Requirements for TAC impairment assessments

When undertaking an impairment assessment, the TAC requests that the following sections, based on the requirements of the Transport Accident Act 1986 and the relevant methodology, are addressed within your report.

The TAC understands that not all of the following sections will be relevant to all impairment assessments. It is expected that responses to the sections below will only be provided if they are relevant to the injury or injuries being assessed.

Report format

If you are using the TAC’s recommended report format, it is expected that an examiner will provide their impairment assessment as an addition under the heading ‘13. Additional Questions’.

An Impairment Assessment report format can also be found in the 4^th Edition of the AMA Guides Chapter 2, pages 11 and 12. This can be utilised when undertaking an assessment, however we strongly recommend that the headings and related text of the TAC’s report template are also considered when providing a report.

1. General requirements for impairment assessments of physical injury or injuries

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:

1.1 How your clinical findings related to the AMA4 criteria required to calculate the impairment score allocated. Quote the relevant tables, figures and text.

1.2 Where relevant, please tabulate measurements of all planes of the relevant joint’s motion, as determined by Goniometer.

1.3 Provide comment on the range of movements observed at the time of examination where these are not consistent with the range of movements measured during the formal examination.

1.4 Provide comment that consideration has been given to page 2/8 of the AMA4 Guides, which states:

'the physician must utilize the entire gamut of clinical skill and judgment in assessing whether or not the results of measurements or tests are plausible and relate to the impairment being evaluated. If in spite of an observation or test result the medical evidence appears not to be of sufficient weight to verify that an impairment to a certain magnitude exists, the physician should modify the impairment estimate accordingly, describing the modification and explaining the reason for it in writing.'

1.5 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.

1.6 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.

2. Stabilisation when assessing impairment of physical injury or injuries

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:

2.1 The medical basis for any conclusion that the client’s medical condition has/has not stabilised or substantially stabilised.

2.2 If ‘not stable’ your anticipated timeframe for stability.

2.3 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.

3. 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:

3.1 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.

3.2 If prior investigations have been provided, please detail why these are inadequate to provide a complete and reliable assessment.

3.3 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.

3.4 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.

4. Apportionment of impairment for physical injury or injuries

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)

4.1 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).

4.2 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.

4.3 If there is any further information that you require when apportioning impairment, please contact the referring party to discuss.

Some clients may have been involved in more than one transport accident. When this is the case specific direction on the requirements of apportionment for each transport accident will be included in the referral documentation.

5. Impairment evaluation of the spine (if applicable)

5.1 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.

5.2 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.

5.3 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.

5.4 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).

6. Impairment evaluation of the upper extremity (if applicable)

6.1 Please tabulate any measurements of relevant joint motion, as determined by Goniometer or use the Upper Extremity Impairment Evaluation Record (p 3/16-17 AMA4).

6.2 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 or Tables 20 and 21, p 4/151, which contain full details of grading procedures required to obtain the impairment score.

6.3 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).

6.4 If using Table 17, p 3/57 of the AMA4 Guides for peripheral vascular disease; please refer to Table 13, p 6/197 as this contains full detail of how the table is applied.

7. Impairment evaluation of the lower extremity (if applicable)

7.1 Please tabulate measurements of all planes of the relevant joint’s motion, as determined by Goniometer.

7.2 Please use only the whole person values in your assessment (p 3/75 AMA4).

7.3 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.

7.4 If using Table 69 p3/89 of the AMA4 Guides for peripheral vascular disease; please refer to Table 14, p 6/198.

8. Impairment evaluation of the skin (if applicable)

8.1 When assessing the skin under Chapter 13 please provide a full description of the scarring (see text under 13.5 Scars and Skin Grafts page 13/279 AMA4).

8.2 Provide colour photographs of the scarring, if possible.

8.3 Please differentiate between any restrictions, tenderness or pain arising from the actual scarring/skin disorder and any other underlying pathology (e.g. a scar is present on the knee but tenderness or pain is actually arising from an underlying orthopaedic condition).

