The ICF and Accident Compensation in Australia
John Walsh
A forum for people who need, use or develop information
Accident compensation in Australia
More than $10 billion per annum (about 1.5% of GDP) is collected in premiums and paid in benefits under:
– Workers’ Compensation (10 statutory schemes) – Motor Transport Compensation (8 statutory schemes) – Public Liability Insurance (generally private insurance) – Medical Indemnity Cover (medical defence and private insurance) – A variety of self-insurance and pooled arrangements
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Importance of classification and assessment
“Disability”, “Impairment”, “Incapacity”, “Handicap” are not well defined except in a pragmatic sense. Their classification and assessment is used in the following areas:
– Benefit entitlement (ie are any benefits payable) – Income benefit entitlement and level (“capacity” test) – “Lump sum” entitlement and level (“impairment” test) – Individual judicial interpretation (“disability” test)
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Method of classification and assessment
Two types of system – statutory and common law Their classification and assessment is used in the following areas:
– In statutory schemes medical experts use guidelines or tables to assess “impairment” (eg AMA 5TH Ed, schemespecific tables) – In statutory schemes medical experts use their own judgement for incapacity assessment – In common law judicial assessment and interpretation is used, after receiving expert medical opinion
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Problems
Problems arise in the following areas:
– Impairment focus inappropriate (especially statutory) – Arbitrary and judgemental (both) – Little scientific basis (common law) – Issues of equity (both) – Litigious and slow (common law) – Unstable at macro-level (both, but especially common law)
Results in claimant inequity, scheme instability and frequent review
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Role of ICF, and problems
ICF can’t solve all problems, but at least provides a framework for better design. Challenges:
– Framework only – “Different world” of insurance industry – Need for specific assessment instruments at an individual level
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Beginnings of a way forward..1
1. AIHW publication of Functioning and Related Health Outcomes Module (FRHOM) provides template and impetus for Schemes to move forward
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Beginnings of a way forward..2
2. Transport Schemes in Victoria (TAC) and NSW (MAA/LTCS) are developing rigorous ways of classifying major claims for eligibility & entitlement Instruments are emerging and being adapted within ICF constructs:
– – – – Care and Needs Assessment (CANS, P-CANS) Inventory for Client and Agency Planning (ICAP) More use of Functional Independence Measure (FIM, WeeFIM) Others…..
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Beginnings of a way forward..3
3. GPSC No 1 in NSW has recently published a report on the operations and outcomes of personal injury compensation in NSW.
The Committee found that assessment of eligibility for compensation should be based on disability, not impairment. However, the Committee also stated that the alternative to medical assessment of impairment is judicial assessment of disability. We know that judicial assessment will destabilise schemes ….. Another way is needed.
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