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permanent impairment claims

If your injury results in permanent impairment you may be entitled to receive permanent impairment compensation.

Please note: The information below is general in nature and your entitlements and the payments you receive may vary depending on your circumstances.

eligibility and impairment levels

To be eligible for lump sum compensation for permanent impairment, you’ll need to have sustained a minimum level of permanent impairment as a result of your injury.

For physical injuries you’ll need to establish you have more than 10 per cent permanent impairment as a result of your injury. For primary psychiatric and psychological injuries you’ll need to have a minimum of 15 per cent permanent impairment as a result of your injury.

No lump sum compensation is payable in relation to secondary psychological injuries. The amount of compensation you receive is determined by the date of your injury and the degree of permanent impairment ultimately assessed.

eligibility for exempt categories of workers

If you are a police officer, paramedic, firefighter, volunteer bush-firefighter or emergency services volunteer you have different minimum permanent impairment requirements.

For physical injuries, you only need to establish you have 1 per cent permanent impairment or more as a result of your injury. For primary psychiatric and psychological injuries you still need to establish you have a minimum of 15 per cent permanent impairment as a result of your injury.

No lump sum compensation is payable in relation to secondary psychological injuries. The amount of compensation you receive is determined by the date of your injury and the degree of permanent impairment ultimately assessed. You may also be entitled to lump sum compensation for ‘pain and suffering’ arising from your impairment.

Lump sum compensation for pain and suffering is only payable where your level of permanent impairment is:

  • in relation to physical injuries - 10% or more
  • in relation to primary psychological injuries - 15% or more.

assessment of permanent impairment

Your impairment must be assessed by a medical specialist listed on the SIRA website as a trained assessor of permanent impairment.

Permanent Impairment: In the opinion of the assessor, your injury must have reached maximum medical improvement. This occurs when the assessor considers your condition is well stabilised, is unlikely to improve further and is unlikely to change substantially in the next year with or without treatment.

making a claim

A permanent impairment claim form is required for claims made on or after 19 June 2012, refer to the permanent impairment information on the SIRA website for more information.

The form provides details of the information you must supply when making a claim. Only one claim for permanent impairment compensation can be made in respect of the injury, unless you’re an exempt worker.

Note: If you’re an exempt worker, you are entitled to make more than one lump sum compensation claim and you’re not required to meet the minimum level of greater than 10 per cent permanent impairment for physical injuries. For primary psychological injuries, you will still need to meet the 15 per cent permanent impairment threshold to be entitled to permanent impairment compensation.

Your employer is required to send your claim and any documentation provided in support of your claim to the insurer.

After you have provided the insurer with all relevant information regarding your claim for permanent impairment compensation, the insurer has two months to determine your claim. This may involve the insurer accepting your claim; making an offer of settlement; or disputing liability for your claim. The insurer may also request you attend an examination by an assessor listed on the SIRA website.

If the insurer is satisfied with the supporting documentation you have provided, they may accept your specialist's assessment and settle the claim for permanent impairment without needing to obtain additional assessments.

complying agreement

A complying agreement is a written agreement between you and the insurer regarding the lump sum payment for permanent impairment and, if eligible, for pain and suffering.

Prior to making the payment for permanent impairment, the insurer must be satisfied that you've obtained independent legal advice or have waived the right to independent legal advice.

The insurer is required to record evidence that this advice has been obtained, or that it has not been obtained, and the details of the agreement.

benefits payable for permanent impairment

The maximum lump sum payment for permanent impairment injuries incurred:

  • between 1 January 2002 and 31 December 2006 is $200,000 (for back injuries which occurred after 31 December 2006 the amount of permanent impairment compensation payable is increased by 5%).
  • between 1 January 2007 and 4 August 2015 is $220,000 (for back injuries which occurred after 31 December 2006 the amount of permanent impairment compensation payable is increased by 5%).
  • on or after 5 August 2015 is $577,050 (for back injuries which occurred after 31 December 2006 the amount of permanent impairment compensation payable is increased by 5%).

For detailed information on benefits payable for permanent impairment compensation refer in the Workers Compensation Benefits Guide on the SIRA website.

benefits payable for pain and suffering – exempt workers

If you’re an exempt worker, you may also receive an additional lump sum payment for pain and suffering if you have 10 per cent or more permanent impairment as a result of your physical injury.

For a primary psychiatric and psychological injury, there is a 15 per cent permanent impairment threshold.

The maximum amount of compensation payable for pain and suffering is $50,000.

workers compensation independent review office

You are responsible for your own legal costs, but to assist those in need, the Workers Compensation Independent Review Office (WIRO) has established the Independent Legal Assistance and Review Service (ILARS).

This service provides access to free independent legal advice to injured workers through the provision of a grant, where there is disagreement with insurers regarding their claim for lump sum compensation for permanent impairment.

The ILARS service applies to non-exempt workers only. For exempt workers, if your claim for permanent impairment compensation is successful, the Workers Compensation Commission has authority to order the insurer pay your legal costs in accordance with scheduled rates.

You can call the WIRO on 13 94 76 or contact them by email to contact@wiro.nsw.gov.au.