I recently have had the experience of undertaking an impairment assessment for an unfamiliar interstate jurisdiction – WorkCover in Queensland. While I am familiar with the principles of impairment assessment generally and regularly undertake impairment assessment in other jurisdictions, my recent Queensland Experience illustrated the difficulties inherent in having so many different workers compensation jurisdictions each with their own variation on the approach to impairment assessment.
Not only does the approach vary from state to state (and Commonwealth), but there can be varying approaches within each jurisdiction dependent on the date of injury, reflecting legislative changes that have occurred. In the Tasmanian state jurisdiction with which I am most familiar, I have argued that it is best that all assessments be conducted according to the current guidelines, rather than having a system whereby an assessor needs to be able to turn back time and conduct an assessment using an earlier outdated methodology. I have discussed some of these issues in my earlier article – Double Whammy for Insurers from Tasmanian Impairment Guidelines
The insurers and their legal advisers have criticised an approach using only the current version of the guidelines – with some justification. The updated guidelines that now apply in Tasmania to all spine impairments , irrespective of date of injury, mean they are now assessed more favourably from the perspective of the worker. The insurers argue that this is unfair. They had not had the opportunity to collect premiums in accordance with the liability imposed by applying the new guidelines to injuries that had occurred before the date of effect of the guidelines.
My Queensland Experience high lights the difficulties in retrospectively applying an earlier methodology. The WorkCover Queensland Website www.workcoverqld.com.au has lots of information and guidelines for the recently introduced methodology using AMA5 and their new Guides to the Evaluation of Permanent Impairment (GEPI), but it was difficult to make sense of the older methodology that used AMA4 and a ‘Table of Injuries’. In particular, I couldn’t find a sample report on the website, only a blank report pro forma and some guidelines that were difficult to follow. Even a colleague with knowledge of impairment assessment systems nationally described the earlier Queensland approach as a ‘dogs’ breakfast’.
In future, I would hesitate to conduct another Queensland impairment assessment. This might mean that a Tasmanian worker having returned from Queensland after an injury might need to return to the sunshine state for an assessment rather than it being done locally. This adds costs, delays and inconvenience.
At a local level we might be able to sort out anomalies in our state-based impairment guidelines (in Tasmania this includes impairment ratings for spinal surgery and CRPS), but a National approach is really needed to improve consistency and reduce ‘red-tape’ associated with the important process of assessing residual disability and impairment due to work-related injury.
At a national level the contentious issue of how to rate impairment due to chronic pain could be tackled. An improved approach to the assessment of spinal impairments could also be developed. It would be too much for each of the current jurisdictions to tackle these issues on their own.
What is really needed is a National Impairment Assessment Guideline. After all, we are one country. Some political will would be needed, so politicians please put this on the national ‘Reduction of Red-Tape’ Agenda!
I agree there should be some sort of consistency in assessment but all this depends on the various legal interpretations and court cases in each state rather than the assessor’s interpretation. This is why it is all so hard and so different in each state. An assessing doctor needs to not only be familiar with the assessment methods but also with how the courts interpret what is being done. This is one reason I am against doctors determining causation. It always comes down to the legal interpretation of the facts relating to the events causing the injury in the end so as long as the assessor is fully compliant with the guidelines there should be impartiality which is the most important thing an assessing doctor can do. I myself am in favour of blind assessments whereby the examiner does not know whether the referrer is the insurer or the worker. This type of system could be set up by a section of WorkCover and done electronically just as lots of companies and government departments do. You submit for a qualified assessor in a certain area and the computer picks the examiner who has to submit the available time frames for each month. It sounds complex but this is the only solution I can see that may reduce the present potential for partiality.