Guidelines for the assessment of permanent impairment Version 3

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Activities of daily living include self-care, personal hygiene, communication, ambulation, travel andsocial and recreational activities.Social functioning refers to capacity to get along with others and communicate effectively.Concentration, persistence and pace is defined as the ability to sustain focussed attention, longenough to permit the timely completion of tasks commonly found in work settings.Adaptation (also called deterioration or de-compensation in work or work-like settings) refers to therepeated failure to adapt to stressful circumstances.Impairment is divided into five classes ranging from no impairment to extreme impairment.Mental and behavioural disorders resulting from an organic brain injury are more suitablyassessed as an organic problem under the Nervous System Impairment Chapter of theseGuidelines (Chapter 5).Approach to assessment of mental and behavioural disorders7.10 The impairment must be attributable to a recognised psychiatric diagnosis in accordance with theDiagnostic Statistics Manual of Mental Disorders (4th Edition) [DSM IV TR], InternationalClassification of Diseases (10th Edition) [ICD 10] or a substantial body of peer review researchliterature. The impairment evaluation report must specify the diagnostic criteria upon which thediagnosis is based.Impairment due to physical injury, for example, deficits in self-care or travel caused by brain orspinal cord injury, is assessed using different criteria by nervous system impairment assessors.The PIRS is not to be used to measure impairment due to pain or somatoform disorders.Where cognitive deficits are suspected, the medical assessor must carefully consider the history ofthe injury, medical treatment and progress through rehabilitation. The medical assessor will alsotake into account results of CT and MRI scans, electroencephalograms (EEGs) and results ofneuropsychological tests.The scale is to be used by an appropriate medical assessor. Clinical judgment will be the mostimportant tool in the application of the scale. The impairment rating must be consistent with arecognised psychiatric diagnosis, and the clinical presentation.In order to measure impairment caused by a specific event, the medical assessor must, in the caseof a worker with a pre-existing psychiatric diagnosis or condition, estimate the overall pre-existingWCT Guidelines 1 October 2011 43
impairment using precisely the method set out in this Chapter, and subtract this value from thecurrent impairment rating.Psychiatric Impairment Rating Scale7.11 Behavioural consequences of psychiatric disorder are assessed on six ‘Areas of Function’, each ofwhich evaluates an area of functional impairment:(i) Self-care and personal hygiene (Table 7.1)(ii) Social and recreational activities (Table 7.2)(iii) Travel (Table 7.3)(iv) Social functioning (relationships) (Table 7.4)(v) Concentration, persistence and pace (Table 7.5)(vi) Adaptation (Table 7.6).7.12 Impairment in each area of function is rated using class descriptors. Classes range from 1 to 5according to severity. The standard form (Figure 7.1) must be used when scoring the PIRS. Theclasses in each Area of Function are described by way of common examples. These are intended tobe illustrative rather than literal criteria. The medical assessor should obtain a history of theworker’s pre-accident lifestyle, activities and habits and then assess the extent to which these havechanged as a result of the psychiatric injury.The medical assessor should take into account variations in lifestyle due to age, gender, cultural,economic, educational and other factors.7.13 The descriptors given in the following tables are not fully comprehensive. The medical assessor mayneed to extrapolate from the descriptors given to place the worker in the correct category.Adjustments for effects of treatment or lack of treatment7.14 An adjustment for the effects of prescribed treatment may be made by the medical assessor if allof the following requirements are met:(i)There is research evidence demonstrating that the treatment prescribed is effective for theworker’s diagnosed psychiatric condition;(ii) The medical assessor is satisfied that the treatment has been appropriate, for example,medication has been taken in the appropriate dose and duration;(iii) There is clear clinical evidence that the treatment has been effective, that is, the worker’ssymptoms have improved and/or functioning has improved; andWCT Guidelines 1 October 2011 44
Page 1 and 2: GUIDELINES FOR THE ASSESSMENT OFPER
Page 3 and 4: ForewordThe Workers Rehabilitation
Page 5 and 6: Table of ContentsPage No.Foreword .
Page 7 and 8: Causation of permanent impairment1.
Page 9 and 10: 1.18 Using these Guidelines and the
Page 11 and 12: Adjustments for Effects of Prosthes
Page 13 and 14: stable and the assessment of perman
Page 15 and 16: 2.8 Although range of motion appear
Page 17 and 18: (ii) Rate the upper extremity impai
Page 19 and 20: 3.7 Use of worksheets is essential.
Page 21 and 22: Table 3.2: Lower Extremity Workshee
Page 23 and 24: Table 3.3. Impairment for ankylosis
Page 25 and 26: Table 3.4Tibial Nerve Impairment Va
Page 27 and 28: Table 4.1 Assessing spinal impairme
Page 29 and 30: Specific interpretation of the AMA
Page 31 and 32: Definitions of clinical findings co
Page 33 and 34: 4.22 When allocating the worker to
Page 35 and 36: Sexual Functioning4.30 Sexual dysfu
Page 37 and 38: 4.45 One or more end plate fracture
Page 39 and 40: 5.7 Headache or other pain potentia
Page 41 and 42: Table 5.2Criteria for rating impair
Page 43 and 44: Chapter 6Ear, Nose and Throat, and
Page 45 and 46: Scarring5% for loss of sense of tas
Page 47: 7.7 In order to measure the impairm
Page 51 and 52: Table 7.3TravelClass 1Class 2Class
Page 53 and 54: Table 7.7 Conversion TableClass1Cla
Page 55 and 56: Psychiatric Impairment Rating Scale
Page 57 and 58: 7.21 Examples1. A worker suffers a
Page 59 and 60: Chapter 8Impairment of Other Body S
Page 61 and 62: Pneumoconiosis (AMA 5 Guides, Secti
Page 63 and 64: 8.23 Hypertensive Cardiovascular Di
Page 65 and 66: The Digestive SystemIntroduction an
Page 67 and 68: Where there is a range of values in
Page 69 and 70: Appendix 1GlossaryCauda equina synd
Page 71 and 72: WorkCover Tasmania - Template for R

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