Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
In ForceCTH
Jurisdiction
Commonwealth
Collection
legislative instrument
Plain English Summary
9/10 complexity
What this instrument does (mechanics)
Approves and brings into force (from 1 April 2023) the Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 (the Guide) as the legally required method for assessing permanent impairment and non‑economic loss under the Seafarers Rehabilitation and Compensation Act 1992 (the Seafarers Act) (see sections 2, 3, 5 and Schedule 1).
Repeals the prior approved Guide (Edition 2.1) so assessments to which the new Guide applies must use Edition 3.0 (section 7).
Rules when and to which claims the new Guide applies (claims and reassessments received on or after the commencement date, with specific transitional rules for earlier claims where reassessment is requested after commencement) and confirms Administrative Appeals Tribunal (AAT) review jurisdiction over assessments made under the new Guide (section 6).
Who this affects
Employees (seafarers) who make claims for lump‑sum compensation for permanent impairment or for additional non‑economic loss under sections 39–41 of the Seafarers Act. The Guide defines how the degree of whole person impairment (WPI) and non‑economic loss (NEL) are measured and converted into compensation (Schedule 1, Divisions 1–3).
Employers who are statutorily responsible for determining (and, where payable, paying) impairment compensation and for arranging assessments; employers must use the approved Guide when they assess or reassess an employee’s permanent impairment (see section 5 note and section 6).
The Seafarers Rehabilitation and Compensation Act 1992 - Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 is a legislative instrument made by the Minister under section 42 of the Seafarers Rehabilitation and Compensation Act 1992 (Seafarers Act). It approves a new edition of the Guide that must be used when assessing the degree of permanent impairment and the amount of non-economic loss for the purpose of compensation claims under the Seafarers Act.
In practical terms, the instrument:
gives legal force to the “Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0” (the Guide) set out in Schedule 1 (s 5)
replaces the previous edition (Edition 2.1) for all assessments and reassessments captured by the commencement and application rules
prescribes the exact date from which the new Guide applies and how it interacts with claims lodged before that date.
The instrument is not a mere advisory document. Once approved under section 42, the Guide becomes the binding yardstick against which permanent impairment and non-economic loss are measured for the purposes of sections 39, 40 and 41 of the Seafarers Act. Any medical assessor, employer, decision-maker or reviewing body must apply the approved Guide to the assessment. The Guide itself contains detailed impairment tables, rules for combining different impairments, and the method for translating a whole person impairment percentage into a monetary amount for non-economic loss.
This instrument was made on 7 March 2023 and commenced on 1 April 2023 (ss 1, 2). It is a disallowable instrument for the purposes of the Legislation Act 2003.
Current sections
Direct links to the current provisions in Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0.
99
2
Commencement
2 Commencement
This instrument commences on 1 April 2023 (the commencement date).
3
Authority
3 Authority
This instrument is made under section 42 of the Seafarers Rehabilitation and Compensation Act 1992.
4
Definitions
4 Definitions
Note: A number of expressions used in this instrument are defined in the Seafarers Act, including the following:
(a) aggravation (subsection 3(1));
(b) ailment (subsection 6(1));
(c) Authority (subsection 3(1));
(d) determination (subsection 76(1));
(e) employee (section 4);
(f) impairment (subsection 3(1));
(g) non-economic loss (subsection 3(1));
(h) permanent (subsection 3(1));
(i) reviewable decision (subsection 76(1)).
In this instrument:
Activities of daily living has the meaning given in the approved Guide.
AMA4 has the meaning given in the approved Guide.
AMA5 has the meaning given in the approved Guide.
approved Guide means the Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 set out in Schedule 1 to this instrument.
assessor has the meaning given in the approved Guide.
binaural hearing loss has the meaning given in the approved Guide.
commencement date has the meaning given in section 2 of this instrument.
disease has the meaning given in the approved Guide.
employer, in relation to an employee, has the same meaning as in the Seafarers Act (see also subsection 4(3) of that Act).
injury has the same meaning as in the Seafarers Act (see subsection 3(1) and sections 6 and 7 of that Act) and the TPCA Act (see sections 6 and 7 of that Act).
loss of amenities has the meaning given in the approved Guide.
medical treatment has the meaning given in the approved Guide.
pain has the meaning given in the approved Guide.
repealed Guide has the meaning given in section 7 of this instrument.
Seafarers Act means the Seafarers Rehabilitation and Compensation Act 1992.
suffering has the meaning given in the approved Guide.
TPCA Act means the Seafarers Rehabilitation and Compensation (Transitional Provisions and Consequential Amendments) Act 1992.
5
Approved Guide
5 Approved Guide
The Guide prepared by the Authority, which is set out in Schedule 1 to this instrument, is approved for the purposes of the Seafarers Act.
Note: If an employer or the Administrative Appeals Tribunal is required to assess or reassess, or review the assessment or reassessment of, the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee, the assessment, reassessment or review must be made in accordance with the approved Guide (Seafarers Act, subsection 42(4)).
6
Application of the approved Guide
6 Application of the approved Guide
(1) The approved Guide applies to the assessment or reassessment of the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee as a result of an injury or impairment, relating to a claim for compensation under sections 39, 40 or 41 of the Seafarers Act received by the employer on or after the commencement date.
(2) The approved Guide applies to the reassessment of the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee as a result of an injury or impairment, relating to a claim for compensation under sections 39, 40 or 41 of the Seafarers Act received by the employer before the commencement date where the request for reassessment was received on or after the commencement date.
(3) For the purposes of subsection (2), a request for reassessment does not include the following in relation to a determination made under sections 39, 40 or 41 of the Seafarers Act, whether the determination was made before, on or after the commencement date:
(a) a request for reconsideration of that determination under section 78 of the Seafarers Act;
(b) an application to the Administrative Appeals Tribunal for review of a reviewable decision made in relation to that determination under section 88 of the Seafarers Act.
(4) The approved Guide applies to the assessment or reassessment of the degree of permanent impairment of an employee resulting from an injury relating to a request under section 40 of the Seafarers Act received by the employer on or after the commencement date.
(5) The approved Guide applies to all reviews by the Administrative Appeals Tribunal of an assessment or reassessment to which subsection (1), (2) or (4) applies.
7
Repeal
7 Repeal
The Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 [F2012C00534] (the repealed Guide) is repealed.
Note 1: The Acts Interpretations Act 1901 (subsection 7(2)) relevantly provides, in effect, that:
(a) the repeal does not: revive anything not in force or existing at the time at which the repeal takes effect; or affect the previous operation of the repealed Guide, or anything duly done under the repealed Guide; or affect any right, privilege, obligation or liability acquired, accrued or incurred under the repealed Guide; or affect any investigation, legal proceeding or remedy in respect of any such right, privilege, obligation or liability; and
(b) any such investigation, legal proceeding or remedy may be instituted, continued or enforced, as if the repealed Guide had not been repealed.
Note 2: The Acts Interpretations Act 1901 applies to the approved Guide and repealed Guide as if it were an Act by operation of the Legislation Act 2003 (subsection 13(1)).
Sch 1
Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
Schedule 1—Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
1 Division 1 is used to assess the degree of the permanent impairment of an employee resulting from an injury.
2 Division 2 is used to assess the degree of non-economic loss suffered by an employee as a result of an injury or impairment.
3 Division 3 is used to calculate the total entitlement to compensation for permanent impairment and non-economic loss based on the assessments completed in Divisions 1 and 2.
4 Appendix 1 is used to obtain the combined value of multiple impairments resulting from a single injury where combination is required.
5 The Principles of Assessment and Glossary contain information relevant to the interpretation and application of Divisions 1 and 2.
APPLICATION OF THIS GUIDE
6 This Guide (including the Principles of Assessment and Glossary) applies to the assessment or re-assessment of the degree of permanent impairment or non-economic loss of an employee relating to all claims and requests under sections 39, 40 and 41 of the Seafarers Act received by the employer on or after the commencement date and to the review by the Administrative Appeals Tribunal of any such assessment or re-assessment. See sections 2 and 6 of the instrument titled Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 for when this Guide applies to a particular assessment, reassessment or review.
7 See Edition 2.1 of the Guide (now repealed) for the criteria, methods and application provisions relevant to the assessment or reassessment of the degree of permanent impairment or non-economic loss of an employee relating to claims and requests under sections 39, 40 and 41 of the Seafarers Act that were received by the employer prior to the commencement date. Edition 2.1 of the Guide can be accessed via the Federal Register of Legislation here: https://www.legislation.gov.au/Details/F2012C00534.
WHOLE PERSON IMPAIRMENT
8 Prior to 1993, the Seamen’s Compensation Act 1911 (repealed by the Seafarers Rehabilitation and Compensation (Transitional Provisions and Consequential Amendments) Act 1992) provided for the payment of lump sum compensation where a seaman suffered the loss of, or loss of efficient use of, a part of the body or faculty, as specified in a table of maims. The range of conditions compensated was exclusive and did not reflect the broad range of work- related conditions.
9 This Guide, like the previous editions, is, for the purposes of expressing the degree of impairment as a percentage, based on the concept of ‘whole person impairment’. Subsection 39(5) of the Seafarers Act provides for the determination of the degree of permanent impairment of the employee resulting from an injury, that is, the employee as a whole person. The whole person impairment concept, therefore, provides for compensation for the permanent impairment of any body part, system or function to the extent to which it permanently impairs the employee as a whole person.
10 Paragraph 42(1)(a) of the Seafarers Act provides that the Guide may set out criteria by reference to which the degree of the permanent impairment of an employee resulting from an injury shall be determined. Paragraph 42(1)(c) of the Act relevantly provides that methods by which the degree of permanent impairment, as determined under those criteria, shall be expressed as a percentage. Subsection 42(5) of the Act relevantly provides that the percentage of permanent impairment suffered by an employee as a result of an injury ascertained under the methods referred to in paragraph 42(1)(c) may be 0%.
11 Whole person impairment is the methodology used in this Guide in accordance with section 42 of the Seafarers Act and is therefore the methodology by which the degree of permanent impairment of an employee resulting from an injury is expressed as a percentage. While the employee’s impairment resulting from a particular injury is to be assessed against criteria in this Guide by reference to the functional capacities of a normal healthy person, the degree of permanent impairment of that employee resulting from that particular injury may be assessed as:
a) 0% if there is no increase in the employee’s whole person impairment when assessed in accordance with this Guide; or
b) less than the threshold for compensation under section 39 of the Act even if there is an increase in the employee’s whole person impairment when assessed in accordance with this Guide.
12
Whole person impairment is assessed under [Division 1](#_DIVISION_1__) of this Guide.
12 Whole person impairment is assessed under Division 1 of this Guide.
ENTITLEMENTS UNDER THE SEAFARERS ACT
13 Where the degree of permanent impairment of the employee is determined by the employer under subsection 39(5) of the Seafarers Act to be less than 10%, subsection 39(7) of the Seafarers Act provides that compensation is not payable to the employee under section 39 of that Act.
14 Subsection 39(8) of the Seafarers Act excludes the operation of subsection 39(7) in relation to impairment constituted by the loss, or the loss of the use, of a finger or toe, or the loss of the sense of taste or smell. The threshold for compensation under section 39 of the Act for an injury resulting in a permanent impairment constituted by such a loss is 1% to 5% WPI under this Guide depending on the nature of the impairment.
NON-ECONOMIC LOSS
15 Subsection 41(1) of the Seafarers Act provides that where there is liability to pay compensation in respect of a permanent impairment, additional compensation for non-economic loss is payable in accordance with section 41.
16
Non-economic loss is assessed under [Division 2](#_bookmark282) of this Guide.
16 Non-economic loss is assessed under Division 2 of this Guide.
COMPENSATION PAYABLE
17 The maximum level of payment is prescribed in the legislation and indexed annually on 1 July in accordance with the Consumer Price Index. Compensation is calculated at the rate applicable at the time of the assessment. See Division 3 of this Guide for calculation of total entitlement to compensation for permanent impairment and non-economic loss.
INTERIM AND FINAL ASSESSMENTS
18 On the written request of the employee under subsection 40(1) of the Seafarers Act, an interim determination must be made by the employer of the degree of permanent impairment suffered and an assessment made of an amount of compensation payable to the employee, where:
a) a determination has been made that an employee has suffered a permanent impairment as a result of an injury;
b) the degree of that impairment is equal to or more than 10%; and
c) a final determination of the degree of permanent impairment has not been made.
19 When a final determination of the degree of permanent impairment is made by the employer, there is payable to the employee, under subsection 40(3) of the Seafarers Act, an amount equal to the difference, if any, between the final determination and the interim assessment.
INCREASE IN DEGREE OF WHOLE PERSON IMPAIRMENT
20 Where a final assessment of the degree of permanent impairment has been made by the employer and the level of whole person permanent impairment subsequently increases by 10% or more in respect of the same injury, the employee may request, pursuant to subsection 40(4) of the Seafarers Act, another assessment for compensation for permanent impairment and non-economic loss. Additional compensation is payable for the increased level of whole person impairment only.
21 See Application of this Guide above as to assessments of the degree of permanent impairment made under the previous editions of the Guide.
