing bleeding;
(c) is managed conservatively; and
(d) resolves fully
An ISV at or near the top of the range will be appropriate if there has been removal of the spleen (splenectomy), with little or no risk of ongoing infections and disorders caused by the loss of the spleen.
Division 12—Hernia injuries
Severe hernia
An incisional hernia if after repair there is either or both—
(a) ongoing pain; and
(b) a restriction on physical activities, sport or employment
An ISV at the top of the range will be appropriate if—
(a) the incisional hernia is reoccurring; and
(b) has a whole of person impairment of 10% or more
Moderate hernia
An incisional hernia that after repair has some real risk of recurring in the short‑term
Minor hernia
An uncomplicated incisional hernia, whether or not repaired