Changes to the way impairment is assessed

Key Points
  • The changes will commence from 1 April 2016, and will apply to all assessments of impairment conducted from that date onwards.
  • One of the key changes will be a less stringent method of assessment for CRPS.
  • This may result in an increase in WPI claims for CRPS, therefore insurers should be mindful of compiling evidence throughout the life of a claim to address such claims.

From 1 April 2016, there will be changes to the way in which whole person impairment (WPI) is assessed, as the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th edition take effect.

Some of the changes may significantly impact stakeholders in the NSW Scheme.  In this update, we highlight one particular change, which is to the assessment of Complex Regional Pain Syndrome (CRPS).

Complex Regional Pain Syndrome (CRPS)

CRPS involves complaints of continuing pain that cannot be explained by injury to a single nerve, and are disproportionate to what might be expected from the incident that caused the injury. It is therefore a condition that poses difficulties for doctors or insurers who are required to assess a WPI claim for CRPS.

Previously, the Guides required a worker to establish 8 separate criteria before a diagnosis of CRPS could be made. Those could include, but were not limited to, factors such as changes in skin colour or temperature, swelling, or joint stiffness / tenderness.

From 1 April 2016, a worker is no longer required to establish 8 separate criteria. Instead, provided some other threshold requirements are met, a diagnosis of CRPS can be made if a worker meets 4 criteria at the time of assessment. We have not repeated the criteria here, but please contact us if you would like further information.

What to expect

If a diagnosis of CRPS is made, the assessment of WPI involves both the worker’s range of motion and also the impact of any sensory deficits on a worker’s activities. This is a subjective assessment made by the doctor, based in part on information given by the worker, which may improve an injured worker’s chances of being assessed at or above the relevant thresholds of 11%, 15%, 21% or 31% WPI.

This creates the potential for CRPS assessments of WPI to be very high, especially because CRPS, by its nature, involves complaints that seem disproportionate to the initial incident causing injury.

It therefore seems reasonable to expect an increase in WPI claims for CRPS moving forward.

What to do?

Although the number of criteria required to be present at the time of assessment has been reduced from 8 down to 4, the 4th edition of the Guides also requires that “the diagnosis has been present for at least one year”, and that “the diagnosis has been verified by more than one examining physician”.

If a treating doctor has diagnosed CRPS, insurers should therefore have an opportunity to have rehabilitation providers, IME’s, or other practitioners assess the types of symptoms necessary to establish CRPS. If an objective review of the evidence shows that the diagnosis has not been present for at least one year, the WPI assessment based on a diagnosis of CRPS may be open to challenge.

Such a challenge would ensure that only appropriate diagnoses are being relied on by injured workers. It would also ensure that any permanent impairment compensation paid to a worker is based on an accurate and appropriate assessment of the worker’s condition.

Post by Doyles Myles and Stewart Cameron 

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