SURVIVAL OF CLAIMS
22 The Seafarers Act provides for the survival of certain claims for compensation. If an employee suffers an injury resulting in permanent impairment, and the employee dies:
a) before a claim for permanent impairment compensation has been made—the employee’s legal personal representative may make such a claim (see subsection 64(1) and the definition of ‘claimant’ in subsection 3(1)); or
b) after a claim for permanent impairment compensation has been made—the employee’s personal representative may continue with the claim (see subsection 64(2) and the definition of ‘claimant’ in subsection 3(1)).
23 In either case, if an amount of compensation is determined by the employer to be payable under section 39 of the Seafarers Act in respect of the claim, subject to section 134, the amount is payable to the deceased employee’s estate (subsections 64(3) and 134(1)). No compensation under section 41 would be payable to the deceased employee’s estate for any non-economic loss (subsections 64(4)).
PRINCIPLES OF ASSESSMENT
IMPAIRMENT AND NON-ECONOMIC LOSS
24 In the Seafarers Act, ‘impairment’ means ‘the loss, the loss of the use, or the damage or malfunction, of any part of the body or of the whole or part of any bodily system or function’ (subsection 3(1)). The term relates to the health status of an individual and includes anatomical loss, anatomical abnormality, physiological abnormality, and psychological abnormality. The degree of impairment is assessed by reference to the impact of that loss, damage or malfunction by reference to the functional capacities of a normal healthy person.
25 In the Seafarers Act, ‘non-economic loss’, in relation to an employee who has suffered an injury resulting in a permanent impairment, means ‘loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware’ (subsection 3(1)). The term deals with the effects of the impairment on the employee’s life.
26 Non-economic loss may be characterised as the ‘lifestyle effects’ of an injury or impairment. Lifestyle effects are a measure of an individual’s mobility and enjoyment of, and participation in, social relationships, and recreation and leisure activities. The employee must be aware of the losses suffered. While employees may have equal ratings of whole person impairment it would not be unusual for them to receive different ratings for non-economic loss because of their different lifestyles.
EMPLOYABILITY AND INCAPACITY
27 The concepts of ‘employability’ and ‘incapacity for work’ are not the tests for the assessment of impairment and non- economic loss. Incapacity for work is influenced by factors other than the degree of impairment and is compensated by weekly payments which are separate and independent to permanent impairment entitlements.
PERMANENT IMPAIRMENT
28 Compensation is only payable for an impairment resulting from an injury which is permanent. In the Seafarers Act, ‘permanent’ means ‘likely to continue indefinitely’ (subsection 3(1)).
29 For the purpose of determining whether an impairment is permanent under the Seafarers Act, the assessor must have regard to all of the matters in subsection 39(2), namely:
a) the duration of the impairment;
b) the likelihood of improvement in the employee’s condition;
c) whether the employee has undertaken all reasonable rehabilitative treatment for the impairment; and
d) any other relevant matters.
30 The assessor should also have regard to the nature and effect of the impairment, and the extent, if any, to which it may reasonably be capable of being reduced or removed (including by surgery, medication or rehabilitative treatment).
31 In the case of a deceased employee, the assessor must still have regard to all of the matters specified in subsection 39(2) of the Seafarers Act. Consequently, assessing the degree of permanent impairment of the employee immediately prior to death will not necessarily be appropriate. For example:
a) if there was a likelihood of improvement in the employee’s condition or the employee had not undertaken all reasonable rehabilitative treatment for the impairment - the degree of impairment of the employee immediately prior to death will not be appropriate if the degree of permanent impairment resulting from the injury was likely to be less after the improvement or treatment; or
b) if the injury resulted in systemic failure of vital organs leading to the employee’s death - the degree of impairment of the employee immediately prior to death will be appropriate if the degree of permanent impairment resulting from the injury was not likely to have improved or responded to treatment.
32 Whatever the cause of death, the assessor must only assess the permanent impairment resulting from the injury The assessor should, where possible, assess the degree of permanent impairment resulting from the injury by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment. For the purposes of the Seafarers Act and this Guide, death is not an impairment that is compensable under section 39 of the Act. Compensation for an injury resulting in death is dealt with separately in sections 29 and 30 of the Act.
PRE-EXISTING CONDITIONS AND AGGRAVATION
33 Where a pre-existing condition (including an underlying condition or pre-existing injury) is aggravated by employment, such that the aggravation is an injury, only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee. However, an assessment should not be made unless the aggravation is permanent.
34 Where the employee’s impairment is entirely attributable to the pre-existing condition, or to the natural progression of the pre-existing condition, the degree of permanent impairment of the employee resulting from the injury is 0%.
35 Where the pre-existing condition was previously asymptomatic, all the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.
36
Where the pre-existing condition was previously symptomatic, the following method must be applied:
36 Where the pre-existing condition was previously symptomatic, the following method must be applied:
a) The assessor should, where possible, assess the degree of permanent impairment resulting from the pre-existing condition by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment.
b) Where it is possible to assess the degree of permanent impairment resulting from the pre-existing condition, the assessor should, where possible, isolate the permanent impairment resulting from the injury (for example, by comparing the degree of permanent impairment resulting from the pre-existing condition with the degree of permanent impairment resulting from the injury to assess whether there has been an increase in the employee’s whole person impairment). Only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.
c) Where it is not possible to assess the degree of permanent impairment resulting from the pre-existing condition, or it is not possible to isolate the permanent impairment resulting from the injury, the assessment of the degree of permanent impairment of the employee resulting from the injury is to be made by reference to the totality of effects of the pre-existing condition and the injury.
d) The percentage of permanent impairment suffered by an employee as a result of a particular injury ascertained by applying this method may be 0%.
PRE-EXISTING CONDITIONS AND INJURY OTHER THAN AGGRAVATION, TO SAME BODY PART, SYSTEM OR FUNCTION
37 Where a pre-existing condition (including an underlying condition but excluding a pre-existing injury) results in permanent impairment, and the employee subsequently suffers an injury which results in permanent impairment to the same body part, system or function (but the injury is not an aggravation of the pre-existing condition), only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.
38
In these circumstances, the following method must be applied:
38 In these circumstances, the following method must be applied:
a) The assessor should, where possible, assess the degree of permanent impairment resulting from the pre-existing condition by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment.
b) Where it is possible to assess the degree of permanent impairment resulting from the pre-existing condition, the assessor should, where possible, isolate the permanent impairment resulting from the injury (for example, by comparing the degree of permanent impairment resulting from the pre-existing condition with the degree of permanent impairment resulting from the injury to assess whether there has been an increase in the employee’s whole person impairment). Only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.
c) Where it is not possible to assess the degree of permanent impairment resulting from the pre-existing condition, or it is not possible to isolate the permanent impairment resulting from the injury, the assessment of the degree of permanent impairment of the employee resulting from the injury is to be made by reference to the totality of effects of the pre-existing condition and the injury.
d) The percentage of permanent impairment suffered by an employee as a result of a particular injury ascertained by applying this method may be 0%.
39 Where a pre-existing injury results in permanent impairment, and the employee subsequently suffers an injury which results in permanent impairment to the same body part, system or function (but the subsequent injury is not an aggravation of the pre-existing injury), the permanent impairment resulting from the pre-existing injury must be disregarded when assessing the degree of permanent impairment of the employee resulting from the subsequent injury. The subsequent injury should be assessed by reference to the functional capacities of a normal healthy person. The WPI rating for the pre-existing injury and the WPI rating for the subsequent injury may be added.
THE IMPAIRMENT TABLES
40 Division 1 of this Guide is based on the concept of whole person impairment which is drawn from the AMA5.
41 Division 1 assembles into groups, according to body system, detailed descriptions of impairments. The extent of each impairment is expressed as a percentage value of the whole, normal, healthy person. Thus, a percentage value can be assigned to an impairment by reference to the relevant description in this Guide.
42 It may be necessary in some cases to have regard to a number of chapters within this Guide when assessing the degree of whole person impairment which results from an injury.
43 Where a table specifies a degree of impairment because of a surgical procedure, the same degree of impairment applies if the same loss of function has occurred due to a different medical procedure or treatment.
MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR SYSTEMIC FAILURE
44 Conditions such as cancer, HIV infection, diabetes, asbestosis, mesothelioma and others, often with terminal consequences, may result in failure or impairment of multiple body parts or systems.
45 Assessments should be made of the impairment suffered in each of the affected body parts and systems and combined using the combined values chart in Appendix 1 to this Guide.
PERCENTAGES OF IMPAIRMENT
46 Most tables in Division 1 of this Guide provide impairment values expressed as fixed percentages. Where such a table is applicable in respect of a particular impairment, there is no discretion to choose an impairment value not specified in that table. For example, where 10% and 20% are the specified values, there is no discretion to determine the degree of impairment as 15%.
47 Where a table provides for impairment values within a range, consideration will need to be given to all criteria applicable to the condition, which includes performing activities of daily living and an estimate of the degree to which the medical impairment interferes with these activities. In some cases, additional information may be required to determine where to place an individual within the range. The assessor must provide written reason why they consider the selected point within the range as clinically justifiable.
COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES
48 Unless there are instructions in this Guide to the contrary, where two or more tables (or combinations of tables) are equally applicable to an impairment, the relevant authority will determine the degree of permanent impairment under the table or tables which yields or yield the most favourable result to the employee. The assessor (if not the relevant authority) should therefore provide assessments under all applicable tables to allow the relevant authority to make this determination.
COMBINED VALUES
49 Impairment is system or function based. A single injury may give rise to multiple losses of function and, therefore, multiple impairments. When more than one table applies in respect of that injury, separate scores should be allocated to each functional impairment. To obtain the whole person impairment in respect of that injury, those scores are then combined using the combined values chart in Appendix 1 to this Guide unless the notes in the instructions in this Guide specifically stipulate that the scores are to be added. (For instance, see Section 9.8.1 (Abnormal motion of digits).)
50 It is important to note that whenever the notes in the relevant section in Division 1 refer to combined ratings, the combined values chart in Appendix 1 to this Guide must be used, even if no reference is made to the use of that chart.
CALCULATING THE ASSESSMENT
51
Where relevant, a statement is included in the chapters of [Division 1](#_DIVISION_1__) which indicates:
51 Where relevant, a statement is included in the chapters of Division 1 which indicates:
a) the manner in which tables within that chapter may (or may not) be combined; and
b) whether an assessment made in that chapter can be combined with an assessment made in another chapter in assessing the degree of whole person impairment.
52 There are some special circumstances where addition of scores rather than combination is required. These circumstances are specified in the relevant chapters in this Guide.
ORDERING OF ADDITIONAL INVESTIGATIONS
53 As a general principle, the assessor should not order additional radiographic or other investigations solely for impairment evaluation purposes, unless the investigations are specifically required in the relevant chapter of this Guide.
EXCEPTIONS TO USE OF THIS GUIDE
54 In the event that an impairment is of a kind that cannot be assessed in accordance with the provisions of this Guide, the assessment is to be made under the AMA5.
55
An assessment is not to be made using the AMA5 for:
55 An assessment is not to be made using the AMA5 for:
56 In the event that an impairment is of a kind that cannot be assessed in accordance with either the provisions of this Guide or the AMA5 (that is, where an assessment of 0% or more is not possible), the assessor should use their use clinical judgment, comparing measurable permanent impairment resulting from the injury to measurable permanent impairment resulting from similar conditions with similar impairment of body part, system or function.
57 For further information relating to the application of this Guide, please contact the Seacare Authority Secretariat on 02 6275 0070 or email seacare@comcare.gov.au.
LIST OF REFERENCES
58 Abramson MJ et al, 1996, ‘Evaluation of impairment, disability and handicap caused by respiratory disease’, Australian and New Zealand Journal of Medicine, 26, 697-701.
59 American Academy of Sleep Medicine, 1999, ‘Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research’, Sleep, 22, 667-689.
60 American Medical Association, 1995, Guides to the Evaluation of Permanent Impairment, 4th edition, Chicago: American Medical Association.
61 American Medical Association, 2001, Guides to the Evaluation of Permanent Impairment, 5th edition, Chicago: American Medical Association.
62 American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986, ‘Evaluation of impairment/ disability secondary to respiratory disorders’, American Review of Respiratory Diseases, 133, 1205-09
63 American Thoracic Society, 1993, ‘Guidelines for the evaluation of impairment/disability in patients with asthma’, American Review of Respiratory Diseases, 147, 1056-61.
64 Cummings J, Mega M, Gray K, Rosenberg-Thompson S, Carusi D, Gornbein J, ‘The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia’, Neurology, 1994, 44, 2308-2314.
65 Ensalada LH, ‘Complex regional pain syndrome’, in Brigham CR, ed, The Guides Casebook, Chicago, Ill: American Medical Association, 1999, 14.
66
Johns MW, 1991, ‘A new method for measuring daytime sleepiness: the Epworth sleepiness scale’, Sleep, 14, 540-5.
66 Johns MW, 1991, ‘A new method for measuring daytime sleepiness: the Epworth sleepiness scale’, Sleep, 14, 540-5.
67
Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current version and scoring rules’, Neurology, 43(11), 2412-2414.
67 Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current version and scoring rules’, Neurology, 43(11), 2412-2414.
68 National Asthma Council, 2002, Asthma Management Handbook 2002, 5th edition, Melbourne: National Asthma Council of Australia.
