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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...
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
Keith H.
20:51 23 Apr 24
After my case stalled with another firm, I decided to give Matthew Garling a call. He took my case and not only won, but achieved an outcome that far exceeded my expectations. This firm is the best... in the business in my opinion and I wouldn't hesitate to recommend them to anyone.read more
Anthony T.
00:50 16 Apr 24
Thank you Matthew and his team who guided me through the legal process, a truly positive experience with total professionalism.
Mikaele N.
03:01 15 Apr 24
Garling &Co Lawyers were awesome, I called every compensation law firm and was told that I couldn't claim for compensation.The whole experience and process was simple and stress free.Mr Matthew... Garling and Allison deserve an accolades for the very best in client service. I would highly recommend their service to anyone.read more
Tamara L.
02:10 15 Apr 24
I want to thank Garling & Co so much for all the help they have given me and helped with my claim. We got the win last week and it was the best news I have gotten considering how much my life has... been turned upside down the past 2 years. Emma and Rebecca have been incredible to work with and explained everything from the start even when I had hesitation to go ahead regarding how much everything would cost or how fair it could go or even if I had a chance, but they explained everything thoroughly, so I understood it all. Thank you for making this process seamlessly easy and helping me get the win it will make things a little easy for me that's for sure financial thank you for all your help I cannot recommend you and your services enough. Thank you again.read more
Sigrid W.
05:01 11 Apr 24
Utter professionalism from first phone call to final settlement. It was a pleasure to be represented by a firm that actually cares for their clients. From office staff, to paralegal and solicitor... Rebecca, Emma and Matthew thank you for your support and expertise throughout my claim. No wonder your firm has won many awards. I'm extremely happy with my outcome and can confidently recommend your firm.read more
BJ S.
01:09 09 Apr 24
Highly recommend Matthew & Allison at Garling and Co ! Quick response ! helpful every step of the way ! If you want the best compensation lawyer, Matthew @ Garling and co is the bestDoesn’t waste... time. Very informative ! excellent guidance! They get the job done ✅Website is perfect guide5 Star ⭐️ is not enoughI’m so grateful to Matthew, Allison and team for my outcome so far !Thank you 😊 Garling and co are awesome 👏 🤩read more
Jaimie K.
06:11 02 Apr 24
Have had a rollercoaster ride with Garling and Co over the several years we have been battling the system that injured workers are faced with. The wheels of progress are slow within this system.... However Garling and co have always stood by me. Calls are returned and matters are always followed up in a timely manner.read more
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Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
Keith H.
20:51 23 Apr 24
After my case stalled with another firm, I decided to give Matthew Garling a call. He took my case and not only won, but achieved an outcome that far exceeded my expectations. This firm is the best... in the business in my opinion and I wouldn't hesitate to recommend them to anyone.read more
Anthony T.
00:50 16 Apr 24
Thank you Matthew and his team who guided me through the legal process, a truly positive experience with total professionalism.
Mikaele N.
03:01 15 Apr 24
Garling &Co Lawyers were awesome, I called every compensation law firm and was told that I couldn't claim for compensation.The whole experience and process was simple and stress free.Mr Matthew... Garling and Allison deserve an accolades for the very best in client service. I would highly recommend their service to anyone.read more
Tamara L.
02:10 15 Apr 24
I want to thank Garling & Co so much for all the help they have given me and helped with my claim. We got the win last week and it was the best news I have gotten considering how much my life has... been turned upside down the past 2 years. Emma and Rebecca have been incredible to work with and explained everything from the start even when I had hesitation to go ahead regarding how much everything would cost or how fair it could go or even if I had a chance, but they explained everything thoroughly, so I understood it all. Thank you for making this process seamlessly easy and helping me get the win it will make things a little easy for me that's for sure financial thank you for all your help I cannot recommend you and your services enough. Thank you again.read more
Sigrid W.
05:01 11 Apr 24
Utter professionalism from first phone call to final settlement. It was a pleasure to be represented by a firm that actually cares for their clients. From office staff, to paralegal and solicitor... Rebecca, Emma and Matthew thank you for your support and expertise throughout my claim. No wonder your firm has won many awards. I'm extremely happy with my outcome and can confidently recommend your firm.read more
BJ S.
01:09 09 Apr 24
Highly recommend Matthew & Allison at Garling and Co ! Quick response ! helpful every step of the way ! If you want the best compensation lawyer, Matthew @ Garling and co is the bestDoesn’t waste... time. Very informative ! excellent guidance! They get the job done ✅Website is perfect guide5 Star ⭐️ is not enoughI’m so grateful to Matthew, Allison and team for my outcome so far !Thank you 😊 Garling and co are awesome 👏 🤩read more
Jaimie K.
06:11 02 Apr 24
Have had a rollercoaster ride with Garling and Co over the several years we have been battling the system that injured workers are faced with. The wheels of progress are slow within this system.... However Garling and co have always stood by me. Calls are returned and matters are always followed up in a timely manner.read more
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
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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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