WorkCover Permanent Impairment Assessments and Lump Sum Offer Payouts
At the end of a workers’ compensation claim in Queensland, a worker can ask the workers’ compensation insurer to arrange for a permanent impairment assessment of their injuries. After the degree of permanent impairment is assessed, the worker will be offered a lump sum offer payout for their injuries.
Here, we look at:
- what happens when a workers’ compensation claim ends;
- the permanent impairment assessment process; and
- lump sum compensation offers to workers.
How long does a workers’ compensation claim last? When does a workers’ comp claim end?
Under section 144A of the Workers Compensation and Rehabilitation Act 2003 (Qld) a worker’s entitlement to weekly wage compensation payments will end when one of the following happens:
- the incapacity because of the work related injury stops;
- the worker has received weekly payments for the incapacity for 5 years;
- compensation reaches the maximum amount.
Under section 144B of the Act a worker’s entitlement to payment of medical expenses will end when:
- the entitlement of the worker to weekly payments of compensation stops; and
- medical treatment by a registered person is no longer required for the management of the injury because the injury is not likely to improve with further medical treatment or hospitalisation.
There are other circumstances in which entitlement of a worker to statutory workers’ compensation benefits will come to an end, for example, in the event of fraud.
How to get assessed for permanent impairment for work related injuries
WorkCover or a self-insurer may arrange for a worker to be assessed for a degree of permanent impairment. If an assessment is not arranged by the insurer, a worker can request for it to be organised and the insurer will book an appointment with an external medical officer (an independent health care professional) or will refer the worker to the Medical Assessment Tribunal.
A worker cannot choose the doctor that performs the assessment.
What happens at a permanent impairment assessment?
A permanent impairment assessment is performed either by one health care professional or, by a Medical Assessment Tribunal. The health care professional will be provided with documents from the statutory claim file and instructions by the insurer.
The health professional will ask questions and perform an examination, in order to assess the worker’s injuries in accordance with the Guidelines for the Evaluation of Permanent Impairment (GEPI). The appointment is not like an appointment with a health care provider for treatment purposes. A worker should not expect to receive advice about future treatment they may require or the long term effects of their injuries.
Issue of a Notice of Assessment and Lump Sum Offer Payout
Once a worker’s injuries have been assessed, WorkCover or the self-insurer must issue a Notice of Assessment to the worker.
A Notice of Assessment must be sent within 10 business days of the insurer receiving the permanent impairment for the worker. Any entitlement of the worker to lump sum compensation must be noted with the inclusion of a lump sum offer, with the Notice of Assessment.
How is the lump sum offer payout for permanent impairment calculated?
The lump sum compensation payable to a worker is calculated by multiplying the worker’s degree of permanent impairment by the maximum statutory compensation payable. The maximum statutory compensation payable as at the date of publication of this article is $349,734.
Workers who suffer both physical and psychological injuries
For workers who suffer both physical and psychological injuries, two (2) Notices of Assessment will issue after their injuries have been assessed.
The Act expressly prevents workers from adding the impairments together to produce an overall percentage of 20% or more.
Disagreeing with the Notice of Assessment
A worker who does not agree with the percentage impairment noted on a Notice of Assessment, can disagree with the Notice of Assessment within 20 business days.
Further assessment of permanent impairment
If a worker disagrees with the percentage impairment stated in the Notice of Assessment, the insurer may decide within 10 business days to arrange for the worker to be assessed again for permanent impairment. If the insurer decides not to arrange for the worker to be reviewed again, it must refer the worker for assessment of the worker’s degree of permanent impairment by the Medical Assessment Tribunal.
Review by Medical Assessment Tribunal
Upon a worker disagreeing with a Notice of Assessment, the insurer may refer the worker for assessment of their injuries by a Medical Assessment Tribunal. Medical Assessment Tribunals are convened by the Workers’ Compensation Regulator, which is a separate statutory authority from WorkCover and independent of all self-insurers.
The Medical Assessment Tribunal is comprised of a panel of three (3) specialist doctors who are briefed with all relevant material on the workers’ compensation file, to re-assess the worker’s permanent impairment. The impairment assessment of the Medical Assessment Tribunal cannot be appealed.
Making an Irrevocable Election with respect to Notice of Assessment
A worker who receives a Notice of Assessment for an injury which is less than 20%, must make an irrevocable election between:
- accepting the lump sum offer of compensation; or
- pursuing a common law claim for damages.
It is important for workers to seek legal advice with respect to a Notice of Assessment, before replying to the lump sum offer and Notice of Assessment.
A worker who accepts a lump sum offer will be forever prevented from pursuing a claim for damages for that injury.
A worker who is assessed with a degree of permanent impairment of 20% or more, may accept the lump sum offer and pursue a common law claim for damages. Very few workers suffer injuries with impairments which are over 20%.
Lump sum compensation versus common law claim for damages
The main differences between lump sum compensation and common law claims for damages are:
|Lump Sum Compensation||Common Law Claim for Damages|
|No-fault claim||Fault based claim|
|Compensation is calculated by multiplying the workers degree of permanent impairment by the statutory maximum||Damages are assessed under a number of “heads of damage”. Depending on the nature and extent of the injuries involved a worker can generally seek damages for past and future losses.|
|Compensation is the same irrespective of the worker’s age, years of experience in their field of work.||Damages claims are tailored to each individual claimant.|
WorkCover Payout Examples
These are some examples of cases in which we were involved, showing the lump sum offers made to our clients, compared with the damages payouts achieved:
|Details of injury||Lump Sum Compensation||Common Law Damages Payout|
|Exacerbation of degenerative cervical spondylosis||0% - $0.00||$110,000|
Lower back injury
|Details of injury||Lump Sum Compensation||Common Law Damages Payout|
|L5/S1 Disc protrusion, requiring 2 surgeries||16% - $47,630||$210,000|
Permanent Impairment Rating Payout Table Qld
The table below sets out some examples of workers’ compensation statutory payout amounts for permanent impairment ratings, for injuries assessed after 1 July 2021.
The payout amounts are a percentage of the maximum statutory compensation payable under the Workers’ Compensation and Rehabilitation Act 2003 (Qld), which is $349,734 (as at 1 July 2021). To calculate the lump sum offer for a permanent impairment rating, you simply multiply the degree of permanent impairment by the maximum statutory lump sum ($349,734).
|Permanent Impairment Rating||Lump Sum Offer for Notice of Assessment|
So, what’s next?
When a worker’s statutory claim comes to an end, it can be very unsettling. If you’re worried about the long term effects of your injury, you should to speak to a workers’ compensation lawyer, to know where you stand. We don’t bite! We promise!
Denning Insurance Law acts for workers in workers’ compensation claims, at every stage of the claim process.
Contact us for a confidential discussion about the end of your statutory claim or a potential common law workers’ compensation claim, including:
- How to respond to a Notice of Assessment
- The common law claim process
- Your potential common law damages
- Our initial views about your case
- The evidence we would gather to prove your case
- The risks associated with accepting a lump sum offer versus pursuing a common law claim
- Our fees and costs