Guidelines for the assessment of permanent impairment Version 3

1.21 The assessment should only reflect the impairment as it is at the time of the assessment. Itshould not include any allowance for a predicted deterioration, such as osteoarthritis in a joint manyyears after an intra-articular fracture, as it is impossible to be precise about any such lateralteration. However, it may be appropriate to comment on this possibility in the impairmentassessment report.Non-assessable injuries1.22 Certain injuries may not result in an assessable impairment covered by these Guidelines and AMA 4Guides. For example, uncomplicated healed sternal and rib fractures do not result in anyassessable impairment.Impairments not covered by WCT Guidelines and AMA 4 Guides1.23 A condition may present which is not covered in the WCT Guidelines or the AMA 4 Guides. Ifobjective clinical findings of such a condition are present, indicating the presence of animpairment, then assessment by analogy to a similar condition is appropriate. Include therationale for the methodology chosen in the impairment evaluation report.Adjustments for Effects of Treatment or Lack of Treatment1.24 The results of past treatment (e.g. operations) must be considered, since the worker is beingevaluated as they present at the time of assessment.1.25 Where the effective long-term treatment of the effects of an injury result in apparent, substantialor total elimination of a physical permanent impairment, but the worker is likely to revert to thefully impaired state if treatment is withdrawn, the medical assessor may increase thepercentage of whole person impairment by 1, 2 or 3% whole person impairment. Thispercentage should be combined with any other impairment percentage using the CombinedValues Chart (pp 322-324, AMA 4 Guides). An example might be long-term drug treatment forepilepsy. This paragraph does not apply to the use of analgesics or anti-inflammatory drugsfor pain relief.1.26 If a worker has declined a particular treatment or therapy that the medical assessor believes wouldbe beneficial, this should neither increase nor decrease the impairment assessment. However, acomment on the matter should be included in the written impairment assessment report.1.27 Equally, if the medical assessor believes that substance abuse is a factor influencing the clinical stateof the worker that should be noted in the impairment assessment report.1.28 For adjustments for the effect of treatment on a permanent psychiatric impairment, refer to 7.14in Chapter 7 Mental and Behavioural Disorders Impairments of these Guidelines.WCT Guidelines 1 October 2011 5