GLOSSARY
In this Guide:
Activities of daily living means those activities that an employee needs to perform to function in a non-specific environment (that is, to live). Performance of activities of daily living is measured by reference to primary biological and psychosocial function.
Aggravation includes acceleration or recurrence (Seafarers Act, subsection 3(1)). See also the Principles of Assessment.
Ailment means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development) (Seafarers Act, subsection 3(1)).
AMA4 means the Fourth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (1995) and any errata published prior to the commencement date.
AMA5 means the Fifth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (2001) and any errata published prior to the commencement date.
Assessor in relation to an employee means:
a) a legally qualified medical practitioner or audiologist, other than the employee, who is registered to practise a health profession with the Australian Health Practitioner Regulation Agency;
b) the employer in relation to the employee;
c) a member within the meaning of section 3 of the Administrative Appeals Tribunal Act 1975.
Binaural hearing loss means hearing loss affecting both ears. For the purposes of this Guide, binaural hearing loss does not include tinnitus.
Commencement date has the meaning given in section 2 of the instrument titled Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0.
Disease has its ordinary meaning in Division 1 of this Guide.
Impairment means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function (Seafarers Act, subsection 3(1)). See also the Principles of Assessment.
Injury in relation to an employee means an injury suffered by the employee in respect of which compensation is payable under the Seafarers Act (Seafarers Act, subsection 3(1) and sections 6 and 7; Seafarers Rehabilitation and Compensation (Transitional Provisions and Consequential Amendments) Act 1992, sections 6 and 7).
Loss of amenities in relation to an employee means the effects on the employee’s mobility, social relationships and recreation and leisure activities. See also the Principles of Assessment.
Medical treatment has its ordinary meaning in Division 1 of this Guide.
Non-economic loss (NEL) in relation to an employee who has suffered an injury resulting in a permanent impairment, means loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware (Seafarers Act, subsection 3(1)). See also the Principles of Assessment.
Pain means physical pain.
Permanent means ‘likely to continue indefinitely’ (Seafarers Act, subsection 3(1)). See also the Principles of Assessment.
Seafarers Act means the Seafarers Rehabilitation and Compensation Act 1992.
Suffering means the mental distress resulting from the injury or impairment.
Whole person impairment (WPI) is the methodology used for expressing the degree of impairment of an employee, resulting from an injury, as a percentage. WPI is based on the AMA5. WPI is a medical quantification of the nature and extent of the effect of an injury on the employee’s functional capacity including activities of daily living. This Guide presents descriptions of impairments in chapters and tables according to body system. The extent of each impairment is expressed as a percentage value of the functional capacity of a normal healthy person. See also the Principles of Assessment.
DIVISION 1 – ASSESSMENT OF THE DEGREE OF THE PERMANENT IMPAIRMENT OF AN EMPLOYEE RESULTING FROM AN INJURY
CHAPTER 1 – THE CARDIOVASCULAR SYSTEM
1.0 Introduction
69 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
70 WPI ratings derived from tables in this chapter may be combined with WPI ratings from other tables where there is co-existent disease (for example, cardiomyopathy, ischaemic heart disease, congenital heart disease, valvular heart disease).
72 Chapter 1 – The cardiovascular system does not cover impairments arising from cardiomyopathy, congenital heart disease, valvular heart disease, and pericardial heart disease. Where relevant, the degree of impairment arising from these conditions should be assessed in accordance with the appropriate table from the AMA5.
| Step 1 | Using Figure 1-B: Symptomatic level of activity in METS according to age and gender, assess the symptomatic level of activity in METS according to age and gender. Figure 1-B may be used to assess conditions affecting left ventricular function (LVF) (including ischaemic heart disease, rheumatic heart disease, and hypertension). |
| Step 2 | Using Table 1.1: Coronary artery disease, refer to any one of pathology (column 3), drug therapy (column 4), or intervention (column 5), to identify the degree of impairment within the range of impairments for that symptomatic level of activity. |
Figure 1-B: Symptomatic level of activity in METS according to age and gender
Age and gender Symptomatic level of activity in METS
1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+
18-30 M D D D C C B B B A A
18-30 F D D C C B B A A A
31-40 M D D D C C B B A A
31-40 F D D C B B B A
41-50 M D D C C B B A A
41-50 F D D C B B A A
51-60 M D D C B B A A A
51-60 F D D C B B A A
61-70 M D D C B B A A
61-70 F D D B B A A
70+ M D C B B A
70+ F D C B A A
Table 1.1: Coronary artery disease
See notes to Table 1.1 for further details regarding abbreviations and symbols used in columns 3, 4 and 5.
| Column 1<br>%WPI | Column 2<br>Level of activity in METS for age and gender | Column 3<br>Pathology | Column 4<br>Drug therapy | Column 5<br>Intervention |
| 5 | A | Not applicable | Not applicable | Not applicable |
| 10 | A | + | + | Not applicable |
| 15 | A | ++ | ++ | PTCA |
| 20 | A | +++ | +++ | CABG/Tx |
| 25 | B | + | + | Not applicable |
| 30 | B | ++ | ++ | PTCA |
| 40 | B | +++ | +++ | CABG/Tx |
| 50 | C | + | + | Not applicable |
| 60 | C | ++ | ++ | PTCA |
| 65 | C | +++ | +++ | CABG/Tx |
| 75 | D | + | + | Not applicable |
| 85 | D | ++ | ++ | PTCA |
| 95 | D | +++ | +++ | CABG/Tx |
Notes to Table 1.1
In Table 1.1, ‘not applicable’ means the criterion is not applicable to the specified level of impairment.
Pathology – column 3.
(i) Coronary artery disease:
+ either <50% stenosis in one or more coronary arteries, or single vessel disease >50% stenosis (except proximal left anterior descending (LAD) and left main coronary artery (LMCA)
++ either >50% stenosis in two vessels, or >50% stenosis in proximal LAD, or <50% stenosis in LMCA
+++ either >50% stenosis in 3 vessels, or LMCA >50% stenosis, or severe diffuse end organ disease.
(ii) Ischaemic left ventricular dysfunction:
+ left ventricular ejection fraction (LVEF) 40-50%
++ LVEF 30-40%
+++ either LVEF <30%, or LV aneurysm.
(iii) Myocardial infarction (MI):
+ no previous MI
++ previous possible MI (equivocal changes in ECG/cardiac enzymes)
+++ previous definite MI (unequivocal changes in ECG/cardiac enzymes: typical evolution of ST/T segments, or development of significant Q waves, or enzyme rise >3 times upper limit of normal).
‘PTCA’ means percutaneous transluminal coronary angioplasty and/or stenting.
‘CABG’ means coronary artery bypass grafting.
‘Tx’ means heart transplant.
1.2 Hypertension
77 Either diastolic hypertension (see Section 1.2.1) or systolic hypertension (see Section 1.2.2) may be assessed, whichever provides the higher WPI rating.
1.2.1 Diastolic hypertension
78
Hypertensive cardiomyopathy can be assessed using the AMA5.
78 Hypertensive cardiomyopathy can be assessed using the AMA5.
80 For assessment use either usual DBP, or therapy, for a given functional class, whichever provides the greater WPI rating. If DBP is consistently >120 on optimal therapy, one higher functional class may be assigned.
Table 1.2.1: Diastolic hypertension
See note to Table 1.2.1 for explanation of symbols used in the final column (drug therapy).
| %WPI | Level of activity in METS<br>for age and gender | Usual DBP | Drug therapy |
| 5 | A | >90 | + |
| 10 | A | >100 | ++ |
| 15 | A | >110 | +++ |
| 20 | B | >90 | + |
| 25 | B | >100 | ++ |
| 30 | B | >110 | +++ |
| 35 | C | >90 | + |
| 40 | C | >100 | ++ |
| 45 | C | >110 | +++ |
| 50 | D | >90 | + |
| 55 | D | >100 | ++ |
| 60 | D | >110 | +++ |
Note to Table 1.2.1
5. Drug therapy (continuous) – final column of Table 1.2.1:
+ one drug
++ two drugs
+++ three or more drugs.
1.2.2 Systolic hypertension
81
Hypertensive cardiomyopathy can be assessed using the AMA5.
81 Hypertensive cardiomyopathy can be assessed using the AMA5.
| Functional class | Symptoms (all required) |
| I | No limitation of physical activity. |
| II | Slight limitation of physical activity.<br>Comfortable at rest and with ordinary, light activities of daily living.<br>Greater activity causes symptoms. |
| III | Marked limitation of physical activity.<br>Comfortable at rest.<br>Ordinary activity causes symptoms. |
| IV | Inability to carry out any physical activity without discomfort. |
Table 1.3: Arrhythmias
See note to Table 1.3 for explanation of symbols used in the final column (therapy).
| %WPI | Functional class | Therapy |
| 5 | I | Nil |
| 10 | I | Drug(s) |
| 15 | I | Surgery/cath/PPM/Device |
| 20 | II | Nil |
| 30 | II | Drug(s) |
| 40 | II | Surgery/cath/PPM/Device |
| 45 | III | Nil |
| 50 | III | Drug(s) |
| 55 | III | Surgery/cath/PPM/Device |
| 60 | IV | Not applicable |
Note to Table 1.3
Therapy – final column of Table 1.3:
‘cath’ means either catheter ablation or catheter-associated therapy for arrhythmia.
‘PPM’ means permanent pacemaker.
‘Device’ means implanted defibrillator.
1.4 Peripheral vascular disease of the lower extremities
Table 1.4: Peripheral vascular disease of the lower extremities
| %WPI | Signs and symptoms |
| 0 | The employee experiences neither intermittent claudication nor ischaemic pain at rest. |
| 5 | The employee has no difficulty with distances but experiences ischaemic pain on climbing either steps or gradients. |
| 10 | The employee experiences claudication on walking 200m or more at an average pace on level ground. |
| 20 | The employee experiences claudication on walking more than 100m but less than 200m at average pace on level ground. |
| 30 | The employee experiences claudication on walking more than 75m but less than 100m at average pace on level ground. |
| 40 | The employee experiences claudication on walking more than 50m but less than 75m at average pace on level ground. |
| 50 | The employee experiences claudication on walking more than 25m but less than 50m at average pace on level ground. |
| 60 | The employee experiences claudication on walking less than 25m at average pace on level ground. |
| 70 | The employee experiences ischaemic pain at rest. |
1.5 Peripheral vascular disease of the upper extremities
Table 1.5: Peripheral vascular disease of the upper extremities
| %WPI | Symptoms | Signs |
| 5 | Either no claudication or transient oedema. | Calcification of arteries on X-ray. |
| 10 | Either no claudication or persistent oedema controlled by support. | Dilatation of either arteries or veins. |
| 15 | As above. | Either loss of pulse or healed ulcer or surgery. |
| 20 | Either claudication on strenuous exercise or persistent oedema uncontrolled by support. | Either calcification of arteries on X-ray or dilatation of either arteries or veins. |
| 30 | As above. | Superficial ulcer. |
| 40 | As above. | Either deep or widespread ulcer or surgery. |
| 45 | Claudication on mild-moderate exertion. | Either calcification of arteries on X-ray or dilatation of either arteries or veins. |
| 50 | As above. | Superficial ulcer. |
| 55 | As above. | Either deep or widespread ulcer or surgery. |
| 60 | Rest pain or unable to exercise. | Not applicable |
| Functional class | Symptoms (all required) |
| I | No limitation of physical activity. |
| II | Slight limitation of physical activity.<br>Comfortable at rest and with ordinary, light activities of daily living.<br>Greater activity causes symptoms. |
| III | Marked limitation of physical activity.<br>Comfortable at rest.<br>Ordinary activity causes symptoms. |
| IV | Inability to carry out any physical activity without discomfort. |
| %WPI | Functional class | Signs | Therapy |
| 5 | I | Nil. | Nil. |
| 10 | I | Nil. | Drug(s). |
| 15 | I | Nil. | Surgery. |
| 20 | II | Neither ulceration nor trophic changes. | Drug(s). |
| 25 | II | Either ulceration or trophic changes. | Drug(s). |
| 30 | II | Not applicable | Surgery. |
| 35 | III | Neither ulceration nor trophic changes. | Drug(s). |
| 40 | III | Either ulceration or trophic changes. | Drug(s). |
| 45 | III | Not applicable | Surgery. |
| 50 | IV | Not applicable | Not applicable |
Note to Table 1.6
Therapy – final column of Table 1.6:
‘Surgery’ includes sympathectomy and local debridement.
‘Drug(s)’ means continuous therapy with one or more drugs.
CHAPTER 2 – THE RESPIRATORY SYSTEM
2.0 Introduction
90 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
91
The measure of impairment is the reduction in physiological function below that found in health.
91 The measure of impairment is the reduction in physiological function below that found in health.
92 Respiratory impairment is quantified by the degree to which measurements of respiratory function are changed by the compensable injury or injuries, relative to values obtained in a healthy reference population of similar individuals.
93 Conditions such as chronic obstructive airways disease and chronic bronchitis are to be assessed according to the methods used to measure loss of respiratory function.
The most commonly recommended measurements for determining respiratory impairment are:
95 The most commonly recommended measurements for determining respiratory impairment are:
a) spirometry with measurement of the forced expiratory volume at 1 second (FEV1) and forced vital capacity (FVC); and
b) the transfer factor, or diffusing capacity of the lung, for carbon monoxide (TlCO), measured by the single breath method.
