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In order to access certain benefits or settlements, or pursue a common law claim for damages, it may be necessary for an injured worker to obtain an assessment from an approved medical specialist of their choice, usually when the worker and employer (or the employer’s insurer) don’t agree on the level of the worker’s impairment.
This assessment will determine the degree of permanent impairment or permanent whole of person impairment (WPI).
An AMS is trained to evaluate impairment using the WorkCover WA Guides for the Evaluation of Permanent Impairment.
An assessment of degree of permanent WPI may be necessary where you are seeking to access:
• a claim for damages at common law; or
• Specialised Retraining Programs; or
• Exceptional Circumstances Medical Payments.
An assessment of degree of permanent impairment may also be required where you are seeking to access a Schedule 2 settlement (a lump sum entitlement for permanent impairment).
(Note: other conditions for eligibility apply to each of these entitlements.)
While treatment continues to be provided by the worker’s treating medical practitioner, only medical practitioners registered as approved medical specialists can undertake impairment assessments.
Getting an assessment
- Access the list of approved medical specialists or contact The Advice and Assistance Unit
- select an approved medical specialist (it is advisable to telephone the approved medical specialist to check their availability and suitability to assess the impairment)
- complete a Request for Assessment by Approved Medical Specialist of a Worker’s Degree of Permanent Impairment (Word - 50kb), registering your selection of the approved medical specialist
- provide any information to the approved medical specialist that may be requested
- attend the approved medical specialist for assessment at the time, date and place as previously arranged
- receive a written report and a certificate of assessment.
How an assessment is made
An approved medical specialist may require the worker to attend at a specified place, to submit to an examination and to answer any question about the injury. The approved medical specialist may also require the worker, employer or employer’s insurer to produce or consent to the production of any relevant document or information. Time limits may apply for meeting these requirements, and penalties exist for non-compliance.
If the assessment is for the purpose of court proceedings then the proceedings could be delayed or dismissed if there is non-compliance with the requirements for assessment by an approved medical specialist.
If you choose to proceed and your assessment reaches the required level for access to one of the compensation pathways discussed above, you should submit the required documentation along with the report and certificate to WorkCover WA for registration.
If a dispute regarding the degree of impairment arises, this may be referred to an AMS panel.
For Schedule 2 settlements
If your injury or illness has resulted in a permanent impairment you may be entitled to a lump sum payment to finalise your claim. A Schedule 2 settlement compensates a permanent impairment based on a fixed formula that measures the type and severity of the permanent injury or illness.
If you were injured on or after 14 November 2005, you may require an assessment of your degree of permanent impairment if your employer and you do not agree on the percentage of impairment.
If this occurs, you must apply to an AMS for an assessment, using the standard procedures described above.
If your employer agrees with the percentage of permanent impairment, you need to sign a prescribed election form. The election form, together with the prescribed agreement form and supporting material, is filed with WorkCover WA.
If no agreement is achieved, you may apply to have the matter determined by an arbitrator of WorkCover WA. WorkCover WA may refer the matter to an AMS panel for further assessment.
If the AMS finds that your condition has not stabilised to the extent required for an evaluation, the AMS is required to give you and your employer a written report of any relevant details provided by you and reasons justifying the finding.
Common Law
(where the cause of action arose on or after 14 November 2005)
In addition to settlements available in the workers’ compensation system, you may be eligible to pursue a common law claim against your employer in the courts.
Eligibility to access common law is strict and you should seek legal advice before commencing any action.
If you decide to pursue a common law claim for damages against your employer, you need to have a permanent WPI of at least 15 per cent.
If your employer does not agree with the degree of WPI, you should apply to an AMS of your choice to obtain an assessment.
This assessment must be provided to WorkCover WA prior to the termination day, which in normal circumstances is 12 months from the date that a claim for weekly compensation payments was made.
Secondary conditions (psychological, psychiatric and sexual) will be disregarded in the assessment for access to common law, but may be included in a court’s assessment of damages.
It may be decided that your condition has not stabilised sufficiently for the assessment to be made. In these circumstances, you may be able to request an extension to the termination day for up to 12 months.
A special evaluation for common law purposes can be made when the condition has not sufficiently stabilised after 18 months (the original 12 months from the date that the claim for weekly payments was made plus a six-month extension).
If you are requesting an AMS to make this special evaluation, you must do so not later than eight weeks before the extended termination day and the request must be accompanied by a copy of the original AMS certificate stating that your condition has not stabilised.
Payment for approved medical specialist services
Payment for the first approved medical specialist assessment, for common law access only, will be made by the insurer or employer. The insurer or employer will also pay where a worker’s condition has not stabilised in assessments to access common law.
Otherwise, as the legislation makes no provision for any particular person to pay, it is the responsibility of the person who requests the assessment to pay.
An employer may dispute the assessment
If an employer disputes the level of impairment after a worker has obtained an assessment, a worker may lodge an application with the Conciliation and Arbitration Services. A conciliation officer or arbitrator may determine the worker's degree of permanent impairment, or refer the question for assessment to an approved medical specialist panel.
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