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How Do Doctors Assess The Level Of WPI For Spinal Injury Claims?

Updated on August 10, 2023 | Published on June 13, 2017

By Matthew Garling

Make a claim for lump sum compensation for permanent impairment.

If you have sustained an injury to your spine such as a neck or low back injury, then you are entitled to make a claim for lump sum compensation for permanent impairment.

To determine the amount of lump sum compensation payable for your spinal injury, you are referred to a medical specialist to assess the level of whole person impairment.

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The Guidelines indicate that the doctor when assessing the level of permanent impairment of the spine, must use a diagnosis related estimate or DRE method.

The level of whole person impairment is determined in accordance with the following:

  • The American Medical Association Guidelines for the Evaluation of Permanent Impairment (Edition 5) “AMA 5”.
  • The NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment (April 2016) “The Guidelines”.

The Guidelines are produced by the State Insurance Regulatory Authority and they amend the AMA 5 Guides.

The Guidelines take precedence over AMA 5.

The spinal injury assessment should include a comprehensive, accurate history, a review of all pertinent medical records available at the assessment, a comprehensive description of the individual’s current symptoms and their relationship to activities of daily living (ADL), careful and thorough physical examinations and all findings of relevant laboratory, imaging, diagnosis and axillary tests available at the assessment. Imaging findings that are used to support the impairment rating should be consistent with symptoms and findings on examination.

Spinal Injury Assessment Procedure

To assess spinal injuries, doctors must consider:

  1. Comprehensive, accurate medical history
  2. Review of pertinent medical records
  3. Detailed description of current symptoms and their impact on daily activities
  4. Thorough physical examination
  5. Findings of relevant laboratory, imaging, diagnostic, and auxiliary tests

The Diagnosis-Related Estimate (DRE) method is used for assessing permanent impairment in the cervical, thoracic, and lumbar spine regions.

  • Radiculopathy
  • Alteration of motion segment integrity
  • Cauda equina syndrome

Spinal Injury Symptoms

The medical assessment must determine which category of DRE impairment an injury meets on the basis of the findings on examination. The doctors look for the following objective findings:

  • Muscle spasm
  • Muscle guarding
  • Asymmetry of spinal motion
  • Non-verifiable radicular pain
  • Absent reflexes
  • Atrophy
  • Weakness and loss of sensation
  • Radiculopathy
  • Alteration of motion segment integrity
  • Cauda equina syndrome

DRE Method

The DRE method is used for assessing permanent impairment in respect of the cervical spine region, thoracic spine region and lumbar spine region.

If for example there is an injury to the lumbar spine, then the doctor must choose the category of DRE impairment. The categories range from Category I to Category V.

In respect of lumbar and thoracic spine injury, the following whole person impairment’s apply in respect of each category:

  • DRE Category I – 0% whole person impairment
  • DRE Category II – 5-8% whole person impairment
  • DRE Category III – 15-18% whole person impairment
  • DRE Category IV – 20-23% whole person impairment
  • DRE Category V – 25-28% whole person impairment

In relation to the cervical spine, the impairment percentages are as follows:

  • DRE Category I – 0% whole person impairment
  • DRE Category II – 5-8% whole person impairment
  • DRE Category III – 15-18% whole person impairment
  • DRE Category IV – 25-28% whole person impairment
  • DRE Category V – 35-38% whole person impairment

DRE Category I

You will be assessed as having a 0% whole person impairment if there are no significant clinical findings, no observed muscle guarding or spasm, no neurological impairment, no structural integrity and no other indication of spinal injury or fracture.

DRE Category II

You will be assessed in this category if on examination the doctor finds some muscle guarding or spasm, some asymmetric loss of range of motion, non-verifiable radicular complaints, or some non-verifiable radicular complaints or a fracture of the spine with 25% or less compression of the vertebral body.

DRE Category III

You are assessed as Category III if you have signs of radiculopathy, loss of relevant reflexes, loss of muscle strength or atrophy of the muscle, history of herniated discs with objective findings of radiculopathy or a fracture of between 20-50% of one of the vertebral bodies.

DRE Category IV

You are assessed in Category IV if you have loss of motion segment integrity, this usually occurs following a fusion or arthrodesis surgery. You may also be Category IV if you have a 50% compression of one vertebral body or greater.

DRE Category V

You will be assessed as DRE Category V if you meet both the criteria contained in Category III and Category IV or additionally a 50% compression of greater of one vertebral body with neurological compromise.

Additional WPI for Surgical Effects

Additional WPI is assigned for the effects of surgery:

  • Spinal surgery without residual symptoms: 1-3% additional WPI
  • Spinal surgery with residual symptoms: 2-3% additional WPI
  • Second operations: 1-2% additional WPI each

Disc replacement surgery is equivalent to spinal fusion. The implementation of a spinal cord stimulator or similar device does not attract any additional WPI.