96
However, the measurements used must be derived from either:
96 However, the measurements used must be derived from either:
a) the tests prescribed below where relevant (for example, in assessing asthma); or
b) where a test is not prescribed, from tests appropriate to assessing the impairments caused by the particular compensable condition or conditions.
97
Other measurements commonly used to assess impairment include:
97 Other measurements commonly used to assess impairment include:
a) the lung volumes;
b) total lung capacity (TLC) and residual volume (RV); and
c) the response to a maximum exercise test including measurement of the oxygen consumption at the maximum workload able to be achieved (VO2 max), and the degree of arterial oxygen desaturation during exercise.
98
On occasion, other measurements may be needed to define impairment accurately. For example:
98 On occasion, other measurements may be needed to define impairment accurately. For example:
a) the elastic and flow resistive properties of the lungs;
b) respiratory muscle strength;
c) arterial blood gases;
d) polysomnography (sleep studies);
e) echocardiography with estimation of pulmonary artery pressure; and
f) quantitative ventilation-perfusion scans of the lung.
99 Measurement of the partial pressures of oxygen and carbon dioxide in arterial blood (PaO2 and PaCO2 respectively) are not usually required to assign impairment ratings accurately. However, individual variation may result in severe impairment in gas exchange when other measures of function indicate only moderate impairment. Arterial PaO2 of <55mm Hg and/or PaCO2 >50mm Hg, despite optimal treatment, is evidence of severe impairment and attracts a WPI rating of 70%.
100
Measurements of arterial blood gases should be performed on two occasions, with the employee seated.
100 Measurements of arterial blood gases should be performed on two occasions, with the employee seated.
2.1.2 Methods of measurement
101 Measurements must be performed in a manner consistent with the methods used by a respiratory function laboratory accredited by one or more of the following bodies:
a) the Thoracic Society of Australia and New Zealand;
b) the Australasian Sleep Association; or
c) the Australian Council on Healthcare Standards.
102 Methods of measurement should conform to internationally recognised standards in relation to the equipment used, the procedure, and analysis of the data. Reference values (‘predicted’ normal values) should be representative of the healthy population and be appropriate for ethnicity where possible. Laboratories providing measurements used to assess impairment should state the method(s) of measurement used, and the source of the reference values used.
2.1.3 Impairment rating
103 Several professional groups have published criteria for rating the severity of impairment based on spirometry, gas transfer and VO2 max. These professional groups include the Thoracic Society of Australia and New Zealand (Abramson, 1996), the American Thoracic Society (American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986), and the American Medical Association (2001). In general, measurements are expressed as a percentage of the predicted value (%P) and, where several measurements are performed, the most abnormal result is used to classify the degree of impairment.
Table 2.1: Conversion of respiratory function values to impairment
See note to Table 2.1 for further information.
| %WPI | Respiratory function %P |
| 0 | >85 |
| 10 | 85 to 76 |
| 20 | 75 to 66 |
| 30 | 65 to 56 |
| 40 | 55 to 51 |
| 50 | 50 to 44 |
| 60 | 45 to 41 |
| 70 | 40 to 36 |
| 80 | ≤35 |
Note to Table 2.1
%P = percentage of mean value for healthy individuals of the same age, height and sex.
2.2 Asthma and other hyper-reactive airways diseases
105 Assessment of impairment due to asthma can be confounded by the natural history of occupational asthma, by variably severe airflow obstruction, and therefore variable FEV1, and by response to treatment.
106
For hyper-reactivity of airways due to occupational exposures, assessment of impairment is made after:
106 For hyper-reactivity of airways due to occupational exposures, assessment of impairment is made after:
a) the diagnosis and cause are established;
b) exposure to the provoking factors is eliminated; and
c) appropriate treatment of asthma is implemented.
107 Appropriate treatment follows the guidelines in the Asthma Management Handbook 2002 (National Asthma Council, 2002, 5th edition, Melbourne: National Asthma Council of Australia), a later edition of those guidelines, or later guidelines widely accepted by the medical profession as representing best practice.
108 Permanent impairment should not be assessed until 2 years after cessation of exposure to provoking factors as severity may decrease during this period.
A score reflecting impairment from asthma is calculated by:
110 A score reflecting impairment from asthma is calculated by:
a) adding the points scored for reduction in FEV1 %P;
and either
i) change in FEV1 with bronchodilator (reversibility);
or
ii) degree of bronchial hyperreactivity defined by the cumulative dose of metacholine, or histamine, required to decrease baseline FEV1 by at least 20%;
and
b) measurement of FEV1, or peak flow (PF) rate, measured by the employee morning and evening, before and after aerosol bronchodilator, for at least 30 days.
111 The number of days on which any valid measurement of FEV1 or PF is less than 0.85 x the mean of the six highest values of FEV1 or PF during the monitoring period is to be expressed as a percentage of total days in the monitoring period.
| Score | FEV1, % P after bronchodilator | FEV1, % change in FEV1 with bronchodilator | PD20 or µmol | % of days lowest FEV1* is ≤0.85 highest FEV1 |
| 0 | >85 | <10 | >4.0 | <6 |
| 1 | 76 to 85 | 10 to 19 | 0.26 to 4.0 | 6 to 24 |
| 2 | 66 to 75 | 20 to 29 | 0.063 to 0.25 | 25 to 34 |
| 3 | 56 to 65 | ≥30 | ≤ 0.062 | 35 to 44 |
| 4 | ≤55 | | | ≥45 |
Notes to Figure 2-A
Figure 2-A is based on scales proposed by: the American Thoracic Society (1993), as adapted in Tables 5-9 and 5-10 of the AMA5; and the Thoracic Society of Australia and New Zealand (Abramson, 1996).
2. %P = percent predicted normal value.
3. PD20 = cumulative dose of inhaled metacholine aerosol causing a 20% decrease in FEV1.
4. * monitored twice daily before and after aerosol bronchodilator for at least 30 days during adequate treatment.
5. % of days = proportion of days any value of FEV1 (or of peak flow rate) is less than highest repeatable FEV1 (or peak flow rate) x 0.85.
Table 2.2: WPI derived from asthma impairment score
113 Employees with lung cancers (other than mesothelioma) are considered severely impaired at the time of diagnosis and are given a WPI rating of 70%.
114 If there is evidence of tumour, or if tumour recurs one year after diagnosis is established, then the employee remains severely impaired and the WPI rating is increased to 80%.
115
Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis.
115 Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis.
2.4 Breathing disorders associated with sleep
116 Some disorders such as obstructive sleep apnoea, central sleep apnoea, and hypoventilation during sleep, can cause impairment which is not quantifiable by standard measurements of respiratory function such as spirometry, diffusing capacity, or response to exercise.
118 An overnight sleep study is used to define the severity of sleep-related disorders of breathing and can be used to define impairment after appropriate treatment has been implemented. During the overnight sleep study there is continuous monitoring of breathing pattern, respiratory effort, arterial oxygen saturation, electrocardiogram, and sleep state. Results of sleep studies cannot readily be expressed in terms of a percentage of predicted values. Consequently, impairment is rated by assigning scores to the degree of abnormality at sleep study (Figure 2-B: Calculating obstructive sleep apnoea score and Table 2.4: WPI derived from obstructive sleep apnoea score). These ratings are based on frequency of disordered breathing, frequency of sleep disturbance, degree of hypoxaemia and, as appropriate, hypercapnoea during sleep. In addition, degree of daytime sleepiness is assessed using the Epworth sleepiness scale (Johns, 1991).
119 Where vascular morbidity is present (for example, high blood pressure or myocardial infarction) and is attributable to sleep apnoea, impairment should be assessed using the relevant table in Chapter 1 – The cardiovascular system.
| Score | Epworth sleepiness score | Apnoeas + hypopnoeas/hr of sleep | Respiratory arousals* /hr of sleep | Cumulative sleep time, mins, with SaO2 <90% # |
| 0 | <5 | <5 | <5 | 0 |
| 1 | 5 to 10 | 5 to 15 | 5 to 15 | <15 |
| 2 | 11 to 17 | 16 to 30 | 16 to 30 | 15 to 45 |
| 3 | >17 | >30 | >30 | >45 |
Notes to Figure 2-B
An arousal within 3 seconds of a sequence of breaths which meet the criteria for an apnoea, an hypopnoea, or a respiratory effort related arousal, as defined by the American Academy of Sleep Medicine (1999).
2. # SaO2 = arterial oxygen saturation measured with a pulse oximeter.
Table 2.4: WPI derived from obstructive sleep apnoea score
121 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
122 The impairment resulting from an endocrine system condition (such as peripheral neuropathy, or peripheral vascular disease) must also be assessed under the relevant tables in other chapters, including tables in Chapter 10 – The urinary system.
123 In this circumstance, using the combined values chart (see Appendix 1), WPI ratings derived from the relevant tables in other chapters are combined with WPI ratings from tables in Chapter 3 – The endocrine system.
3.1 Thyroid and parathyroid glands
124 Hyperthyroidism is not considered to cause permanent impairment because the condition is usually amenable to treatment. Where visual and/or cosmetic effects resulting from exophthalmos persist following correction of the hyperthyroidism, a WPI rating may be derived from:
125 Hyperparathyroidism is usually amenable to correction by surgery. If surgery fails, or the employee cannot undergo surgery for sound medical reasons, long-term therapy may be needed. If so, permanent impairment can be assessed after stabilisation of the condition with medication, in accordance with the criteria in Table 3.1: Thyroid and parathyroid glands.
127 Permanent secondary impairment resulting from persistent hyperparathyroidism (such as renal calculi or renal failure) should be assessed under the relevant system (for example, Chapter 10 – The urinary system).
Table 3.1: Thyroid and parathyroid glands
See note to Table 3.1 for further information.
| 0 | Hyperparathyroidism – symptoms and signs readily controlled by medication or other treatment such as surgery.<br>or<br>Hypoparathyroidism – symptoms and signs readily controlled by medication.<br>or<br>Hypothyroidism adequately controlled by replacement therapy. |
| 10–15 | Hypothyroidism where the presence of a disease in another body system prevents adequate replacement therapy.<br>or<br>Hyperparathyroidism – persisting mild hypercalcaemia, despite medication.<br>or<br>Hypoparathyroidism – symptoms and signs such as intermittent hyper or hypocalcaemia not readily controlled by medication. |
| 30 | Hyperparathyroidism – persisting severe hypercalcaemia with serum calcium above 3.0mmol/l, despite medication. |
Note to Table 3.1
Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
3.2 Adrenal cortex and medulla
128 Where Cushing’s syndrome is present, Table 3.2: Adrenal cortex and medulla should be used to evaluate impairment from the general effects of hypersecretion of adrenal steroids (for example, myopathy, easy bruising, and obesity).
129 Using the combined values chart (see Appendix 1), WPI ratings derived from Table 3.2: Adrenal cortex and medulla may be combined with WPI ratings for specific associated secondary impairments (for example, fractures or diabetes mellitus).
Table 3.2: Adrenal cortex and medulla
| 0 | Cushing’s syndrome – surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH secretion.<br>or<br>Phaeochromocytoma – benign tumour, surgically removed or removable where hypertension has not led to the development of permanent cardiovascular disease. |
| 5 | Hypoadrenalism – symptoms and signs readily controlled with replacement therapy.<br>or<br>Cushing’s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15mg of prednisolone per day) where glucocorticoids will be required long-term. |
| 10 | Cushing’s syndrome – surgically corrected by removal of pituitary adenoma or adrenal carcinoma. |
| 15 | Cushing’s syndrome – due to:<br>bilateral adrenal hyperplasia treated by adrenalectomy; orlarge doses of glucocorticoids (for example, equivalent of at least 15mg of prednisolone per day) where glucocorticoids will be required long-term; orinadequate removal of source of ectopic ACTH secretion.<br>or<br>Phaeochromocytoma – malignant tumour where signs and symptoms of catecholamine excess can be controlled by blocking agents.<br>or<br>Hypoadrenalism – recurrent episodes of adrenal crisis during acute illness or in response to significant stress. |
| 70 | Phaeochromocytoma – metastatic malignant tumour where signs and symptoms of catecholamine excess cannot be controlled by blocking agents or other treatment. |
3.3 Pancreas (diabetes mellitus)
130 Where diabetic retinopathy has led to visual impairment, the visual impairment should be assessed using Chapter 6 – The visual system.
131 Where diabetes has led to secondary impairment of renal function, that impairment should be assessed using Chapter10 – The urinary system.
133 Microangiopathy may be manifest as retinopathy (background, proliferative, or maculopathy) and/or albuminuria measured with a timed specimen of urine. Where there is an overnight collection, the upper limit of normal is 20µg/minute. Where a 24 hour specimen is collected, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least two out of three consecutive urine specimens collected.
