Impairment assessment

An Impairment Assessment report format can also be found in the 4^th Edition of the AMA Guides Chapter 2, pages 11 and 12.

Please conduct a complete and thorough Impairment Assessment in accordance with the:

American Medical Association Guides 4^th Edition for accidents from 19 May 1998 to present
American Medical Association Guides 2^nd Edition for accidents from 1 January 1987 to 18 May 1998

In your assessment, confirm the methodology applied within your assessment report and include the following:

How your clinical findings related to the AMA4 criteria required to calculate the impairment score allocated. Quote the relevant tables, figures and text.
Where relevant, please tabulate measurements of all planes of the relevant joint’s motion, as determined by Goniometer.
Please provide a combined whole person impairment for all physical injuries assessed (under each applicable chapter of the AMA4 Guides) with reference to the specific criteria and detailing any charts or figures from AMA4 used in making the assessment.
Alternatively, if you do not wish to provide a combined whole person impairment, please ensure you have provided a list of all clinical findings and the resulting impairments for each part, unit, system and structure and we will combine these to determine the resulting level of permanent impairment.

Stabilisation

The AMA4 Guides definition of stability prescribes that a condition or injury can be considered stable if it is unlikely to change substantially and by more than 3% whole person impairment in the next year with or without medical treatment. See page 315 of the Glossary.

Please provide your opinion on stability including:

The medical basis for any conclusion that the client’s medical condition has/has not stabilised or substantially stabilised
If ‘not stable’ your anticipated timeframe for stability
If ‘not stable’ please provide a bottom line impairment assessment to the best of your ability. Please note that there are certain situations where the TAC can finalise impairment regardless of stability, which is why we ask you to apply your best effort at providing a bottom line assessment.

Investigations

If additional investigations or tests are required for you to complete your examination and assessment, the following must be addressed before the referring party can consider the request:

Please detail the reason(s) as to why you are unable to provide a reliable assessment based on the enclosed information and your examination findings.
If prior investigations have been provided, please detail why these are inadequate to provide a complete and reliable assessment.
If investigations are required for you to be able to provide an impairment score, please detail the table(s) and or text from the AMA 4^th Edition Guides relevant to the radiology you are requesting.
If you have provided a provisional impairment score, but require further investigations, please detail your reasoning as to why this score is provisional and how this score may alter with the further radiology/investigations requested.

Apportionment

The TAC’s legislation instructs that the degree of impairment(s) from unrelated injuries or causes must not be included when determining the degree of impairment.

'If apportionment is needed, the analysis must consider the nature of the impairment and its possible relationship to each alleged factor, and it must provide an explanation of the medical basis for all conclusions and opinions… The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' (AMA4 Guides, page 2/10)

When apportioning the spine, the DRE category allocated based on the previous findings would be subtracted from the DRE category based on the current findings (Page 101, AMA4).
When apportionment is required, a descriptive comparison of specific clinical findings for each impairment / unrelated impairment, with reference to specific criteria from AMA4 for that particular part of the body, should be included.
If there is any further information that you require when apportioning impairment, please contact the referring party to discuss.

Multi accidents (if applicable)

You will note that the client was involved in multiple transport accidents. We therefore ask that you please apportion any impairment accordingly.

We note the client has a previous TAC claim, please consider apportionment and provide impairment ratings for each claim, if applicable.

We note the client has two TAC claims, please consider apportionment and provide impairment ratings for each claim if applicable.

We note the client has two previous TAC claims in which impairment was assessed, please consider apportionment when assessing the current TAC claim.

We note the client had a previous TAC claim in which impairment was assessed. Please consider apportionment when assessing the current TAC claim.

Impairment evaluation of the spine (if applicable)

For all transport accidents on or after the 14^th December 2016, the Spinal Impairment Guides Modification Document (SIGMD) methodology also applies. Subject to the modifications effected by the SIGMD, pages 94 to 111 of the AMA4 Guides set out the approach, procedures and directions relevant to the assessment of spinal impairment. Please include confirmation of the methodology applied within your assessment.
When assessing the spine using the Injury Model (DRE) the following information is required:
1. The diagnostic components / differentiators used to place the patient within the category selected – please refer to the long descriptors under the DRE category chosen (also listed in Table 71, p 109) and SIGMD Table A if applicable.
2. A detailed explanation of any objective clinical findings used to select the category.
When assessing the client’s spine injury, the legislation advises that an assessment of impairment must be based on the person’s current impairment as at the date of the assessment, including any changes in the signs and symptoms following any medical or surgical treatment undergone by the person in respect of the injury.
When apportioning the spine, the DRE category allocated based on the previous findings would be subtracted from the DRE category based on the current findings (p 101, AMA4).

Impairment evaluation of the upper extremity (if applicable)

If using Tables 13, 14 and/or 15, p 3/51 to 3/54 of the AMA4 Guides for nerve deficits, please refer to Tables 11 and 12, p 3/58 and 3/49, which contain full details of grading procedures required to obtain the impairment score.
If using Strength Evaluation a detailed explanation of why you believe this is a 'rare case' and why the patient’s loss of strength represents an impairing factor that has not been considered adequately is required (p 3/64 AMA4).

Impairment evaluation of the lower extremity (if applicable)

Please use only the whole person values in your assessment (p 3/75 AMA4).
If using Table 68, p 3/89 of the AMA4 Guides for nerve deficits, please refer to Tables 20 and 21, p 4/151 which contain full details of grading procedures required to obtain the impairment score.

