Whole Person Impairment: Greater Than 10%?

Being involved in a motor vehicle accident can be a traumatic experience, often resulting in physical and psychological injuries.


If you've been involved in a motor vehicle accident in New South Wales (NSW) and sustained significant injuries, you may have come across the term "Whole Person Impairment" or WPI. Understanding what WPI means and how it impacts your CTP claim is crucial to ensure you receive fair compensation for your injuries and losses.

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WHAT IS WHOLE PERSON IMPAIRMENT (WPI)?

Whole Person Impairment (WPI) refers to the assessment of the overall impact of an injury on an individual's body as a whole. 

Contained within the Act of Parliament that governs motor accident compensation; whole person impairment is a way of determining the extent of compensation that an injured person is entitled to receive from the CTP insurer, and also limiting who can and cannot recover damages for non-economic loss. 


Injured accident victims are not entitled to be automatically compensated for pain, suffering and all the ways in which your life has been or will be affected by the injuries your sustained in the accident. 


If the CTP insurer declines to accept that you are entitled to be compensated, you have 28 days to seek an internal review of that decision. If the CTP insurer does not vary its decision, it will be necessary for an application to be lodged with the Personal Injury Commission for the independent assessment of your whole person impairment.

ASSESSING IMPAIRMENT

You have to be found to have a whole person impairment that is greater than 10%. 

Whole person impairment assessments cannot be undertaken by your general practitioner, physiotherapist, psychologist or other treatment provider. The degree of permanent impairment must be assessed by an independent medical specialist with qualifications that enable them to assess permanent impairment.


These specialists evaluate the extent of a person's injuries and assign a percentage score that represents the level of impairment they have sustained in accordance with the AMA4 Guides.

HOW IS WHOLE PERSON IMPAIRMENT CALCULATED?

The government considers people with a greater than 10% whole person impairment to have more serious injuries and allows them to recover damages for non-economic loss. Those with 10% or under do not. 


The assessment will also take into consideration whether your condition has reached maximum medical improvement and whether any deduction needs to be made on account of previous injury to the same part of your body (a pre-existing medical condition).

The NSW Government has adopted Guidelines which have the force of law and which doctors must apply and some of the rules in the Act and the Guidelines are as follows:

GUIDELINES

  1. Whole person impairment is based on the medical impairment to a body part rather than how it affects the individual impairment.

  2. The Guidelines do not permit an impairment assessment for ‘pain’ and they do not generally take into account the impact of most injuries on your activities of daily living.

  3. You cannot combine your whole person impairment assessment from physical injuries with your whole person impairment assessment of your psychiatric injuries to get over the 10% threshold. So if you have 5% whole person impairment in relation to your physical injuries and 6% whole person impairment in relation to your psychiatric condition, you cannot add 5 + 6 to get to 11%.  To qualify for non-economic loss you have to have 11% or more for your physical impairment or 11% or more for your psychiatric impairments.

For help with understanding Whole Person Impairment and getting the compensation you deserve, reach out to the team at CTP Claim Guide to help with your CTP or lump sum claim.

NAVIGATING THE WPI ASSESSMENT PROCESS

The WPI assessment process can be complex and may require multiple examinations and consultations with medical experts. It's essential to seek legal representation from an experienced personal injury lawyer to ensure your rights are protected and your injuries are accurately assessed.

ABOUT THE PERSONAL INJURY COMMISSION

The Personal Injury Commission is a government body responsible for resolving disputes related to personal injury claims in New South Wales. The aim of the Personal Injury Commission is to provide a fair, timely, and cost-effective dispute resolution process for all parties.

Personal Injury Commission Gavel
Personal Injury Commission Medical Assessor

GETTING ASSIGNED A MEDICAL ASSESSOR

In the Personal Injury Commission, medical assessments are typically conducted by an independent medical examiner, who is a specialist in the relevant field of medicine. The independent medical examiner is chosen by the Personal Injury Commission. It is luck of the draw!


It's important to note that the medical assessment process is an objective evaluation largely based on the medical evidence presented and the examination of the injured person. Therefore, it's important that you provide all relevant medical records and information to the Personal Injury Commission to ensure an accurate assessment of your whole person impairment.

GETTING YOUR MEDICAL REPORT

During the medical assessment, the independent medical examiner will assess your injuries, take a medical history from you, conduct a physical examination if the assessment relates to physical injuries you sustained in the accident and review any relevant medical records including imaging. The independent medical examiner will also assess your ability to perform various activities such as walking, lifting, and sitting which may require to move your body parts in a certain way to allow the doctor to take measurements.


Based on their assessment, the independent medical examiner will provide a medical report that includes their assessment of whole person impairment.

Guy holding patient's arm for Medical Report
Car with a smashed Frontend

GETTING LEGAL SUPPORT

Understanding the assessment process and how your assessment of whole person impairment impacts your claim is essential to ensure you understand your entitlements.


If you've been involved in a motor vehicle accident and are considering a CTP claim, don't hesitate to consult with a reputable personal injury lawyer. They can provide expert guidance, handle the complexities of the claims process, and ensure your rights are protected throughout your journey to fair and just compensation for your injuries and losses.

FREQUENTLY ASKED QUESTIONS

  • Can I dispute the whole person impairment assessment undertaken by the Personal Injury Commission?

    You can dispute the decision on limited grounds. 


    Either party may apply to the President to refer a medical assessment by a single medical assessor to a review panel for review. Such an application may only be made on the grounds that the decision was incorrect in a material respect.


    An application for review of a medical assessment must be made within 28 days after the parties to the medical dispute were issued with the original certificate for the medical assessment for which the review is sought.

  • What does maximum medical improvement mean?

    Before undergoing an assessment of your whole person impairment, it is essential that your injury has reached maximum medical improvement. 


    Maximum medical improvement is when your condition has stabilised and is not expected to undergo significant changes in the coming year, regardless of whether you receive further treatment or not. If you are uncertain about whether you have reached this stage, we recommend that you consult with your treating doctor or specialist for clarification.

  • Can I claim lump sum compensation if my whole person impairment is below the 11% threshold?

    Yes, even if your whole person impairment is assessed at less than 11% you may still be eligible to make a lump sum claim for compensation for your loss of earnings.

  • Who can assess my whole person impairment?

    A health practitioner must be authorised to give evidence in court and other dispute resolution proceedings.


    Health practitioners may be authorised in one of three ways:

    1. Being the treating practitioner of the injured person
    2. Agreement between the parties to a joint assessment, where the injured person is legally represented
    3. Appointment by the Authority, either to its list of health practitioners authorised to give evidence or for the purposes and duration of a specific claim.

    A link to the health practitioners authorised to give evidence in your CTP claim is below:


    https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/motor-accident-disputes/List-of-authorised-health-practitioners-by-specialty.pdf

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