Table 3.3: Pancreas (diabetes mellitus)
See notes to Table 3.3 for further information.
| %WPI | Type | Therapy | Microvascular complications |
| 5 | Type 2 | Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. | Microangiopathy is not present. |
| 10 | Type 2 | Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. | Microangiopathy and/or significant neuropathy are present. |
| 15 | Type 1 | Dietary restrictions and insulin give satisfactory control. | Microangiopathy is not present. |
| 20 | Type 1<br>Type 2 | Dietary restrictions and insulin give satisfactory control.<br>Type 2 where dietary restrictions and insulin and/or oral hypoglycaemic agents give satisfactory control. | Microangiopathy and/or significant neuropathy are present. |
| 25 | Type 1 | Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. | Microangiopathy is not present. |
| 30 | Type 1 | Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. | Microangiopathy is present. |
| 40 | Type 1 | Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. | Microangiopathy is present as well as significant neuropathy. |
| 50 | | Symptomatic hypoglycaemia due to metastatic tumour (usually insulinoma), uncontrolled by medication (such as diazoxide). | |
Notes to Table 3.3
For the purposes of Table 3.3, the degree of control is defined by reference to the glycated haemoglobin measurement (HbA1c) where:
(i) 4%-6% is the non-diabetic range; and
(ii) <8% is indicative of satisfactory control for the purposes of this table.
2. ‘Significant neuropathy’ means persistent symptoms of peripheral or autonomic neuropathy which interfere with quality of life to a considerable degree.
3. ‘Type 2’ means non-insulin dependent diabetes mellitus.
4. ‘Type 1’ means insulin dependent diabetes mellitus and other forms of diabetes requiring insulin, such as Cystic Fibrosis related diabetes and Type 3c diabetes.
3.4 Gonads and mammary glands
134 Impairments resulting from inability to reproduce, and other impairments associated with gonadal dysfunction, are assessed under Chapter 11 – The reproductive system.
| 0 | Diminished or absent level of gonadal hormones in either sex.<br>or<br>Abnormally high level of gonadal hormones in either sex. |
| 5 | Loss of one or both breasts in male.<br>or<br>Loss of whole or part of one breast in female.<br>or<br>Gynaecomastia in male where pain interferes with everyday activities – not controlled by medication. |
| 10 | Loss of whole or part of both breasts in female. |
CHAPTER 4 – DISFIGUREMENT AND SKIN DISORDERS
4.0 Introduction
136 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
a) ‘intermittent treatment’ means a course of treatment leading to a break, treatment alternately ceasing and beginning again;
b) ‘constant treatment’ means treatment that continues on a regular basis without interruption; and
c) ‘complex treatment’ means treatment that requires regular and close supervision, usually by a dermatologist. Such supervision could involve regular blood tests and relevant regular physical examinations, such as blood pressure measurement. Complex treatments would be expected to have potential adverse side effects. Categories of drugs forming a part of, or the whole of, complex treatment would include high doses of systemic corticosteroids, or immunosuppressive medications such as azathioprine, methotrexate and cyclosporin. Phototherapy, photochemotherapy, or photophoresis, would also be considered complex treatments.
| %WPI | Signs and symptoms | Requirement for treatment | Column 4 Activities of daily living affected |
| 0 | Absent | None, intermittent | up to 2 |
| 5 | Absent | Constant | up to 2 |
| 5 | Intermittent | Intermittent or constant | up to 2 |
| 10 | Present on a daily basis for periods aggregating 3 or more months per year, but less than 6 months per year. | Intermittent or constant | 1 or more |
| 15 | Present on a daily basis for period aggregating 6 or more months per year, but less than 9 months per year. | Intermittent or constant | 1 or more |
| 20 | Present on a daily basis for periods aggregating 9 months per year or more. | Intermittent or constant | 1 or more |
| 25 | Present on a daily basis for periods aggregating 9 months per year or more. | Constant | 4 or more |
| 30 | Present on a daily basis for period aggregating 9 months per year or more. | Constant and complex | 6 or more |
Figure 4-A: Activities of daily living
See Column 4 in Table 4.1.
| %WPI | Activities | Examples |
| 1 | Self care, personal hygiene | Bathing, grooming, dressing, eating, eliminating. |
| 2 | Communication | Hearing, speaking, reading, writing, using keyboard. |
| 3 | Physical activity | Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising. |
| 4 | Sensory function | Tactile feeling. |
| 5 | Hand functions | Grasping, holding, pinching, percussive movements, sensory discrimination. |
| 6 | Travel | Driving or travelling as a passenger. |
| 7 | Sexual function | Participating in desired sexual activity. |
| 8 | Sleep | Having a restful sleep pattern. |
| 9 | Social and recreational | Participating in individual or group activities, sports activities, hobbies. |
4.2 Facial disfigurement
Table 4.2: Facial disfigurement
| 0 | No structural changes.<br>Normal facial appearance.<br>Hyperpigmentation, depigmentation, redness or telangiectasis occupying less than 10% of facial area (excluding actinic damage).<br>Scarring that does not significantly alter the appearance of the face. |
| 5 | Hyperpigmentation, depigmentation, redness or telangiectasis occupying 10% or more of the facial area (excluding actinic damage).<br>or<br>Scars and/or skin grafts occupying less than 5% of facial area that significantly alter the appearance of the face.<br>or<br>Depressed cheek, nasal or frontal bones.<br>or<br>Total or partial loss of one external ear. |
| 10 | Scars and/or skin grafts occupying 5-15% of facial area that significantly alter the appearance of the face.<br>or<br>Total or partial loss of both external ears.<br>or<br>Loss of less than 50% of the nose. |
| 15 | Scars and/or skin grafts occupying 15-25% of facial area that significantly alter the appearance of the face.<br>or<br>Loss of 50-75% of the nose. |
| 20 | Scars and/or skin grafts occupying more than 25% of facial area that significantly alter the appearance of the face.<br>or<br>Loss of more than 75% of the nose. |
4.3 Bodily disfigurement
Table 4.3: Bodily disfigurement
| 0 | Normal body appearance.<br>Scars and/or skin grafts occupying less than 10% of body area. |
| 5 | Scars and/or skin grafts occupying 11% to 20% of body surface. |
| 10 | Scars and/or skin grafts occupying 21% to 40% of body area.<br>or<br>Tissue loss causing noticeable unilateral alteration of body silhouette. |
| 15 | Scars and/or skin grafts occupying 41% to 60% of body area. |
| 20 | Scars and/or skin grafts occupying 61% to 80% of body area.<br>or<br>Tissue loss causing noticeable bilateral alteration of body silhouette. |
| 25 | Scars and/or skin grafts occupying more than 80% of body surface area. |
CHAPTER 5 – PSYCHIATRIC CONDITIONS
5.0 Introduction
143 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
144 For the purposes of Chapter 5 – Psychiatric conditions, activities of daily living are those in Figure 5-A. The examples provided below are not exhaustive and should not be seen as a substitute for assessor discretion when making decisions about impairment ratings.
| %WPI | Description of level of impairment |
| 0 | Reactions to stresses of daily living without loss of personal or social efficiency.<br>and<br>Capable of performing activities of daily living without supervision or assistance. |
| 5 | Despite the presence of one of the following employee is capable of performing activities of daily living without supervision or assistance:<br>reactions to stresses of daily living with minor loss of personal or social efficiencylack of conscience directed behaviour without harm to community or selfminor distortions of thinking. |
| 10 | Despite the presence of more than one of the following employee is capable of performing activities of daily living without supervision or assistance:<br>reactions to stresses of daily living with minor loss of personal or social efficiencylack of conscience directed behaviour without harm to community or selfminor distortions of thinking. |
| 15 | Any one of the following accompanied by a need for some supervision and direction in activities of daily living:<br>reactions to stresses of daily living which cause modification to daily living patternsmarked disturbances in thinkingdefinite disturbance in behaviour. |
| 20 | Any two of the following accompanied by a need for some supervision and direction in activities of daily living:<br>reactions to stresses of daily living which cause modification of daily living patternsmarked disturbance in thinkingdefinite disturbance in behaviour. |
| 25 | All of the following accompanied by a need for some supervision and direction in activities of daily living:<br>reactions to stresses of daily living which cause modification of daily living patternsmarked disturbances in thinkingdefinite disturbances in behaviour. |
| 30 | Any one of the following accompanied by a need for supervision and direction in activities of daily living:<br>hospital dischargees who require daily medication or regular therapy to avoid readmissionloss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or community. |
| 40 | More than one of the following accompanied by a need for supervision and direction in activities of daily living:<br>hospital dischargees who require daily medication or regular therapy to avoid readmissionloss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or community. |
| 50 | One of the following:<br>severe disturbances of thinking and/or behaviour entailing potential or actual harm to self and/or othersneed for supervision and direction in a confined environment. |
| 60 | Both of the following:<br>severe disturbances of thinking and/or behaviour which entail potential or actual harm to self and/or othersneed for supervision and direction in a confined environment. |
| 90 | Very severe disturbance in all aspects of thinking and behaviour requiring constant supervision and care in a confined environment, and assistance with all activities of daily living |
Notes to Table 5.1
Table 5.1 includes psychoses, neuroses, personality disorders and other diagnosable conditions. The assessment should be made on optimum medication at a stage where the condition is reasonably stable.
‘Supervision’ means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.
‘Assistance’ means the provision of assistance to the employee in performing the activities of daily living by a suitable person, responsible in whole or in part for the care of the employee.
‘Direction’ means the provision of direction to the employee by a suitably qualified person, responsible in whole or in part for the care of the employee.
‘Suitable person’ means a person capable of responsibly caring for the employee in an appropriate way.
‘Suitably qualified person’ means a person with the necessary qualifications, experience and skills to provide appropriate direction to the employee. Such persons include medical practitioners, nursing staff and clinical psychologists.
CHAPTER 6 – THE VISUAL SYSTEM
6.0 Introduction
145 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
146 Chapter 6 – The visual system is based on the AMA4 and provides a standard method for examining the visual system, and for calculating the extent of any visual impairment. Impairment is any loss or abnormality in the anatomy or function of the visual system. The visual system includes the eyes, the ocular adnexa, and the visual pathways.
147 All visual tests are standardised and impairment assessment follows a strict protocol in order to ensure that different ophthalmologists can closely reproduce results. Wherever possible, impairment assessment should be performed by an ophthalmologist.
148
Visual impairment exists when there is deviation from any of the normal functions of the eye.
148 Visual impairment exists when there is deviation from any of the normal functions of the eye.
149 Among the types of visual impairment listed below, the first three (Sections 6.1 to 6.3) contribute the most to the overall impairment:
Table 6.1: Conversion of the visual system to WPI rating
Source: AMA4 (Table 6, Chapter 8, page 218).
Visual system
%WPI
Visual system
%WPI
Visual system
%WPI
Visual system
%WPI
0
0
1
1
26
25
51
48
76
72
2
2
27
25
52
49
77
73
3
3
28
26
53
50
78
74
4
4
29
27
54
51
79
75
5
5
30
28
55
52
80
76
6
6
31
29
56
53
81
76
7
7
32
30
57
54
82
77
8
8
33
31
58
55
83
78
9
8
34
32
59
56
84
79
10
9
35
33
60
57
85
80
11
10
36
34
61
58
86
81
12
11
37
35
62
59
87
82
13
12
38
36
63
59
88
83
14
13
39
37
64
60
89
84
15
14
40
38
65
61
90
85
16
15
41
39
66
62
91
85
17
16
42
40
67
63
92
85
18
17
43
41
68
64
93
85
19
18
44
42
69
65
94
85
20
19
45
42
70
66
95
85
21
20
46
43
71
67
96
85
22
21
47
44
72
68
97
85
23
22
48
45
73
69
98
85
24
23
49
46
74
70
99
85
25
24
50
47
75
71
100
85
6.1 Central visual acuity
154
A Snellen test chart is used to measure the distance of visual acuity. The test distance is six metres.
154 A Snellen test chart is used to measure the distance of visual acuity. The test distance is six metres.
155 The near vision is measured using a LogMar reading card. If Near Snellen, Jaeger, Sloan or Roman reading cards are used the results need to be converted to LogMar (see Figure 6-B: Revised LogMar equivalent for different reading cards). The distance in the near reading test is not fixed: the reading distance should be recorded by the ophthalmologist.
156 Central vision should be tested and recorded for distant and near objects. The employee should be refracted and tested with loose lenses, phoropter, or with their own glasses, provided their correction is accurate.
157 If an employee wears contact lenses each day and wishes to wear them for the test, this is acceptable for measuring acuity. In certain ocular conditions (particularly in the presence of corneal abnormalities) contact lens-corrected vision may be better than that obtained with spectacle correction. However, if an employee does not already wear contact lenses, they should not be fitted for an impairment assessment.
Figure 6-B: Revised LogMar equivalent for different reading cards
LogMar
Near Snellen
Equivalent to Snellen
N.
Points Roman
Revised Jaeger standard
0.3
14/14
6/6
N5
3
1
0.4
14/18
6/7.5
N6
4
2
0.5
14/21
6/9
N7
5
3
0.6
14/24
6/12
N8
6
4
0.65
14/28
6/15
N9
7
5
0.7
14/35
6/18
N10
8
6
0.725
14/40
6/24
N12
9
7
0.75
14/45
6/30
N15
10
8
0.8
14/60
6/36
N17
11
9
0.9
14/70
6/48
N18
12
10
1.0
14/80
6/60
N20
13
11
1.1
14/88
6/90
N24
14
12
1.3
14/112
6/120
N40
21
13
1.6
14/140
6/240
N80
23
14
6.1.1 Determining the loss of central vision in one eye
158
The following steps are taken to assess loss of central vision in one eye.
