SECTION ONE - 585 SECTION TEN: PARTICIPATION Chapter 21 Lump Sum Compensation Payments Chapter 22 Alternatives to Lump Sum Awards Chapter 23 Assessment of Injuries and Disablement Chapter 21 examines the many difficulties attendant upon attempting to restore the victim of a road accident to the same position in which he or she would have been in, financially, as if he or she had not or the breadwinner had not been injured. The Once-and-for-all lump sum payment of compensation has the advantages of finality and allows the claimant independence in disposal of the award. These advantages are, however, greatly outweighed by the disadvantages attendant upon the difficulties in accurately estimating future economic loss. Incorrect prognoses frequently result in under or over compensation while the impact of HIV/AIDS upon the South African population compounds the difficulties of quantifying compensation for the future. Interviews with and information received from disabled persons strongly suggest that these once-and-for-all awards may result in insecurity and continuing impoverishment because of insufficiency of compensation funds or mismanagement thereof. Alternatives to such lump sum awards include the Undertakings provisions of Section 17 of the RAF Act, annuity or structured settlements used in North America, the United Kingdom and Europe and reviewable periodic payments found in Australia and Canada. Chapter 22 examines the purpose, issue and use of Section 17 Undertakings and offers a critique of the current administration thereof by the RAF. Undertakings are a form of periodic payment, but the current experience of all concerned suggests that an entirely new infrastructure of professional and competent management and administrators including experienced healthcare personnel is required before the purposes of either the current or the proposed scheme can be implemented. Annuity or structured settlements retain the core challenges of calculation of once-and-for-all lump sum compensation although the annuity stream ensures continuing availability of funds for the victim/claimant. The advantage of reviewable periodic payments is that they provide for actual loss, avoid uncertainty, enable benefits to be accessed almost immediately and eliminate double compensation. Because they are reviewable they can be adjusted to the changing needs of the road accident victim according to improvement or deterioration in health or disability, increase or decrease in costs of services and facilities, and so on. In respect of economic loss, these benefits take the appropriate form of monetary payments for loss of income, loss of earning capacity and for support while healthcare, rehabilitation and life care needs are met by the provision of services, equipment and facilities by suppliers who are paid directly by the administrators of the scheme. 586 ROAD ACCIDENT FUND COMMISSION REPORT 2002 Volume 1 No road accident benefits should be subject to taxation and necessary legislation should be enacted. Central to the provision of road accident benefits must be the recognition that the claimant has a clinically and objectively identifiable injury requiring medical and perhaps rehabilitative or life care intervention, disability preventing continuing or future employment justifying income support benefits, impairment (or handicap or loss of functioning) which may motivate life enhancement benefits. There is no dispute that claimants should be required to submit to an assessment in order to assess the impact of injury, loss of functioning or impairment in relation to such benefits. The medico-legal reports used in the current scheme of road accident compensation do not always "talk the same language" and apply the same criteria to the assessment of each individual patient. Chapter 23 identifies some of the advantages of utilising assessment guidelines as including objectivity, consistency, greater certainty and efficiency. It is emphasised that there can be no replacement of physical assessment by the patient conducted by professionally trained medical personnel. The chapter discusses some of the guidelines which are in use in road accident compensation or benefit schemes including the Abbreviated Injury Scale which classifies type and severity of injury, the American Medical Association Guides (AMA Guides) which uses a Whole Person Impairment concept representing an estimate of the degree to which an individual’s capacity to carry out daily activities has been diminished and the International Classification of Functioning, Disability and Health (ICF) developed by the World Health Organization which describes the experience of disability or functioning of a person with a health condition.