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Long-term injury or impairment

For: Claimants Advocates

If you have a work-related injury or illness that results in a permanent impairment, you may be able to apply for a compensation payment.


Eligibility

Under the Safety, Rehabilitation and Compensation Act 1988, you are considered to have a permanent impairment when you experience a permanent loss, loss of use, damage or malfunction of a:

  • part of your body
  • bodily system or function, or
  • part of a bodily system or function.

To decide if you are eligible, a claims manager considers whether:

Types of payments available

Permanent impairment benefit

You are entitled to make a claim for a permanent impairment benefit under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).

The degree of impairment is described as a percentage based on the concept of 'whole person impairment' (WPI).

For most compensable injuries, your injury needs to have a level of impairment (WPI) of more than 10 per cent. Exceptions to this include:

  • hearing loss—usually 5 per cent WPI
  • loss of finger, toe, sense of taste or smell—no threshold.

The Assessment of the Degree of Permanent Impairment guide (PDF, 4.5 MB) contains more information about WPI assessment.

See Compensation for injuries resulting in permanent impairment—section 24 of the SRC Act.

Non-economic loss compensation

If your claim for permanent impairment compensation is accepted, you may also be entitled to compensation for any non-economic loss you experience.

A non-economic loss payment is designed to compensate you for the effect your impairment has had on your life (pain and suffering).

See Compensation for non-economic loss—section 27 of the SRC Act.

How to make a claim

To make a claim for compensation for permanent impairment and non-economic loss, submit a claim form to your claims manager.

Employees of an Australian Government agency or statutory authority

  1. Complete the Permanent Impairment and Non-economic Loss Compensation Claim form (PDF, 141.9 KB).

    The form has three parts:

    • a permanent impairment claim form
    • a non-economic loss questionnaire
    • a checklist for employees.

    Read the Permanent Impairment and Non-economic Loss Compensation Claim form notes to assist (PDF, 128.0 KB) for guidance to complete the form.

    A separate claim form is required for each compensable injury or illness.

  2. We recommend you include supporting evidence with your application. However, you or your representative can provide more evidence at any time before we make a determination.

    The non-economic loss questionnaire asks you and your doctor to provide a score under each category. You and your doctor must provide examples that show the impact of the work-related injury or illness on your daily living activities. You may enclose additional medical evidence that we may not already have.

  3. Submit the form with any supporting evidence:

Employees of a self-insured licensee

If you work for an organisation which is a self-insured licensee, a staff member in your organisation or a third-party provider manages your claim. Speak with your human resources team for more information.

See a list of corporations and organisations with a self-insurance licence.

After we receive your claim

Assessment of the claim

An assessment of permanent impairment can be undertaken by a legally qualified medical practitioner of your choice. You may want to obtain an assessment from a medical specialist in an area relevant to your specific injury or illness.

Your impairment must be assessed against the Assessment of the Degree of Permanent Impairment guide (PDF, 4.5 MB), or if no methodology is provided for your injury or illness in this guide, the American Medical Association Guide to the Evaluation of Permanent impairment (5th Edition) (AMA5) may be used.

When there is sufficient medical evidence, your claims manager makes a determination on your permanent impairment claim.

If there is not enough evidence, a claims manager may refer you to an independent medical examiner to assess your permanent impairment.

The examiner is likely to be a specialist in a field relevant to your injury or illness and they are given relevant information about your claim, such as a case summary and medical reports. If you have other information that may help the examiner, such as radiological or other medical investigations, you can bring them to the assessment.

It is important you attend the scheduled appointment with the medical examiner. However, if you need to reschedule the examination, contact your claims manager as soon as possible to avoid any cancellation fees.

Contact with you

We register and acknowledge your application within two working days of receiving the claim. Your claims manager also notifies your employer. If you do not receive an acknowledgement within a week, please contact your claims manager.

We contact you or your representative regularly to update you of the progress of your claim.

While we make every effort to make a determination within 90 days, each claim is considered on its own merits and delays can occur due to:

  • the complexity of the claim
  • unavailability of specialists
  • rescheduling of appointments.

We call to let you know the decision on your permanent impairment claim and detail the decision in a formal letter.

You can contact your claims manager to discuss or clarify any aspect of the determination letter. As the determination impacts you and the employer, they are provided with a copy of the determination.

Possible outcomes of a claim

A decision may be to:

  • accept liability for a degree of permanent impairment
  • consult with you about an interim payment, or
  • reject liability.

Permanent impairment payment

The Permanent Impairment calculator (XLS, 29.5 KB) is used to determine the amount of permanent impairment and non-economic loss payments.

The Permanent Impairment factsheet (PDF, 79.4 KB) includes more information.

Interim payment

An interim payment may be offered when:

  • you have an accepted claim for permanent impairment, and
  • your permanent impairment has reached a degree of impairment of at least 10 per cent but is likely to increase.

An interim payment is only payable where:

  • your impairment is not yet stable
  • your condition is not likely to improve
  • an interim determination has been made
  • you have accepted the offer of an interim payment.

In all circumstances, the claims manager will advise you of your review rights and provide reasons for the decision in writing.

If you disagree with the determination

If you disagree with our determination, you can ask us to reconsider it. You need to submit an application for reconsideration within 30 days of our determination or apply for an extension of time.

Your employer is also able to apply for a reconsideration if they do not agree with our determination.

For more information about this process, see Apply for a reconsideration.

Invalidity retirement

Applying for invalidity retirement is usually the final step if you have been injured.

Comcare does not administer the invalidity retirement process. An application for invalidity retirement is managed by your nominated superannuation fund.

For employees of Australian Government agencies and statutory authorities, Comcare’s role is limited to providing a recommendation to the superannuation fund administrator that either supports—or does not support—an application for invalidity retirement.

Our Invalidity Retirement factsheet (PDF, 103.2 KB) provides information on invalidity retirement, including our role in the process.

Page last reviewed: 18 December 2019
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Comcare
GPO Box 9905, Canberra, ACT 2601
1300 366 979 | www.comcare.gov.au

Date printed 27 May 2020

https://www.comcare.gov.au/claims/supports-benefits/long-term-injury