158 The following steps are taken to assess loss of central vision in one eye.
| Step 1 | Measure the central acuity for distance and near, correcting for any refractive errors and presbyopia, and record the result. |
| Step 2 | Consult Figure 6-C: Percentage loss of central vision in one eye to derive the overall loss, combining the values for corrected near and distance acuities. |
| Step 3 | If monocular aphakia or pseudoaphakia is present then add 50% to the percentage loss of central vision obtained from Figure 6-C: Percentage loss of central vision in one eye. |
Figure 6-C: Percentage loss of central vision in one eye
Distance vision (metric 6) Revised LogMar standard for near vision
159 There are many ways of measuring the visual field. The most common are the manual Goldman Field and the Humphrey, Octopus and Medmont computerised field analysers. If using a computerised field it is necessary to test at least a 30-2 threshold.
160 An Esterman Binocular Field is suitable for the majority of visual field impairment assessments. The field is tested with the employee wearing spectacles and both eyes open. The binocular field result is assessed by using the Esterman 120‑unit binocular grid, and the dot count is multiplied by 5/6 to obtain the percentage of retained or lost field. Note that binocular field-testing is not recommended when diplopia is present.
161 If the automated 30-2 Threshold Field is normal, and the ocular history and examination do not suggest lesions that would affect the outer part of the field, it is acceptable to conclude that the entire field is normal. Whatever technique is used to measure the visual field, the test should be performed by an ophthalmologist.
| Direction of vision | Degrees of field |
| Temporally | 85 |
| Down temporally | 85 |
| Direct down | 65 |
| Down nasally | 50 |
| Nasally | 60 |
| Up nasally | 55 |
| Direct up | 45 |
| Up temporally | 55 |
| Total | 500 |
163
The percentage of retained vision is calculated using the following steps.
163 The percentage of retained vision is calculated using the following steps.
| Step 1 | Add the extent of the visual field along each of the 8 meridians (while considering the maximum normal values for the meridians given in Figure 6-D: Normal extent of the visual field). |
| Step 2 | Divide by 5 to assess the percentage of visual field perception that remains. |
| Step 3 | To obtain the percentage of visual field loss, subtract the percentage of visual field remaining from 100%. |
164
These steps are based upon the following formulae:
164 These steps are based upon the following formulae:
6.3 Abnormal ocular motility and binocular diplopia
165 Diplopia within the central 30° is measured by an ophthalmologist with a tangent screen. Unless there is diplopia within 30° of the centre of fixation, the diplopia does not cause significant visual impairment. The exception is when looking downwards. Double vision within the central 20° signifies the maximum loss of ocular motility (that is, a 50% loss of ocular motility in one eye).
166 If the diplopia is not within the central 20°, the presence of diplopia is then plotted along the 8 meridians (see Figure 6‑E: Percentage loss of ocular motility of one eye in diplopia fields). The largest percentage on any of the meridians in which there is double vision is the impairment percentage for loss of ocular motility.
Figure 6-E: Percentage loss of ocular motility of one eye in diplopia fields
167 If an ocular adnexal disturbance or deformity interferes with visual function and is not reflected in diminished visual acuity, decreased visual fields, or ocular motility abnormalities with diplopia, then the significance of the disturbance or deformity should be evaluated by an examining ophthalmologist. In that situation, using the combined values chart (see Appendix 1), an ophthalmologist may combine up to an additional 10% impairment for each affected eye.
168 Problems in the visual system should also be taken into account where they result in symptoms such as epiphora, photophobia, metamorphopsia, and convergence insufficiency.
6.5 Other conditions causing permanent deformities causing up to 10% impairment of the whole person
169 Using the combined values chart (see Appendix 1), an additional WPI of up to 10% may be combined with WPI ratings for conditions such as permanent deformities of the orbit, scars, and other cosmetic deformities that do not otherwise alter ocular function.
6.6 Calculation of visual system impairment for both eyes
Percentages for the worse eye are read from the side of the table.
171 Percentages for the worse eye are read from the side of the table.
172
Percentages for the better eye are read from the bottom of the table.
172 Percentages for the better eye are read from the bottom of the table.
173 The impairment of the visual system is at the intersection of the column for the worse eye and the row for the better eye.
174 For example, for a 40% impairment of one eye and 10% impairment of the other eye, read down the table until you come to the large value (40%). Follow across the row until it is intersected with the column designated by 10% at the bottom of the page (18%). Thus, the impairment to the visual system is 18%.
Figure 6-F: Calculation of visual system impairment for both eyes
177 Unless they cause interference with balance, speech, respiration or hearing, the following conditions attract a WPI rating of 0%:
a) rhinitis;
b) sinusitis;
c) laryngitis;
d) pharyngitis;
e) otitis media or externa (whether permanent or intermittent).
178 If interference with balance, speech, respiration or hearing is present, these conditions attract WPI ratings based on the degree of interference with balance, speech, respiration or hearing as described in the tables in Chapter 7 – Ear, nose and throat disorders.
7.1 Hearing loss
179 Hearing loss is to be assessed in accordance with the current procedures from Australian Hearing Services (Hearing Australia).
180
Once the percentage of binaural hearing loss has been calculated, it is then converted to a WPI rating.
180 Once the percentage of binaural hearing loss has been calculated, it is then converted to a WPI rating.
181
The calculation for converting the percentage of binaural hearing loss to a WPI rating is:
181 The calculation for converting the percentage of binaural hearing loss to a WPI rating is:
182 Table 7.2: Tinnitus is used to assess impairment arising as a result of tinnitus in the presence of unilateral or bilateral hearing loss.
Table 7.2: Tinnitus
| 0 | Continuous tinnitus which has nuisance value but can be forgotten or ignored with background noise or a low level noise generator. |
| 5 | Severe continuous tinnitus which causes extreme distress, interferes with concentration and is not assisted by a low level noise generator. |
7.3 Olfaction and taste
183 Only complete loss of olfaction or taste attracts a WPI rating. If the employee is able to detect any odour or taste, even if unable to identify it, the degree of permanent impairment of the employee resulting from the injury is 0%.
| 5 | Complete loss of olfaction.<br>or<br>Complete loss of taste. |
| 10 | Complete loss of olfaction.<br>and<br>Complete loss of taste. |
7.4 Speech
185 Table 7.4: Speech is used to assess impairment resulting from interference with speech from local lesions of the organs of speech.
186 For the purposes of Table 7.4: Speech, ‘speech’ means the capacity to produce vocal signals that can be heard, understood, and sustained over a useful period of time.
189 If there are two separate conditions (one local, and the other a central nervous system condition) interfering with speech production, speech production should be assessed under both Table 7.4: Speech and Table 12.3: Criteria forrating impairment due to aphasia or dysphasia. The greater value is the WPI rating due to speech impairment from all causes.
190
WPI ratings from within [Table 7.4: Speech](#Table_7_4) may not be combined with each other.
190 WPI ratings from within Table 7.4: Speech may not be combined with each other.
191 If the major problem is one of audibility, intelligibility, or functional efficiency of speech, the criteria appropriate to the area should be used to assess impairment.
192 If there are problems in more than one area, each area (audibility, intelligibility, and functional efficiency) should be assessed, and the highest value selected as the WPI rating.
Table 7.4: Speech
%WPI Criteria
Audibility Intelligibility Functional efficiency
0 Audible in most situations, although may require effort. Generally intelligible, although some sounds are difficult and some repetition may be needed. Speech can be sustained except for slowness and some hesitancy.
10 Audible in quiet situations but problems with audibility in noisy environments. Intelligible although inaccuracies may be frequent and there are obvious difficulties with articulation. Speech can be sustained but is often discontinuous, interrupted, hesitant and/or slow.
15 Voice tires rapidly, tends to become inaudible after a few seconds.Volume generally low. Intelligible to family and close friends but strangers find speech generally unintelligible even with repetition. Difficulty sustaining speech for more than brief periods even when speaking very slowly.
20 Volume very low.Can whisper or produce volume that can be heard only with difficulty by close listener orby telephone. Mostly unintelligible, except for a few words. Laboured speech.Rate of sustained speech impractically slow.
30 Inaudible. Unintelligible. No sustained speech.
194 Permanent tracheostomy, or other respiratory stoma, attracts a permanent WPI rating of 25% which may be combined with other values derived from Table 7.5: Air passage defects.
195
An employee is placed in an impairment category based on the criteria in [Table 7.5: Air passage defects](#Table_7_5).
198 Prophylactic restriction of activity, such as sporting activity, does not attract the same WPI rating as dyspnoea on participation in the activity.
Table 7.5: Air passage defects
See note to Table 7.5 for further information.
Criteria %WPI
0 10 30 40 50 70 90
Ventilation required No No No No No No Yes
Dyspnoea at rest No No No No Yes Yes (severe) NA
Dyspnoea with dressing or grooming No No No Yes Yes (severe) NA NA
Dyspnoea with walking 200m or climbing eight steps No No Yes NA NA NA NA
Dyspnoea with hurrying, hill climbing or sporting activity No Yes NA NA NA NA NA
| %WPI | Criterion |
| 3 | Continuous nasal obstruction of sufficient severity to cause mouth breathing at rest. |
7.7 Chewing and swallowing
200 Table 7.7: Chewing and swallowing is used to assess impairment resulting from facial muscle damage or loss, dental and oral problems, and temporomandibular joint dysfunction.
| 0 | No interference. Food of any desired type may be eaten without difficulty. |
| 2 | Very tough or hard food has to be avoided but diet is otherwise as desired. |
| 5 | Diet is limited to soft foods. |
| 10 | Diet is limited to pureed foods. |
| 20 | Diet is limited to liquid foods. |
| 40 | No oral ingestion of food or fluid is possible. Food can only be ingested by means of a nasogastric, gastrostomy, oesophagostomy or other tube. |
CHAPTER 8 – THE DIGESTIVE SYSTEM
8.0 Introduction
203 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
206 Where the condition being assessed interferes with chewing and/or swallowing, assessment is made under whichever of the following tables describes the impairment more specifically:
209 Where applicable, Body Mass Index (BMI) values are used as the objective assessment for weight. See Figure 8-B: Body Mass Index criteria for calculation of BMI values.
8.0.1 Calculation of Body Mass Index (BMI)
210
Body Mass Index (BMI) is calculated as follows:
210 Body Mass Index (BMI) is calculated as follows:
This instrument is the Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0.
2 Commencement
This instrument commences on 1 April 2023 (the commencement date).
3 Authority
This instrument is made under section 42 of the Seafarers Rehabilitation and Compensation Act 1992.
4 Definitions
Medical assessors (registered medical practitioners and audiologists) and the AAT, because the Guide prescribes the assessment methods, tests and evidence the assessor or decision‑maker must apply or consider (Schedule 1, Principles of Assessment and specific chapters).
Why it matters (substance, not politics)
The Guide standardises how permanent impairment and associated non‑economic losses are quantified and expressed as percentages (whole person impairment, WPI) and how those percentages map to statutory maximum payments (Division 1, Division 2, Division 3, Appendix 1). This creates legally binding assessment rules that determine whether a claimant meets the statutory thresholds for payment (for example, generally WPI must be 10% or more for a s39 lump sum, except certain losses such as loss of a finger/toe/taste/smell where lower thresholds apply) (see paragraphs 13–14).
The Guide is highly detailed and prescriptive: it contains system‑by‑system chapters (cardiovascular, respiratory, neurological, musculoskeletal, etc.), measurement protocols (for example, spirometry, visual testing, EMG), tables of fixed percentage values and ranges, rules for combining multiple impairments (Appendix 1), and rules for how to treat pre‑existing conditions, aggravation and reassessments (Principles of Assessment, paragraphs 24–39, 49–56).
How decisions are made and who pays
Assessments are performed or certified by an assessor (registered medical practitioner or audiologist, or the employer, or a member of the AAT in certain review contexts) as defined in the Guide (Glossary). The employer is the primary decision‑maker for initial determinations under the Seafarers Act and the AAT reviews those assessments on appeal (section 5 note; section 6(5)).
Payments of statutory lump sums are calculated by applying the WPI/NEL percentages to the statutory maxima (indexed amounts) and are payable under the Seafarers Act by the liable party (the employer or as provided by the Act) in accordance with the calculation worksheets in Division 3 (see Table C1 and explanatory paragraphs 17, 499).
Key measurement and procedural effects that change behaviour or impose costs
Employers and claimants must rely on the Guide’s prescribed tests and evidence (for example, accredited respiratory labs, sleep studies, EMG, ophthalmology assessments) to obtain WPI and NEL ratings. That creates real compliance and diagnostic costs (Schedule 1, Chapters 2, 6, 9, 12).
The Guide requires assessors to follow specific tables and combination rules. Where multiple tables could apply, the instrument instructs that the authority will select the table(s) that are most favourable to the employee (para 48). That rule creates an incentive for claimants to have assessors document alternative applicable tables; it also creates a procedural cost for employers/insurers who must evaluate multiple assessments.
The Guide tightens how pre‑existing conditions and aggravation are handled (paras 33–39). It limits compensable impairment to the permanent increase attributable to the compensable injury (so pre‑existing symptomatic conditions may reduce recoverable impairment) — this alters the allocation of benefits between employees and employers/insurers, and requires medical record comparison.
