Basic terminology – a guide to understanding key terms

AMA Guides
American Medical Association Guides to Evaluation of Permanent Impairment (4th, 5th or 6th Edition).
Approved Medical Specialist for WCC (Workers Compensation Commission for Dispute Resolution
When a permanent impairment results from the addition or combination of a prior impairment with the existing impairment from the accident, then the permanent impairment is apportioned (or distributed) between the current injury and the prior impairment condition(s). Apportionment generally means that the employer is not required to pay for that portion of the total impairment that is due to a prior impairment not related to the compensable condition.
Certified Independent Medical Examiner
Clarification Report
Where the client believes the report did not fully answer the question asked or it is felt the responses were not clear, ambiguous or contradictory in nature. Clarification requested of any point/s in the medical report is at no additional cost to the client.
Client (referrer)/Case Manager
The person that makes the referral for an IME assessment and to whom the independent medical report is addressed to.
COMCARE Trained Assessor of Permanent Impairment
Compensable Injury or Illness
An injury/illness caused by an accident for which the person is entitled to receive compensation or capable of being compensated.
The gradual deterioration of organs and cells along with loss of function.
The same injury or an underlying condition that gradually declines/weakens/disintegrates in function or condition through natural progression.
A restriction or lack of ability to perform an activity in the manner of or within the range considered normal for a person.
Includes: (a) any physical or mental ailment, disorder, defect or morbid condition whether of sudden or gradual development (b) The aggravation, acceleration, exacerbation or recurrence of any pre-existing disease.
Economic Loss
Personal injury compensation that is made in respect of lost earnings or lost capacity to earn.
A further injury set off by a separate incident and causes an injury or illness to have a heightened effect, with greater suffering or incapacity, though without worsening the underlying injury or disease itself.
File Review
A medical consultant is forwarded medical reports and information and provides a report without actually examining the person. File reviews may be an option when the person is unable or unwilling to travel to an appointment or when a family member has made a claim on behalf of a deceased patient.
Fitness for Duty Assessment
Addresses the relevant issues regarding an individual’s non-compensable medical condition(s) and the effect upon their capacity to perform their inherent job (normal duties) safely and efficiently. It addresses the person’s overall return to work capability in either normal or alternative employment. A referral for this type of assessment usually comes from Commonwealth Government Departments (i.e. Dept. of Human Services; Dept. of Defence etc.).
QLD WorkCover trained assessor
Insurance and Care New South Wales is a New South Wales government agency that provides insurance and care service to statutory authorities and people with injuries under various compensation schemes.
Icare Lifetime Care
The Lifetime Care and Support Authority of New South Wales (division of iCare) provides lifetime care and support for people severely injured in motor accidents in New South Wales regardless of who was at fault.
Injury Management Consultant – WorkCover approved
A loss of physiological, anatomical or psychological structure or function.
Independent Medical Examination (IME)
Conducted by the relevant medical specialist of your choice and is a truly comprehensive assessment which will answer all your questions and address: • diagnosis • causation • liability • prognosis • treatment needs • work capacity • permanent impairment • any other relevant issue.
Integrated Assessment
Usually involves provision of multiple reports from various selected independent consultants who have discussed their medical findings with each other prior to finalising their reports i.e. there are as many reports published as there are consultants involved. This collaborative approach adds insight and value to each individual report, providing the client with comprehensive information to assist in making appropriate case decisions. A lead independent consultant is usually allocated and they complete their report ultimately taking into consideration the opinion and findings made of the other independent consultant(s) report(s). In Queensland, integrated assessments are approached in a slightly different way. This approach involves a ‘panel’ of consultants, chaired by a selected independent consultant. This Chair is ultimately responsible for producing a single report on behalf of the panel, taking into consideration the discussions and opinions of the various panel members.
Motor Accidents Authority – Trained Assessor Permanent Impairment Disputes Assessor
Medical Assessment Service
Medical Conditions
Any injury or illness that meets the standard criteria for a diagnosis in the International Classification of Diseases, Tenth Revision (or most current revision)
Non-economic loss
Non-economic loss compensation can include pain and suffering and impairment payments which may be paid under workers’ compensation, motor vehicle accident, public liability and criminal compensation schemes.
Nominated treating doctor
Permanent Impairment Assessment
An assessment of the level of permanent impairment sustained by an individual as a result of a compensable injury (i.e. usually workers compensation or motor vehicle accident claims). An assessment of a worker’s degree of permanent impairment is usually only conducted when the independent consultant considers that the person’s condition has stabilised to the extent required for an evaluation of permanent impairment. This is considered to occur when the person’s condition is unlikely to change substantially in the ensuing 12 months with or without further medical treatment (i.e. further recovery or deterioration is not anticipated). At this stage the worker is considered to have reached maximum medical improvement (MMI).There may be exceptions to the principle in some legal jurisdictions in that the condition must be stable for an evaluation to be done even though the person’s condition may still have chance of improvement through other treatment modalities not trialled, albeit the person has decided not to proceed with other treatment options at that stage.
Pre-existing medical condition
A medical condition or related complication that occurred before or is ongoing at the time of a compensable incident or accident.
Pre-injury employment
Employment of a person in a position that is the same as or equivalent to the position in which the person was employed before the injury. If during the period in which an employer has an obligation to provide employment to an injured person, the person has a demonstrated full capacity for pre-injury duties and hours, the employer has an obligation to provide the person pre-injury employment.
A further injury set off by a separate incident and causes an injury or illness to occur again to the same degree. A return of a sign, symptom or disease after remission.
Rehabilitation Assessment
An assessment of a person’s capacity to undertake a Rehabilitation and Return to Work Program. It includes an assessment of the person across clinical, psychosocial and occupational parameters. The information gathered from the person, the workplace and health providers will recommend whether a Rehabilitation and Return to Work Program is required, and if so, an appropriate rehabilitation outcome is identified that aims to maintain the person in the workplace or return them to work.
Secondary Injury
An injury that is, or results from, the aggravation, acceleration, exacerbation, deterioration or recurrence of a prior injury.
Self-insurers are employers approved by SIRA to manage their own Workers Compensation Claims.
State Insurance Regulatory Authority. SIRA regulates workers compensation insurance, CTP (green slips) insurance and home building compensation insurance in NSW and provides independent dispute resolution services.
Suitable Employment Duties
Employment for which the person is currently suited, having regard to: • the nature of the person’s incapacity and the details provided in medical information including, but not limited to, the certificate of capacity supplied by the person and • the nature of the person’s pre-injury employment and • the person’s age, education, skills and work experience and • the person’s place of residence and • any plan or document prepared as part of the rehabilitation and return to work planning process and • any workplace rehabilitation services that are being, or have been, provided to or for the person and regardless of whether: • the work or the employment is available and • the work or the employment is of a type or nature that is generally available in the employment market.
Supplementary Report
Where the client requires the medical consultant to comment or respond to additional questions and/or file material, such as video surveillance, in addition to the original assessment. In these cases, the medical consultant will dictate a supplementary report. This does not usually require a further medical examination of the person.
Victorian Workplace Assessor
WorkCover Approved
Workers Compensation Commission
WorkCover Trained Assessor of Permanent Impairment