Importance of Maximizing WPI for Spinal Injuries

Obtaining the highest possible WPI for a spinal injury is essential, as the timing and method of making a claim for WPI are critical. Individuals only have one chance to obtain lump sum compensation for WPI, and any mistakes can have serious consequences on their ongoing entitlements to workers’ compensation.

To ensure the highest possible WPI for a spinal injury, consult with an accredited specialist in personal injury and an expert in workers’ compensation.

Conclusion

Spinal injuries are the most common types of injury. To obtain an assessment of greater than 10% for a spine injury only will require signs of radiculopathy such as sensory loss, loss of reflexes and loss of muscle strength or atrophy. These are objective findings found by the medical practitioner on examination.

Alternatively, a worker must have undergone a fusion or disc replacement surgery to qualify for the higher Category IV impairment to obtain a greater than 20% whole person impairment.

The level of whole person impairment is crucial in determining a worker’s ongoing entitlement to workers compensation.

Refer to our previous article on whole person impairment claims to find out what benefits you are entitled to receive depending on the level of whole person impairment assessed.

It is important therefore to obtain the highest whole person impairment possible for your spinal injury.

When and how to make a claim for whole person impairment is critical as you only have one chance to obtain lump sum compensation for whole person impairment and if you get it wrong, it can have serious consequences on your ongoing entitlements to workers compensation.

You need to speak to an accredited specialist in personal injury and an expert in Workers Compensation to obtain the highest possible whole person impairment for your spinal injury.

Please call Matthew Garling of Garling & Co Lawyers on (02) 8329 9500 or email  info@garlingandco.com.au for further information and complete our FREE case assessment form HERE.

Garling & Co Lawyers

Matthew Garling

Matthew Garling is an Accredited Specialist in Personal Injury Law approved by New South Wales Law Society. He is admitted to practice in the Supreme Court of NSW and the High Court of Australia. Matthew is also a member of...
Kimberly B.
23:14 14 Feb 24
Mathew is very knowledgable and has been of great assistance to me. All the staff are friendly and helpful. I'm so happy I found this firm.Thank you Mathew and team for your great work in my case.... I am 100% happy with what you achieved for me.read more
Julie M.
10:16 16 Jan 24
My last stage of Workers compensation claim was managed by Emma Perkins, Natasha Stojanovic, Rebecca Dunshea and Kelli Robinson at Garling and Co. Lawyers who went the extra mile with their service... from the beginning to the end of 3 years of my case. I have become very anxious with almost everything after a workplace injury and a lot of times I probably ask more questions than I need to, but Emma Perkins always finds clear answers to my questions in a short time and explains to me patiently even using her mealtime or between her meeting and make me feel that I have been very well take care and supported. I am so grateful and extremely satisfied. The excellent service, attitude, and culture of Metthew Garling and his team are second to none with a very high success rate. If you going to battle with your workplace injury for a short or long period, you are better off with Garling and Co. lawyers who are able back you up every step of the way. I strongly recommend it to anybody who needs their service like me. Julieread more
patrick P.
01:46 19 Dec 23
I like to say that I had a very wonderful experience,And the support, and also understanding with all my requests,I could not ask for a better team!Thank you Emma and also her assistant Rebecca... thank youread more
Kazi H.
13:38 13 Dec 23
Work cover fund is GOVT’S money but insurer think that it is from their 14th generation. So only they can have it. Not only that, people from the work, IME doctor from insurer, back to work... coordinator from work, Rehab provider from any side push the worker as hard as possible that the worker (doesn’t matter how the workers mental or psychical condition) either go back to his pre injury duty or leave the job.More over on that very bumpy any difficult journey some of them only treat the worker as a MONEY MAKING MECHINE .in some point worker feels like, no rooms to breath. On that moment need someone to support legally, someone to care, someone to relive.On my case I believe that, somehow, I manage to make my God happy. That’s why God sends me to Matthew Gerling and his team Allison, Rebecca and Nathan, and all of GARLING & co Lawyers.I am not good enough in English, can’t express my gratitude.Matthew, Allison, Rebecca and Nathan, please accept my appreciation and pass it to others.read more
Carol L.
01:32 29 Nov 23
Professional, understanding and friendly
Sean G.
23:21 14 Nov 23
Matthew Garling and everyone I spoke to at Garling and Co were kind, caring and compassionate. They were sensitive to my psychological condition and were patient in explaining everything to me, so... that I clearly understood the legal process. I am exceptionally grateful for the settlement outcome that Garling and Co obtained for me. Many thanks.read more
waqas A.
08:33 13 Nov 23
Great Experience with Garling & Co. Matthew explained everything in detail during the first appointment. Allison, Nathan, Rebecca and the staff have been extremely helpful. Thank You to the team and... lawyers at Garling & Co. for making the long process easy for me and getting an excellent outcome for my compensation claim.I would highly recommend Garling & Co. Lawyersread more
Saskia L.
21:42 08 Nov 23
The world of workers compensation is long, hard and confusing, but Emma and Rebecca at Garling & Co always treated my case with kindness, respect and understanding. No question was ever silly and... they always had time to make sure I knew what would happen next and how we could best prepare. I am so thankful for their expertise and could not have chosen anyone better to represent me.read more
Antonio P.
08:46 06 Nov 23
Thank you Matthew and his team for taking care of my case couldn’t ask for a better results and couldn’t have better team to do that thank you
Julie M.
00:40 06 Nov 23
Garlic & Co Lawyers have been wonderful, supporting me through some difficult times. With their assistance, positive outcomes were achieved. Many thanks to the Team.Julie
READ ALL TESTIMONIALS