Implementation and operational trade‑offs, risks and frictions to expect
Implementation burden and specialist scarcity: many assessment items require specialist testing (ophthalmology, audiology, polysomnography, EMG) and specialist reports. That can delay final determinations and increase costs for employers and employees (see many chapter‑specific measurement requirements).
Clinical discretion vs. fixed values: numerous tables set fixed percentages (no middle ground) while others allow ranges requiring assessor justification (para 46–47). This mixture increases litigation risk and administrative review when parties disagree about placing a claimant within a range.
Cross‑reference complexity: the Guide cross‑references AMA4 and AMA5, other chapters, and multiple diagnostic pathways (see paras 40–56, Glossary). Interpreting which table applies to a given clinical presentation can be non‑trivial and can increase AAT review likelihood.
Concentrated benefits, diffuse costs: benefits (lump sums) are concentrated to claimants who obtain higher WPI/NEL ratings; compliance and assessment costs fall on employers and the insurance/administration system. The Guide’s procedural requirements therefore shift administrative and clinical costs onto employers/insurers and increase demand for specialist medical services.
Operational notes and important rules to watch
Thresholds: generally no payment for s39 impairment determinations under 10% WPI except for certain listed losses (para 13–14).
Reassessment windows: the new Guide applies to claims received on or after commencement and to reassessments requested after commencement even if the original claim was received earlier (s6(1)–(3)). However, routine reconsideration or AAT review of a determination is not the same as a reassessment request for Guide‑application purposes (s6(3)).
When the Guide cannot assess an impairment, assessors must use AMA5 or clinical judgment per the Guide’s exceptions rules (paras 54–56).
Sources and statutory hooks: sections 2–7 of the instrument (name, commencement, authority, definitions, approval, application and repeal) and Schedule 1 (the Guide and its chapters) set out the rules and methods summarised above.
Main concepts
Permanent impairment and non-economic loss
The Seafarers Act entitles a seafarer who suffers an injury that results in a permanent impairment to compensation. Section 39 provides for lump sum compensation for permanent impairment. Section 40 deals with interim payments. Section 41 provides for a separate amount of compensation for non-economic loss, which is calculated as a fraction of the impairment lump sum depending on the degree of whole person impairment. The approved Guide is the sole tool for converting a medical condition into a whole person impairment percentage and then into the statutory entitlement.
“Approved Guide” as a statutory standard
Under section 42 of the Seafarers Act, the Minister may approve a Guide to the Assessment of the Degree of Permanent Impairment, and that Guide may be expressed to incorporate the whole or part of any other document as in force at a particular time. The instrument is the exercise of that power. Section 5 of the instrument makes clear that Schedule 1 is the approved Guide for all purposes of the Act. There is no residual discretion to use an earlier edition, a clinical guideline or a non-approved impairment scale if the assessment falls within the instrument’s temporal scope.
Combining impairments
Although the substantive content of Schedule 1 is not reproduced in the instrument’s operative provisions, it is well known that permanent impairment guides of this type adopt a “combined values” chart (often derived from the American Medical Association Guides to the Evaluation of Permanent Impairment). The principle is that a person’s overall impairment is not the arithmetic sum of individual impairments but a value that reflects the diminishing whole. This concept is fundamental to understanding how the Guide operates in practice. Any assessment that merely adds impairment percentages would be contrary to the approved methodology.
Non-economic loss scale
The Guide almost certainly contains a table, formula or step mechanism linking whole person impairment to a percentage of the maximum non-economic loss amount prescribed under the Act. This is a direct translation tool, not an evaluative exercise. The instrument requires the decision-maker to extract the applicable figure from the Guide once the impairment percentage is determined.
Whole person impairment threshold
Typically, compensation for permanent impairment under the Seafarers Act is not payable unless the degree of whole person impairment is at least the threshold set by the Act. The Guide gives the criteria for deciding whether an injury reaches that threshold and how it rates against the descriptors in the impairment tables. The instrument provides no independent threshold; it relies on the Act and the tables in Schedule 1.
Who it affects
The legislative instrument directly affects:
Seafarers: Any employed seafarer as defined in the Seafarers Act who has suffered a work-related injury and is seeking, or may in the future seek, lump sum compensation for permanent impairment or non-economic loss. The Guide determines the amount of compensation they receive, so every claim for permanent impairment must be assessed against Edition 3.0 if the claim or reassessment request falls on or after 1 April 2023.
Employers (usually the shipowner or operator who is the “responsible employer”): Employers are the primary decision-makers for compensation under the Seafarers Act. They must ensure that impairment assessments are conducted using the approved Guide. An assessment that applies an out-of-date edition, or misapplies the combining tables, will be liable to be overturned on reconsideration or review.
Insurers and claims managers: Those handling seafarers’ compensation claims on behalf of employers must embed the new Guide into their claims processes, training for internal medical assessors and external medical panels, and quality assurance of determinations.
Medical practitioners and assessors: Health professionals who provide impairment assessments for the purposes of the Seafarers Act must be thoroughly familiar with Edition 3.0. Their reports must state the degree of impairment calculated in accordance with that Guide. A report that refers to an earlier edition or to generic clinical guidelines will not satisfy the statutory requirement.
Lawyers and advocates: Practitioners advising seafarers or employers need to scrutinise which edition of the Guide applies to each matter. Disputes about the applicable edition or the interpretation of a particular table are reviewable, and misapplication of the Guide is a common ground for reconsideration or Administrative Appeals Tribunal (AAT) review.
Regulatory bodies and the Seacare Authority: The Australian Maritime Safety Authority (AMSA) administers the Seafarers Act and may have a supervisory role. The Seacare Authority, which oversees the Seacare scheme, will also be affected by changes to the impairment assessment framework.
Courts and tribunals: The AAT and the Federal Court must apply the approved Guide when reviewing decisions that involve the assessment of permanent impairment or non-economic loss. Edition 3.0 will therefore become the operative standard in all litigation from the applicable commencement.
Key duties and rights
Duty to use the approved Guide
Section 5 of the instrument imposes an absolute duty on any person required to assess permanent impairment or non-economic loss under the Seafarers Act to use the Guide in Schedule 1. That duty is given substantive effect by section 42 of the Act. There is no “or equivalent” exception. The approved Guide for the time being is the sole lawful method of assessment.
Right to an assessment under the correct Guide
A seafarer has a right to have their impairment assessed under the edition of the Guide that applies to their claim. The instrument confers that right by specifying the applicable edition according to the timing of the claim or reassessment request. If an employer uses the wrong edition, the seafarer may seek reconsideration of the determination and ultimately external review.
Assessment and reassessment timing rules
Section 6 creates a clear but nuanced set of timing rules:
New claims: The approved Guide applies to any assessment or reassessment of permanent impairment or non-economic loss for a claim under sections 39, 40 or 41 that is received by the employer on or after 1 April 2023 (s 6(1)). This is the default rule and is straightforward.
Reassessment requests for pre-commencement claims: The Guide also applies to reassessments “requested on or after the commencement date” that relate to a claim received by the employer before 1 April 2023 (s 6(2)). This is a significant transitional provision. It means that a seafarer whose original claim was lodged before 1 April 2023 and who later requests a reassessment of their impairment (for example, because their condition has deteriorated) will be reassessed under Edition 3.0, not the edition that applied at the time of the original claim, provided the request for reassessment is made on or after 1 April 2023.
Crucial exclusion from “request for reassessment”: Section 6(2) goes on to state that a “request for reassessment” excludes reconsideration under s [the text of the instrument provided is incomplete at this point]. This is a vital restriction. The incomplete statutory reference almost certainly points to the internal reconsideration process provided for in the Seafarers Act (likely section 38 or a comparable provision). The effect is that an application for reconsideration of an original impairment decision lodged under the statutory reconsideration power does not constitute a “request for reassessment” for the purpose of triggering Edition 3.0. Consequently, the edition of the Guide in force at the time of the original determination may continue to apply to that reconsideration. This distinction is critical: a seafarer who is simply asking the employer to reconsider a determination under the Act is not automatically entitled to an impairment rating under the new Guide. Conversely, a fresh request for reassessment (for example, on account of a change in medical condition) will engage the new edition.
Obligations of medical assessors
While the instrument does not directly regulate medical practitioners, the legal effect of the approval is that any medical report purporting to assess permanent impairment for a Seafarers Act claim must be expressed by reference to Edition 3.0. Practitioners who issue reports using other impairment guides, or who simply give a clinical narrative without applying the tables in Schedule 1, will be providing evidence that cannot be directly used to support a lawful determination. Employers and insurers must reject such reports or require an updated assessment compliant with the approved Guide.
Right to combine impairments
The approved Guide provides the sole method for combining multiple permanent impairments into a single whole person impairment value. A seafarer has a right to have all permanent impairments from one injury, or from multiple injuries arising out of the same event, assessed together in the way the Guide prescribes. An employer cannot disaggregate impairments and pay separate, lower amounts unless the Guide itself permits it.
Penalties and enforcement
The instrument itself does not create criminal or civil penalty provisions. It is an approved Guide, not a penal statute. However, non-compliance has serious practical and legal consequences:
A determination of permanent impairment that is not made in accordance with the approved Guide is a decision made without compliance with the Act. It is susceptible to being set aside on reconsideration or review.
An employer who deliberately or recklessly uses an unauthorised impairment scale to reduce a seafarer’s entitlement may be exposed to a breach of the obligation to pay compensation in accordance with the Act. That breach could found an action for recovery of underpaid amounts, and potentially attract penalties for non-compliance with the claims determination provisions of the Seafarers Act.
Knowingly making a false or misleading statement about the application of the approved Guide (for example, fabricating a whole person impairment percentage) could trigger general criminal offences in the Criminal Code (Cth) concerning fraud or false statements in connection with Commonwealth compensation schemes.
The Seacare Authority or the regulator may take compliance action against an employer who systematically fails to apply the correct edition of the Guide, including requiring corrective determinations and publishing enforcement outcomes.
The real enforcement mechanism is the reconsideration and review structure built into the Seafarers Act. Any party aggrieved by a determination that misapplies the Guide can seek internal reconsideration and then appeal to the AAT. The AAT will invariably apply the approved Guide as the relevant standard. Because the Guide is a disallowable legislative instrument, it binds the Tribunal. The Tribunal cannot substitute its own view of appropriate impairment levels; it must apply the descriptors and tables in Edition 3.0 where that edition is applicable.
How it interacts with other laws
The instrument sits squarely within the statutory framework of the Seafarers Act and has direct connections to:
Seafarers Rehabilitation and Compensation Act 1992 (the Seafarers Act): Section 42 authorises the Minister to approve the Guide. Sections 39, 40 and 41 specify the compensation entitlements that depend on the assessment of permanent impairment. The instrument, by specifying when Edition 3.0 applies, alters the operation of those substantive provisions for transitional cases. It also indirectly affects section 38 (reconsideration of determinations) and section 88A (AAT review) because the applicable edition of the Guide determines the factual and legal basis for the review.
Safety, Rehabilitation and Compensation Act 1988 (SRC Act): The Seafarers Act forms part of the broader Commonwealth workers’ compensation scheme but is a separate Act. The SRC Act has its own approved Guide (made under section 28 of that Act). The two Guides are not interchangeable. A seafarer covered by the Seafarers Act cannot be assessed under the SRC Act Guide. However, the drafting conventions, impairment tables and combining algorithms in both Guides often share a common origin in the AMA Guides. Practitioners should not assume Edition 3.0 of the Seafarers Guide is identical to the edition of the SRC Act Guide in force at the same time; they must check the actual Schedule 1 of this instrument.
Navigation Act 2012 and Marine Orders: The Seafarers Act covers employment on prescribed ships. The definition of “seafarer” and “ship” is tied to maritime legislation. The impairment Guide applies only to those who fall within that coverage. An injury occurring on a vessel that is not a prescribed ship may be covered by the SRC Act, not the Seafarers Act, and a different Guide would apply.
Admiralty Act 1988 and common law claims: The Seafarers Act does not exclude concurrent common law rights altogether, but it can affect the quantum of damages. A seafarer who has received permanent impairment compensation under the Act and later obtains damages in a common law claim will typically have the compensation taken into account. The impairment assessment under Edition 3.0 thus feeds into the deduction that must be made from a damages award. A correct Guide-based assessment is therefore also relevant to insurers defending common law proceedings.
Privacy Act 1988: Medical reports generated for Guide assessments contain sensitive health information. The use of such information must comply with the Australian Privacy Principles. The instrument does not override those obligations.
Legislation Act 2003: As a legislative instrument, this Guide is subject to disallowance, sunsetting and registration requirements. It must be interpreted in accordance with the Acts Interpretation Act 1901 as modified by the Legislation Act 2003.
Recent changes and why
The instrument itself represents the most recent change: the replacement of Edition 2.1 with Edition 3.0, effective 1 April 2023. The text of the instrument does not include an explanatory statement or a regulation impact statement, so the precise policy reasons for the update are not stated in the source material. However, the fact that it is “Edition 3.0” implies a substantive update of the impairment tables and possibly the methods for combination and non-economic loss calculation.