Essentials for TAC providers

How to invoice the TAC

Getting paid

Health and service providers registration

Disability service providers

What we can pay for

How to seek TAC approval

Purpose, Principles, Expectations

Principle 1: Measure and demonstrate the effectiveness of treatment

Principle 2: Adopt a biopsychosocial approach

Principle 3: Empower the injured person to manage their injury

Principle 4: Implement goals focused on optimising function, participation and return to work

Principle 5: Base treatment on the best available research evidence

Glossary of terms

Collaboration and support for the Clinical Framework

Outcome measures

Enhanced Recovery Program

Vocational Rehabilitation Pilot

Injury Support Program

Active Recovery Clinics

Providing quality and safe services


Impairment assessment An Impairment Assessment report format can also be found in the 4^th Edition of the AMA Guides Chapter 2, pages 11 and 12. Please conduct a complete and thorough Impairment Assessment in accordance with the: American Medical Association Guides 4^th Edition for accidents from 19 May 1998 to present American Medical Association Guides 2^nd Edition for accidents from 1 January 1987 to 18 May 1998 In your assessment, confirm the methodology applied within your assessment report and include the following: How your clinical findings related to the AMA4 criteria required to calculate the impairment score allocated. Quote the relevant tables, figures and text. Where relevant, please tabulate measurements of all planes of the relevant joint’s motion, as determined by Goniometer. Please provide a combined whole person impairment for all physical injuries assessed (under each applicable chapter of the AMA4 Guides) with reference to the specific criteria and detailing any charts or figures from AMA4 used in making the assessment. Alternatively, if you do not wish to provide a combined whole person impairment, please ensure you have provided a list of all clinical findings and the resulting impairments for each part, unit, system and structure and we will combine these to determine the resulting level of permanent impairment. Stabilisation The AMA4 Guides definition of stability prescribes that a condition or injury can be considered stable if it is unlikely to change substantially and by more than 3% whole person impairment in the next year with or without medical treatment. See page 315 of the Glossary. Please provide your opinion on stability including: The medical basis for any conclusion that the client’s medical condition has/has not stabilised or substantially stabilised If ‘not stable’ your anticipated timeframe for stability If ‘not stable’ please provide a bottom line impairment assessment to the best of your ability. Please note that there are certain situations where the TAC can finalise impairment regardless of stability, which is why we ask you to apply your best effort at providing a bottom line assessment. Investigations If additional investigations or tests are required for you to complete your examination and assessment, the following must be addressed before the referring party can consider the request: Please detail the reason(s) as to why you are unable to provide a reliable assessment based on the enclosed information and your examination findings. If prior investigations have been provided, please detail why these are inadequate to provide a complete and reliable assessment. If investigations are required for you to be able to provide an impairment score, please detail the table(s) and or text from the AMA 4^th Edition Guides relevant to the radiology you are requesting. If you have provided a provisional impairment score, but require further investigations, please detail your reasoning as to why this score is provisional and how this score may alter with the further radiology/investigations requested. Apportionment The TAC’s legislation instructs that the degree of impairment(s) from unrelated injuries or causes must not be included when determining the degree of impairment. 'If apportionment is needed, the analysis must consider the nature of the impairment and its possible relationship to each alleged factor, and it must provide an explanation of the medical basis for all conclusions and opinions… The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' (AMA4 Guides, page 2/10) When apportioning the spine, the DRE category allocated based on the previous findings would be subtracted from the DRE category based on the current findings (Page 101, AMA4). When apportionment is required, a descriptive comparison of specific clinical findings for each impairment / unrelated impairment, with reference to specific criteria from AMA4 for that particular part of the body, should be included. If there is any further information that you require when apportioning impairment, please contact the referring party to discuss. Multi accidents (if applicable) You will note that the client was involved in multiple transport accidents. We therefore ask that you please apportion any impairment accordingly. or We note the client has a previous TAC claim, please consider apportionment and provide impairment ratings for each claim, if applicable. or We note the client has two TAC claims, please consider apportionment and provide impairment ratings for each claim if applicable. or We note the client has two previous TAC claims in which impairment was assessed, please consider apportionment when assessing the current TAC claim. or We note the client had a previous TAC claim in which impairment was assessed. Please consider apportionment when assessing the current TAC claim. Impairment evaluation of the spine (if applicable) For all transport accidents on or after the 14^th December 2016, the Spinal Impairment Guides Modification Document (SIGMD) methodology also applies. Subject to the modifications effected by the SIGMD, pages 94 to 111 of the AMA4 Guides set out the approach, procedures and directions relevant to the assessment of spinal impairment. Please include confirmation of the methodology applied within your assessment. When assessing the spine using the Injury Model (DRE) the following information is required: The diagnostic components / differentiators used to place the patient within the category selected – please refer to the long descriptors under the DRE category chosen (also listed in Table 71, p 109) and SIGMD Table A if applicable. A detailed explanation of any objective clinical findings used to select the category. When assessing the client’s spine injury, the legislation advises that an assessment of impairment must be based on the person’s current impairment as at the date of the assessment, including any changes in the signs and symptoms following any medical or surgical treatment undergone by the person in respect of the injury. When apportioning the spine, the DRE category allocated based on the previous findings would be subtracted from the DRE category based on the current findings (p 101, AMA4). Impairment evaluation of the upper extremity (if applicable) If using Tables 13, 14 and/or 15, p 3/51 to 3/54 of the AMA4 Guides for nerve deficits, please refer to Tables 11 and 12, p 3/58 and 3/49, which contain full details of grading procedures required to obtain the impairment score. If using Strength Evaluation a detailed explanation of why you believe this is a 'rare case' and why the patient’s loss of strength represents an impairing factor that has not been considered adequately is required (p 3/64 AMA4). Impairment evaluation of the lower extremity (if applicable) Please use only the whole person values in your assessment (p 3/75 AMA4). If using Table 68, p 3/89 of the AMA4 Guides for nerve deficits, please refer to Tables 20 and 21, p 4/151 which contain full details of grading procedures required to obtain the impairment score.