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Kimberly B.
23:14 14 Feb 24
Mathew is very knowledgable and has been of great assistance to me. All the staff are friendly and helpful. I'm so happy I found this firm.Thank you Mathew and team for your great work in my case.... I am 100% happy with what you achieved for me.read more
Julie M.
10:16 16 Jan 24
My last stage of Workers compensation claim was managed by Emma Perkins, Natasha Stojanovic, Rebecca Dunshea and Kelli Robinson at Garling and Co. Lawyers who went the extra mile with their service... from the beginning to the end of 3 years of my case. I have become very anxious with almost everything after a workplace injury and a lot of times I probably ask more questions than I need to, but Emma Perkins always finds clear answers to my questions in a short time and explains to me patiently even using her mealtime or between her meeting and make me feel that I have been very well take care and supported. I am so grateful and extremely satisfied. The excellent service, attitude, and culture of Metthew Garling and his team are second to none with a very high success rate. If you going to battle with your workplace injury for a short or long period, you are better off with Garling and Co. lawyers who are able back you up every step of the way. I strongly recommend it to anybody who needs their service like me. Julieread more
patrick P.
01:46 19 Dec 23
I like to say that I had a very wonderful experience,And the support, and also understanding with all my requests,I could not ask for a better team!Thank you Emma and also her assistant Rebecca... thank youread more
Kazi H.
13:38 13 Dec 23
Work cover fund is GOVT’S money but insurer think that it is from their 14th generation. So only they can have it. Not only that, people from the work, IME doctor from insurer, back to work... coordinator from work, Rehab provider from any side push the worker as hard as possible that the worker (doesn’t matter how the workers mental or psychical condition) either go back to his pre injury duty or leave the job.More over on that very bumpy any difficult journey some of them only treat the worker as a MONEY MAKING MECHINE .in some point worker feels like, no rooms to breath. On that moment need someone to support legally, someone to care, someone to relive.On my case I believe that, somehow, I manage to make my God happy. That’s why God sends me to Matthew Gerling and his team Allison, Rebecca and Nathan, and all of GARLING & co Lawyers.I am not good enough in English, can’t express my gratitude.Matthew, Allison, Rebecca and Nathan, please accept my appreciation and pass it to others.read more
Carol L.
01:32 29 Nov 23
Professional, understanding and friendly
Sean G.
23:21 14 Nov 23
Matthew Garling and everyone I spoke to at Garling and Co were kind, caring and compassionate. They were sensitive to my psychological condition and were patient in explaining everything to me, so... that I clearly understood the legal process. I am exceptionally grateful for the settlement outcome that Garling and Co obtained for me. Many thanks.read more
waqas A.
08:33 13 Nov 23
Great Experience with Garling & Co. Matthew explained everything in detail during the first appointment. Allison, Nathan, Rebecca and the staff have been extremely helpful. Thank You to the team and... lawyers at Garling & Co. for making the long process easy for me and getting an excellent outcome for my compensation claim.I would highly recommend Garling & Co. Lawyersread more
Saskia L.
21:42 08 Nov 23
The world of workers compensation is long, hard and confusing, but Emma and Rebecca at Garling & Co always treated my case with kindness, respect and understanding. No question was ever silly and... they always had time to make sure I knew what would happen next and how we could best prepare. I am so thankful for their expertise and could not have chosen anyone better to represent me.read more
Antonio P.
08:46 06 Nov 23
Thank you Matthew and his team for taking care of my case couldn’t ask for a better results and couldn’t have better team to do that thank you
Julie M.
00:40 06 Nov 23
Garlic & Co Lawyers have been wonderful, supporting me through some difficult times. With their assistance, positive outcomes were achieved. Many thanks to the Team.Julie
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
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University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
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