6Applying the Tables

6 Applying the Tables

Assessing functional capacity

(1) The impairment of a person must be assessed on the basis of what the person can, or could do, not on the basis of what the person chooses to do or what others do for the person.

Applying the Tables

(2) The Tables may only be applied to a person’s impairment after the person’s medical history, in relation to the condition causing the impairment, has been considered.

Note: For additional information that must be taken into account in applying the Tables see section 7.

Impairment ratings

(3) An impairment rating can only be assigned to an impairment if:

(a) the person’s condition causing that impairment is permanent; and

Note: For permanent see subsection 6(4).

(b) the impairment that results from that condition is more likely than not, in light of available evidence, to persist for more than 2 years.

Example: A condition may last for more than 2 years, but the impairment resulting from that condition may be assessed as likely to improve or cease within 2 years – if this is the case, an impairment rating under the Tables cannot be assigned to the impairment.

Permanency of conditions

(4) For the purposes of paragraph 6(3)(a) a condition is permanent if:

(a) the condition has been fully diagnosed by an appropriately qualified medical practitioner; and

(b) the condition has been fully treated; and

Note: For fully diagnosed and fully treated see subsection 6(5).

(c) the condition has been fully stabilised; and

Note: For fully stabilised see subsection 6(6).

(d) the condition is more likely than not, in light of available evidence, to persist for more than 2 years.

Fully diagnosed and fully treated

(5) In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated for the purposes of paragraphs 6(4)(a) and (b), the following is to be considered:

(a) whether there is corroborating evidence of the condition; and

(b) what treatment or rehabilitation has occurred in relation to the condition; and

(c) whether treatment is continuing or is planned in the next 2 years.

Fully stabilised

(6) For the purposes of paragraph 6(4)(c) and subsection 11(4) a condition is fully stabilised if:

(a) either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years; or

(b) the person has not undertaken reasonable treatment for the condition and:

(i) significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment; or

(ii) there is a medical or other compelling reason for the person not to undertake reasonable treatment.

Note: For reasonable treatment see subsection 6(7).

Reasonable treatment

(7) For the purposes of subsection 6(6), reasonable treatment is treatment that:

(a) is available at a location reasonably accessible to the person; and

(b) is at a reasonable cost; and

(c) can reliably be expected to result in a substantial improvement in functional capacity; and

(d) is regularly undertaken or performed; and

(e) has a high success rate; and

(f) carries a low risk to the person.

Impairment has no functional impact

(8) The presence of a diagnosed condition does not necessarily mean that there will be an impairment to which an impairment rating may be assigned.

Example: A person may be diagnosed with hypertension but with appropriate treatment the impairment resulting from this condition may not result in any functional impact.

Assessing functional impact of pain

(9) There is no Table dealing specifically with pain and when assessing pain the following must be considered:

(a) acute pain is a symptom which may result in short term loss of functional capacity in more than one area of the body; and

(b) chronic pain is a condition and, where it has been diagnosed, any resulting impairment should be assessed using the Table relevant to the area of function affected; and

(c) whether the condition causing pain has been fully diagnosed, fully treated and fully stabilised for the purposes of subsections 6(5) and (6).