Long-term injury or impairment (2024)

Eligibility

Under the Safety, Rehabilitation and Compensation Act 1988, you are considered to have a permanent impairment when you experience a permanent loss, loss of use, damage or malfunction of a:

• part of your body
• bodily system or function, or
• part of a bodily system or function.

To decide if you are eligible, a claims manager considers whether:

• you have an impairment
• your impairment is permanent
• you have an assessable permanent impairment in accordance with the Assessment of the Degree of Permanent Impairment Guide
• the degree of your impairment meets the thresholds for compensation
• you have been paid a previous lump sum benefit for permanent impairment.

Types of payments available

Permanent impairment benefit

You are entitled to make a claim for a permanent impairment benefit under theSafety, Rehabilitation and Compensation Act 1988 (SRC Act).

The degree of impairment is described as a percentage based on the concept of 'whole person impairment' (WPI).

For most compensable injuries, your injury needs to have a level of impairment (WPI) of more than 10 per cent. Exceptions to this include:

• hearing loss—usually 5 per centWPI
• loss of finger, toe, sense of taste or smell—no threshold.

For more information, see:

• Assessment of the Degree of Permanent Impairment Guide, which contains more detail about WPI assessment.
• Explanation of Permanent Impairment Provisions factsheet (PDF, 106.7 KB)
• Compensation for injuries resulting in permanent impairment—section 24 of the SRC Act.
• The Health and Other Services (Compensation) Act 1995 sets out requirements for authorities to notify Medicare about certain determinations made under the SRC Act. Determinations to pay combined permanent impairment and non-economic loss payments of $5000 or more are included in these circ*mstances. Scheme guidance – Application of Health and Other Services (Compensation) Act 1995 provides guidance to authorities regarding these reporting requirements.

Non-economic loss compensation

If your claim for permanent impairment compensation is accepted, you may also be entitled to compensation for any non-economic loss you experience.

A non-economic loss payment is designed to compensate you for the effect your impairment has had on your life (pain and suffering).

For more information, see:

• Compensation for non-economic loss—section 27 of the SRC Act
• The Health and Other Services (Compensation) Act 1995 sets out requirements for authorities to notify Medicare about certain determinations made under the SRC Act. Determinations to pay combined permanent impairment and non-economic loss payments of $5000 or more are included in these circ*mstances. Scheme guidance – Application of Health and Other Services (Compensation) Act 1995 provides guidance to authorities regarding these reporting requirements.

How to make a claim

To make a claim for compensation for permanent impairment and non-economic loss, submit a claim form to yourclaims manager.

Employees of an Australian Government agency or statutory authority

1. Complete the Permanent Impairment and Non-economic Loss Compensation Claim form (PDF, 141.9 KB).

   The form has three parts:

   • a permanent impairment claim form
   • a non-economic loss questionnaire
   • a checklist for employees.

   Read the Permanent Impairment and Non-economic Loss Compensation Claim form notes to assist (PDF, 139.9 KB) for guidance to complete the form.

   A separate claim form is required for each compensable injury or illness.

2. It is important that your doctor provides an objective assessment in relation to your impairment in accordance with the Assessment of the Degree of Permanent Impairment Guide, or if no methodology is provided for your injury or illness in this guide, theAmerican Medical Association Guide to the Evaluation of Permanent impairment (5th Edition) (AMA5) may be used.
3. We recommend you include supporting evidence with your application. However, you or your representative can provide more evidence at any time before we make a determination.

   The non-economic lossquestionnaire asks you and your doctor to provide a score under each category. You and your doctor must provide examples that show the impact of the work-related injury or illness on your daily living activities. You may enclose additional medical evidence that we may not already have.

4. Reasonable costs for your doctor to complete the Permanent Impairment and Non-economic Loss Compensation form will be met by Comcare. However, Comcare will only meet the cost of other submitted medical reports or assessments if the report or the assessment is used in determining your permanent impairment.
5. Submit the completed form with any supporting evidence:

• email to general.enquiries@comcare.gov.au
• mail to Comcare, GPO Box 9905, Canberra ACT 2601.

Employees of a self-insured licensee

If you work for an organisation which is a self-insured licensee, a staff member in your organisation or a third-party provider manages your claim. Speak with your human resources team for more information.

See a list of corporations and organisations with a self-insurance licence.

After we receive your claim

Assessment of the claim

Once your claim for permanent impairment and non-economic loss has been received by Comcare, your claims manager will review the medical evidence and assess your impairment in accordance with the approved Comcare guide or guides by the American Medical Association.

