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To access certain benefits under the Workers’ Compensation and Injury Management Act 1981 (the Act), for injuries sustained on or after 14 November 2005, it may be necessary for an injured worker to obtain an assessment from a medical specialist or an approved medical specialist of their choice.
1. An assessment of degree of permanent whole of person impairment (WPI) may be necessary where an injured worker is seeking to access:
- common law; or
- specialised retraining; or
- medical expenses for exceptional circumstances.
2. An assessment of degree of permanent impairment may also be required where an injured worker is seeking to access:
- Schedule 2 entitlements. (Lump sum entitlement for permanent impairment)
(Note: other conditions for eligibility apply to each of these entitlements.)
An employer or an employer’s insurer may also request an assessment of a worker’s degree of impairment and the worker is required to attend.
An approved medical specialist is trained to evaluate impairment using the WorkCover WA Guides for the Evaluation of Permanent Impairment. See the link in the right panel.
When an impairment assessment is questioned and involved in a dispute, an impairment assessment conducted by an approved medical specialist must be used.
The forms required to undertake an assessment of permanent impairment are available below. They are to be used by an approved medical specialist in undertaking the impairment assessment.
There are 10 administrative forms used in the impairment assessment process. However, Form AMS 1 is to be used by workers, employers or employers’ insurers.
The remaining forms are to be completed only by an approved medical specialist.
These forms incorporate the legislative requirements and it is recommended they be used without significant changes to the format. If you have any questions regarding the use of the forms or the impairment assessment systems, please contact the Approved Medical Specialist Officer at WorkCover WA.
Form AMS 1 (request for assessment by an approved medical specialist of a worker's degree of permanent impairment)
This form is to be completed by a worker, employer or employers' insurer . The form is addressed to the approved medical specialist. The person making the request for the assessment selects from the list of approved medical specialists (AMS's) and should contact the specialist prior to completing the form to ensure they are available, as strict time limits apply for a worker seeking access to common law damages, specialised retraining programs or exceptional circumstances medical payments. It is also recommended that the applicant checks that the injury to be assessed is within the AMS's specialty area.
The person making the request is to complete all sections of the form and is responsible for ensuring contact details are correct. If you require assistance completing the form, please contact Advisory Services on 1300 794 744.
Form AMS 2 (requirement for worker to attend an examination)
This form is only to be used by an approved medical specialist and is sent to the worker. This form indicates an official requirement to attend an impairment assessment. There are penalties if a worker fails to attend as required.
Form AMS 3 (requirement to produce relevant documents or information for an impairment assessment)
This form is used when an approved medical specialist requires a worker, employer or employer’s insurer to produce relevant documents and information to assist in the impairment assessment. The worker, employer or employer’s insurer must provide to the approved medical specialist, relevant documents or information.
Form AMS 4 (requirement to consent to another party to produce relevant documents or information for an impairment assessment) An approved medical specialist uses this form when they require consent from the worker, employer or employer's insurer, for another party to provide relevant documents or information required for the impairment assessment.
Form AMS 4a (requirement to produce information for an impairment assessment)
An approved medical specialist uses this form after an impairment assessment examination, when additional information is required from the worker.
Form AMS 5 (report on evaluation of the degree of impairment)
This form details the evaluation of the worker’s degree of permanent impairment. The approved medical specialist is to forward a copy of the report to both the worker and employer along with the Certificate of Degree of Permanent Impairment, or Form AMS 6 (below).
Form AMS 6 (Certificate of Degree of Permanent Impairment)
This form defines the level of permanent impairment.The approved medical specialist will also forward a copy of the Certificate with the report to both the worker and employer.
This form may have the PIRs Rating Form attached when a psychological injury is being assessed
Form AMS 7 (report in worker's condition not stabilised)
An approved medical specialist will use this form when the worker has been assessed, but their injury has not stabilised to the extent required by the Act, and the WorkCover WA Guides for the Evaluation of Permanent Impairment.
The approved medical specialist is to forward this report, with the certificate or Form AMS 8, to both the worker and the employer.
Form AMS 8 (certificate where worker's condition not stabilised)
This form certifies that a worker has been assessed but has not stabilised to the extent required by the Act and the WorkCover WA Guides for the Evaluation of Permanent Impairment. The approved medical specialist will forward this Certificate with the report to both the worker and the employer.
PIRs Rating Form
This form details the psychiatric assessment of a worker's permanent psychological injury, and should be attached to Form AMS 6.
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