8.4 Comment on whether there are limitations on activities of daily living by providing specific examples. Refer to AMA4 Guides glossary, page 317 for guidance on activities of daily living. Please classify any limitations in terms of ADLS in terms of:

Arising from the physical effects of any skin disorder or scarring.
Arising from psychological effects of any skin disorder or scarring.
Arising from any potential overlap with other body part injuries.

8.5 Describe any treatment required for the skin disorder and the frequency of any such treatment (e.g. intermittently or constantly).

8.6 Comment whether scar revision would improve the function and cosmetic deformity of the scar and whether the scar 'can be changed, made less visible, or concealed.' (Page 13/279 AMA4).

8.7 We request that you provide a single rating to account for the skin as a single organ system when estimating the current impairment from all causes.

8.8 When providing your score, please give consideration to the text at the top of page 279 of the AMA Guides 4^th Ed (Chap 13), wherein it says, 'Impairment estimates or ratings for the skin generally should be expressed in whole numbers ending in 0 or 5, except for class 1 estimates, for which smaller increments may occasionally be justified.'

8.9 If there is facial scarring, please differentiate between a rating for facial impairment under Chapter 9 of AMA4 and the rating (if any) for any remaining skin impairment from Table 2 of Chapter 13.

9. Impairment evaluation for psychiatric injury (if applicable)

9.1 Impairment evaluation methodology:

For all transport accidents on or after 26 July 2006 to current, the Guide to the Evaluation of Psychiatric Impairment for Clinicians (GEPIC) methodology applies
For transport accidents 19 May 1998 to 25 July 2006 the Clinical Guidelines to the Rating of Psychiatric Impairment (CGRPI) applies

Include confirmation of the methodology applied within your assessment.

9.2 Class scores of the mental functions

Please find below a preferred psychiatric class scores summary table to assist with providing your impairment assessment. It would be helpful if you could include comments within this summary table in regard to the descriptors or equivalent symptoms that you found the client to exhibit for each of the six mental functions based on your review of the clinical history and mental state examination undertaken.

9.3 Psychiatric Impairment Assessment

Please provide your overall median class of assessment (applying the median method as described in the CGRPI or GEPIC) and include confirmation of the following:

Your estimate of overall psychiatric impairment (or collective score) from within the applicable median class.
The percentage of overall psychiatric impairment that pre-existed or is otherwise unrelated to the transport accident.
The percentage of overall psychiatric impairment that is related to the transport accident.

9.4 Impairment related to the transport accident

Section 46B of the Transport Accident Act 1986 states:

'In determining a degree of impairment of a person, regard must not be had to any psychiatric or psychological injury, impairment or symptoms arising as a consequence of, or secondary to, a physical injury.'

From the percentage of psychiatric impairment that is related to the transport accident please confirm:

The percentage that is secondary to physical injury.
The percentage that is not secondary to physical injury.
Please include your reasoning as to how you have determined your apportioned scores of secondary and non-secondary transport accident-related impairment.

9.5 Stabilisation of non-secondary impairment

Please provide your opinion on stability including:

Whether the non-secondary psychiatric symptoms have stabilised.
If the non-secondary psychiatric component is considered ‘not stable,’ your anticipated timeframe for stability.
If the client requires further treatment, please comment on the client’s willingness and capacity to undertake treatment.
Whether the treatment recommended will change your assessment of the client’s non-secondary psychiatric impairment.
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.

Preferred psychiatric class scores summary table

Selection of class scores for individual mental functions

Mental function	Class score	Justification of choice of class
Intelligence
Thinking
Perception
Judgement
Mood
Behaviour

Requirements for TAC impairment assessments

Report format

If you are using the TAC’s recommended report format, it is expected that an examiner will provide their impairment assessment as an addition under the heading ‘13. Additional Questions’.

1. General requirements for impairment assessments of physical injury or injuries

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:

1.1 How your clinical findings related to the AMA4 criteria required to calculate the impairment score allocated. Quote the relevant tables, figures and text.

1.2 Where relevant, please tabulate measurements of all planes of the relevant joint’s motion, as determined by Goniometer.

1.3 Provide comment on the range of movements observed at the time of examination where these are not consistent with the range of movements measured during the formal examination.