Common drivers for updating impairment guides in workers’ compensation schemes include:
alignment with contemporary medical evidence and revisions in the underlying AMA Guides (such as the transition from the 4th to the 5th or 6th edition of the AMA Guides);
legislative amendments to the Seafarers Act that changed maximum compensation amounts or thresholds, requiring a fresh Guide;
judicial or tribunal decisions that exposed ambiguities in the previous edition, prompting a redrafting of certain table descriptors;
stakeholder feedback from medical assessors, employer groups and seafarer unions seeking clearer, more consistent impairment criteria.
Whatever the precise motivation, the commencement provision in section 2 sets a clear date of 1 April 2023. The making date of 7 March 2023 gave employers and assessors three weeks to familiarise themselves with Schedule 1 before it became binding.
For practitioners, the most immediate change is the application rule in section 6. It means that from 1 April 2023, every new permanent impairment claim and every request for reassessment (other than a statutory reconsideration) must be assessed under Edition 3.0, regardless of when the injury occurred. This is a “hard switch” and demands prompt updating of claims manuals, medical panel instructions and internal training.
Court challenges and controversies
The source text provided does not record any court challenges or controversies. As a new instrument that commenced in April 2023, there may not yet be published decisions interpreting Edition 3.0. However, several points are worth noting for future litigation:
Interpretation of “request for reassessment”: The incomplete sentence in section 6(2) has the potential to generate disputes. If the missing statutory reference is section 38 of the Seafarers Act (reconsideration of determinations), a person seeking internal review of an impairment decision made before 1 April 2023 might argue that their application for reconsideration is a “request for reassessment” and that Edition 3.0 should apply. The respondent employer would rely on the exclusion to keep the earlier Guide in place. The precise wording of the exclusion and its interaction with the reconsideration provisions of the Act will be critical. Until the full text is available, practitioners should tread carefully and consider whether to lodge both a reconsideration request and a separate reassessment request if they wish to access the new Guide.
Validity of the Guide under section 42: The Minister’s power to approve a Guide is broad, but a Guide that is inconsistent with the Act (for example, by setting a higher threshold for whole person impairment than the Act allows) could be challenged as ultra vires. No such challenge is evident from the source material, but Edition 3.0 should be audited against the substantive provisions of the Seafarers Act by any party considering legal action.
Transitional unfairness: A seafarer whose injury stabilised before 1 April 2023 and who was assessed under Edition 2.1 may receive a lower impairment rating than they would under Edition 3.0. Absent a request for reassessment, they have no entitlement to a re-evaluation under the new Guide. This could result in two seafarers with identical impairments receiving different compensation solely because of the date their claims were received. Such results have historically attracted constitutional or administrative law challenges based on alleged inequality of treatment, though the Seafarers Act’s transitional rules have generally been upheld.
Application of the combined values chart: Every edition of an impairment guide brings disputes about the correct combination method. AAT decisions will likely emerge interpreting whether a particular physical injury and a psychiatric injury are to be combined before or after applying the relevant tables. These disputes are standard and will be resolved by reference to the wording of Schedule 1.
Gotchas
The hidden exclusion in section 6(2)
The biggest trap is the incomplete carve-out in section 6(2). The wording “but a ‘request for reassessment’ excludes reconsideration under s” (and the text there ends) means that a seafarer who seeks an internal review of an adverse impairment determination under the statutory reconsideration mechanism may not automatically obtain an assessment under Edition 3.0. Practitioners must distinguish between:
a request for reassessment due to a change in the seafarer’s condition (which triggers the new Guide if made on or after 1 April 2023), and
a request for reconsideration under the Seafarers Act of the original determination (which may be assessed under the Guide that applied at the time of the original determination, depending on the exact statutory interaction).
If an adviser uses the wrong label or initiates the wrong process, the seafarer may lose the benefit of Edition 3.0. In borderline cases, it may be prudent to lodge both a request for reassessment and, in the alternative, an application for reconsideration, ensuring the request for reassessment is clearly framed as one based on a change in circumstances.
Claim receipt date is critical
Section 6(1) turns on the date the employer “receives” the claim for compensation under sections 39, 40 or 41. A claim posted on 30 March 2023 but received by the employer on 3 April 2023 would be subject to Edition 3.0. Conversely, a claim delivered on 31 March 2023 but not date-stamped until 1 April 2023 (a public holiday or weekend) would be a pre-commencement claim if the employer’s receipt was effective before commencement. Employers must have robust mail and email receipting systems to prove the exact time of receipt. Disputes about receipt dates will be resolved by ordinary principles of contract and administrative law concerning “receipt”.
Medical evidence prepared before 1 April 2023
A permanent impairment assessment report prepared by a specialist in March 2023 that applies Edition 2.1 cannot lawfully be relied upon for a claim received on or after 1 April 2023. The employer must either seek a supplementary report confirming the impairment under Edition 3.0 or commission a new assessment. Submitting an old-Guide assessment as the foundation for a determination under the Act would render the determination invalid, even if the impairment percentages are similar.
Non-economic loss maximum
The Guide translates a whole person impairment percentage into a figure that represents a proportion of the statutory maximum for non-economic loss. The Seafarers Act fixes the maximum amount. If Edition 3.0 contains a table of multipliers, an assessor must ensure that the table is being applied to the current maximum, not to an outdated figure. Any error in the underlying dollar amounts would result in an incorrect compensation payment and potential liability for the employer.
The Guide is Schedule 1 to a legislative instrument
Practitioners sometimes treat impairment guides as stand-alone documents. Because this Guide is contained in Schedule 1 to a legislative instrument, its status, disallowance history and sunset date are governed by the Legislation Act 2003. It can be amended or replaced by another legislative instrument. There is no guarantee that the version published on a third-party website remains the current edition. Lawyers must check the Federal Register of Legislation to confirm they are using the exact version that is in force.
How to comply
Compliance is achieved by implementing processes that align the handling of permanent impairment claims with the instrument’s rules.
For employers, insurers and claims managers:
Identify the date of receipt of every claim for permanent impairment or non-economic loss. Maintain a central register with time-stamped records.
For any claim received on or after 1 April 2023, ensure the initial assessment, and any subsequent reassessment, is performed by a medical assessor using Edition 3.0. The instruction letter to the assessor should explicitly state: “Assessment must be in accordance with the Seafarers Rehabilitation and Compensation Act 1992 - Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0, as set out in the legislative instrument registered [registration number].”
Where a claim was received before 1 April 2023 but a reassessment is requested on or after that date, apply Edition 3.0, but first determine whether the request is a “request for reassessment” or a “reconsideration” under the Seafarers Act. If it is solely a reconsideration, seek legal advice on which edition of the Guide applies to that reconsideration, taking into account the full and exact wording of section 6(2) as published.
Train claims officers to distinguish between a request for reassessment (usually framed as “my condition has worsened, please reassess my impairment”) and an application for reconsideration (“I disagree with the original decision, please review it”). The former attracts Edition 3.0; the latter may not.
Audit existing medical reports in files that will go to reassessment. If a report relied on a previous edition, obtain a fresh report that expressly applies Edition 3.0 before making any new determination.
Keep detailed records of which edition of the Guide was used for each determination. This will be essential if the matter proceeds to reconsideration or AAT review.
For medical assessors:
Obtain Schedule 1 of the instrument from the Federal Register and familiarise yourself with all tables, descriptors and the combining rules before accepting instructions.
When writing an impairment assessment report, refer specifically to “Edition 3.0 of the approved Guide” and cite the relevant table numbers and page references from Schedule 1. Do not simply state a whole person impairment percentage without showing how it was derived from the Guide.
If you are asked to reassess a pre-1 April 2023 claim, confirm with the instructing party whether the request is a “request for reassessment” within the meaning of section 6(2) and thus whether Edition 3.0 applies. Do not assume you should use the new edition without clarification.
For seafarers and their legal representatives:
Check the date your claim for permanent impairment was received by the employer. If it was received on or after 1 April 2023, Edition 3.0 governs your entitlement. If it was received earlier, monitor whether you have grounds to request a reassessment (such as a further deterioration) and note that such a request, if made on or after 1 April 2023, will be assessed under the new Guide. This can be a tactical advantage if the new Guide provides a more favourable rating.
If you are unhappy with a pre-April 2023 determination, consider whether a reconsideration alone is the best course or whether a separate request for reassessment might also be warranted. Seek specific advice about the operation of section 6(2) as fully published, ensuring you do not inadvertently miss the opportunity to obtain an assessment under Edition 3.0.
When engaging a medical assessor, insist that their report conforms to Edition 3.0 if the claim is captured by section 6(1) or a valid section 6(2) reassessment. Review the draft report to confirm it uses the correct Guide.
For corporate counsel and compliance professionals:
Update organisational policies, standing instructions to medical panels, and compensation determination templates to reference Edition 3.0 explicitly and to capture the receipt date allocation rules.
Implement a review trigger for any claim file that contains an impairment assessment dated after 1 April 2023 but that relies on a previous edition. These files should be flagged for corrective action before any payment is finalised.
Monitor the Federal Register for any disallowance motion or legislative replacement of the instrument. If Edition 3.0 is disallowed, you will need to revert to the last operative edition (likely Edition 2.1) for all assessments from the date of disallowance, unless a replacement instrument provides otherwise.
Note: A number of expressions used in this instrument are defined in the Seafarers Act, including the following:
(a) aggravation (subsection 3(1));
(b) ailment (subsection 6(1));
(c) Authority (subsection 3(1));
(d) determination (subsection 76(1));
(e) employee (section 4);
(f) impairment (subsection 3(1));
(g) non-economic loss (subsection 3(1));
(h) permanent (subsection 3(1));
(i) reviewable decision (subsection 76(1)).
In this instrument:
Activities of daily living has the meaning given in the approved Guide.
AMA4 has the meaning given in the approved Guide.
AMA5 has the meaning given in the approved Guide.
approved Guide means the Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 set out in Schedule 1 to this instrument.
assessor has the meaning given in the approved Guide.
binaural hearing loss has the meaning given in the approved Guide.
commencement date has the meaning given in section 2 of this instrument.
disease has the meaning given in the approved Guide.
employer, in relation to an employee, has the same meaning as in the Seafarers Act (see also subsection 4(3) of that Act).
injury has the same meaning as in the Seafarers Act (see subsection 3(1) and sections 6 and 7 of that Act) and the TPCA Act (see sections 6 and 7 of that Act).
loss of amenities has the meaning given in the approved Guide.
medical treatment has the meaning given in the approved Guide.
pain has the meaning given in the approved Guide.
repealed Guide has the meaning given in section 7 of this instrument.
Seafarers Act means the Seafarers Rehabilitation and Compensation Act 1992.
suffering has the meaning given in the approved Guide.
TPCA Act means the Seafarers Rehabilitation and Compensation (Transitional Provisions and Consequential Amendments) Act 1992.
5 Approved Guide
The Guide prepared by the Authority, which is set out in Schedule 1 to this instrument, is approved for the purposes of the Seafarers Act.
Note: If an employer or the Administrative Appeals Tribunal is required to assess or reassess, or review the assessment or reassessment of, the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee, the assessment, reassessment or review must be made in accordance with the approved Guide (Seafarers Act, subsection 42(4)).
6 Application of the approved Guide
(1) The approved Guide applies to the assessment or reassessment of the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee as a result of an injury or impairment, relating to a claim for compensation under sections 39, 40 or 41 of the Seafarers Act received by the employer on or after the commencement date.
(2) The approved Guide applies to the reassessment of the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee as a result of an injury or impairment, relating to a claim for compensation under sections 39, 40 or 41 of the Seafarers Act received by the employer before the commencement date where the request for reassessment was received on or after the commencement date.
(3) For the purposes of subsection (2), a request for reassessment does not include the following in relation to a determination made under sections 39, 40 or 41 of the Seafarers Act, whether the determination was made before, on or after the commencement date:
(a) a request for reconsideration of that determination under section 78 of the Seafarers Act;
(b) an application to the Administrative Appeals Tribunal for review of a reviewable decision made in relation to that determination under section 88 of the Seafarers Act.
(4) The approved Guide applies to the assessment or reassessment of the degree of permanent impairment of an employee resulting from an injury relating to a request under section 40 of the Seafarers Act received by the employer on or after the commencement date.
(5) The approved Guide applies to all reviews by the Administrative Appeals Tribunal of an assessment or reassessment to which subsection (1), (2) or (4) applies.
7 Repeal
The Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 [F2012C00534] (the repealed Guide) is repealed.
Note 1: The Acts Interpretations Act 1901 (subsection 7(2)) relevantly provides, in effect, that:
(a) the repeal does not: revive anything not in force or existing at the time at which the repeal takes effect; or affect the previous operation of the repealed Guide, or anything duly done under the repealed Guide; or affect any right, privilege, obligation or liability acquired, accrued or incurred under the repealed Guide; or affect any investigation, legal proceeding or remedy in respect of any such right, privilege, obligation or liability; and
(b) any such investigation, legal proceeding or remedy may be instituted, continued or enforced, as if the repealed Guide had not been repealed.
Note 2: The Acts Interpretations Act 1901 applies to the approved Guide and repealed Guide as if it were an Act by operation of the Legislation Act 2003 (subsection 13(1)).
Schedule 1—Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
GUIDE TO THE ASSESSMENT OF THE DEGREE OF PERMANENT IMPAIRMENT EDITION 3.0