Guidelines for the assessment of permanent impairment Version 3

1.11 Disability, on the other hand, is a consequence of an impairment. The WHO definition is “anyrestriction or lack of ability to perform an activity in the manner or within the range considerednormal for a human being”. 11.12 Confusion between the two terms can arise because in some instances the clearest way to measureimpairment is by considering the effect on a person’s ‘activities of daily living’ (that is, on theconsequent disability). In several places, the AMA 4 Guides refer to restrictions in the activities ofdaily living of a person, i.e., the consequent disability is being used as an indicator of severity ofimpairment.1.13 Two examples may help to emphasise the distinction:(i)(ii)The impairment resulting from the loss of the little finger of the right hand would be equal forboth a bank manager and a concert pianist and so, give rise to the same assessment underthese Guidelines. However, the loss of the finger will result in a greater disability for theconcert pianist due to the impact on his or her occupation.An upper arm injury might make it impossible for an injured person to contract the fingers ofthe right hand. That loss of function is an impairment. However, the consequences of thatimpairment, such as an inability to hold a cup of coffee, or button up clothes, constitute adisability.1.14 A ‘handicap’ is a further possible consequence of an impairment or disability, being a disadvantagethat limits or prevents the fulfilment of a role that is or was normal for that individual. The concertpianist in the example above is likely to be handicapped by his or her impairment.1.15 It must be emphasised, in the context of these Guidelines, that it is not the role of the medicalassessor to quantify disability or handicap.1.16 Where alteration in activities of daily living forms part of the impairment evaluation, for examplewhen assessing brain injury or scarring, refer to the Table of Activities of Daily Living on page 317of AMA 4 Guides. The medical assessor should explain how the injury impacts on activities of dailyliving in the impairment evaluation report.Assessment of Impairment1.17 The medical assessor should consider the available evidence and be satisfied that there:(i)(ii)(iii)was an injury to the part being assessed caused by the work related injury;is a defined diagnosis that can be confirmed by examination; andis an impairment as defined at 1.9 (above).1 World Health Organisation. International Classification of Impairments, Disabilities and Handicaps, Geneva, 1980.WCT Guidelines 1 October 2011 3