1.4 Provide comment that consideration has been given to page 2/8 of the AMA4 Guides, which states:

2. Stabilisation when assessing impairment of physical injury or injuries

Please provide your opinion on stability including:

2.1 The medical basis for any conclusion that the client’s medical condition has/has not stabilised or substantially stabilised.

2.2 If ‘not stable’ your anticipated timeframe for stability.

3. 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:

3.1 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.

3.2 If prior investigations have been provided, please detail why these are inadequate to provide a complete and reliable assessment.

4. Apportionment of impairment for physical injury or injuries

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.

4.1 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).

4.3 If there is any further information that you require when apportioning impairment, please contact the referring party to discuss.

5. Impairment evaluation of the spine (if applicable)

5.2 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.

5.4 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).

6. Impairment evaluation of the upper extremity (if applicable)

6.1 Please tabulate any measurements of relevant joint motion, as determined by Goniometer or use the Upper Extremity Impairment Evaluation Record (p 3/16-17 AMA4).

6.4 If using Table 17, p 3/57 of the AMA4 Guides for peripheral vascular disease; please refer to Table 13, p 6/197 as this contains full detail of how the table is applied.

7. Impairment evaluation of the lower extremity (if applicable)

7.1 Please tabulate measurements of all planes of the relevant joint’s motion, as determined by Goniometer.

7.2 Please use only the whole person values in your assessment (p 3/75 AMA4).

7.4 If using Table 69 p3/89 of the AMA4 Guides for peripheral vascular disease; please refer to Table 14, p 6/198.

8. Impairment evaluation of the skin (if applicable)

8.1 When assessing the skin under Chapter 13 please provide a full description of the scarring (see text under 13.5 Scars and Skin Grafts page 13/279 AMA4).

8.2 Provide colour photographs of the scarring, if possible.

Arising from the physical effects of any skin disorder or scarring.
Arising from psychological effects of any skin disorder or scarring.
Arising from any potential overlap with other body part injuries.

8.5 Describe any treatment required for the skin disorder and the frequency of any such treatment (e.g. intermittently or constantly).

8.6 Comment whether scar revision would improve the function and cosmetic deformity of the scar and whether the scar 'can be changed, made less visible, or concealed.' (Page 13/279 AMA4).

8.7 We request that you provide a single rating to account for the skin as a single organ system when estimating the current impairment from all causes.

9. Impairment evaluation for psychiatric injury (if applicable)

9.1 Impairment evaluation methodology:

For all transport accidents on or after 26 July 2006 to current, the Guide to the Evaluation of Psychiatric Impairment for Clinicians (GEPIC) methodology applies
For transport accidents 19 May 1998 to 25 July 2006 the Clinical Guidelines to the Rating of Psychiatric Impairment (CGRPI) applies

Include confirmation of the methodology applied within your assessment.

9.2 Class scores of the mental functions

9.3 Psychiatric Impairment Assessment

Please provide your overall median class of assessment (applying the median method as described in the CGRPI or GEPIC) and include confirmation of the following:

Your estimate of overall psychiatric impairment (or collective score) from within the applicable median class.
The percentage of overall psychiatric impairment that pre-existed or is otherwise unrelated to the transport accident.
The percentage of overall psychiatric impairment that is related to the transport accident.

9.4 Impairment related to the transport accident

Section 46B of the Transport Accident Act 1986 states:

From the percentage of psychiatric impairment that is related to the transport accident please confirm:

The percentage that is secondary to physical injury.
The percentage that is not secondary to physical injury.
Please include your reasoning as to how you have determined your apportioned scores of secondary and non-secondary transport accident-related impairment.

9.5 Stabilisation of non-secondary impairment

Please provide your opinion on stability including:

Whether the non-secondary psychiatric symptoms have stabilised.
If the non-secondary psychiatric component is considered ‘not stable,’ your anticipated timeframe for stability.
If the client requires further treatment, please comment on the client’s willingness and capacity to undertake treatment.
Whether the treatment recommended will change your assessment of the client’s non-secondary psychiatric impairment.
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.

Preferred psychiatric class scores summary table

Selection of class scores for individual mental functions

Mental function	Class score	Justification of choice of class
Intelligence
Thinking
Perception
Judgement
Mood
Behaviour