When there is sufficient medical evidence,your claims managermakes a determination on your permanent impairment claim.

If there is not enough evidence, a claims manager may refer you to an independent medical examiner to assess your permanent impairment.

The examiner is likely to be a specialist in a field relevant to your injury or illness and they are given relevant information about your claim, such as a case summary and medical reports. If you have other information that may help the examiner, such as radiological or other medical investigations, you can bring them to the assessment.

It is important you attend the scheduled appointment with the medical examiner. However, if you need to reschedule the examination, contact yourclaims manager as soon as possible to avoid any cancellation fees.

Contact with you

We register and acknowledge your application within two working days of receiving the claim. Your claims manager also notifies your employer. If you do not receive an acknowledgement within a week, please contactyour claims manager.

Wecontact you or your representative regularly to update you ofthe progress of your claim.

While we make every effort to make a determination within 90 days, each claim is considered on its own merits and delays can occur due to:

• the complexity of the claim
• unavailability of specialists
• rescheduling of appointments.

We call to let you know the decision on your permanent impairment claim and detail the decision in a formal letter.

You can contact yourclaims managerto discuss or clarify any aspect of the determination letter. As the determination impacts you and the employer, they are provided with a copy of the determination.

Possible outcomes of a claim

A decision may be to:

• accept liability for a degree of permanent impairment
• consult with you about an interim payment, or
• reject liability.

Permanent impairment payment

The Permanent Impairment calculator (XLS, 37.0 KB) is used to determine the amount of permanent impairment and non-economic loss payments.

The Permanent Impairment factsheet (PDF, 103.8 KB) includes more information.

Under the Health and Other Services (Compensation) Act 1995 , Comcare is required to inform Medicare of your permanent impairment application, even if you have not claimed the cost of any medical treatment that relates to your compensable condition from Medicare.

If you are entitled to a permanent impairment payment of more than $5,000 and have claimed the cost of medical treatment in relation to your compensable condition from Medicare, Comcare would be required to first reimburse Medicare any benefits that Medicare has paid to you for that treatment.

Comcare is also required to deduct the amount payable to Medicare from your entitlement.

Interim payment

An interim payment may be offered when:

• you have an accepted claim for permanent impairment, and
• your permanent impairment has reached a degree of impairment of at least 10 per cent but is likely to increase.

An interim payment is only payable where:

• your impairment is not yet stable
• your condition is not likely to improve
• an interim determination has been made
• you have accepted the offer of an interim payment.

In all circ*mstances, the claims managerwill advise you of your review rights and providereasons for the decision in writing.

A non-economic loss payment is not payable at the time that an interim payment is made.

The non-economic loss component will be assessed once your impairment is considered stable and a final assessment can be made.

Electing to sue for damages

You can elect to sue the Australian Government, an Australian Government statutory authority, a licensed corporation or another employee under section 45 of the Safety, Rehabilitation and Compensation Act 1988 (SRC Act), rather than receive a lump sum payment for permanent impairment or non-economic loss.

You cannot make an election to sue once the permanent impairment or non-economic loss payment is received.

If you are an employee of an Australian Government agency or statutory authority, complete the Section 45 Election form (PDF, 115.3 KB).

If you are employed by an organisation which is self-insured, contact your human resources team for more information on this process.

An election to sue the Australian Government, an Australian Government statutory authority, licensed corporation or another employee cannot be revoked. Once Comcare has received your signed Section 45 Election form, this will permanently waive your right to a permanent impairment payment from Comcare for that injury or disease. Given the significance of this decision, you may wish to seek legal advice.

The Permanent Impairment and Section 45 Election factsheet (PDF, 132.3 KB) contains more information about electing to sue for damages.

If you disagree with the determination

If you disagree with our determination, you can ask us to reconsider it. You need to submit an application for reconsiderationwithin 30 days of our determination or apply for an extension of time.

Your employer is also able to apply for a reconsideration if they do not agree with our determination.

For more information about this process, see Apply for a reconsideration.

Invalidity retirement

Applying for invalidity retirement is usually the final step if you have been injured.

Comcare does not administer the invalidity retirement process. An application for invalidity retirement is managed by your nominated superannuation fund.

For employees of Australian Government agencies and statutory authorities, Comcare’s role is limited to providing a recommendation to the superannuation fund administrator that either supports—or does not support—an application for invalidity retirement.

Our Invalidity Retirement factsheet (PDF, 115.3 KB) provides information on invalidity retirement, including our role in the process.