Search

How do doctors assess the level of WPI for spinal injury claims?

Updated on November 03, 2021 | 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.

Find out if you have a claim in just 2-minutes

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.

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

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 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 whole person impairment

In addition to the impairment allowable for each category, further impairment is added for the effects of surgery. Spinal surgery with no residual symptoms attract a further whole person impairment of between 1-3%. Spinal surgery with residual symptoms attract an additional whole person impairment of between 2-3%. Second operations can attract between a further 1-2% whole person impairment each.

Disc replacement surgery is the equivalent of a spinal fusion.

The implementation of a spinal cord stimulator or similar device does not attract any additional whole person impairment.

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) 8518 1120 or email Matthew at mgarling@garlingandco.com.au for further information.

Matthew Garling

Matthew Garling, Founder of Garling & Co is a NSW Law Society Accredited Specialist in Personal Injury Law. He specialises in compensation law and has acted on behalf of thousands of injured people in work accidents, motor vehicle accidents and negligence cases over the last 20 years.

Daniel F.
08:48 10 Nov 21
My wife suffered psychological injury.Never having similar experience she had to get legal advice.Workers compensation law is complex and she needed someone to help her navigate her way through.... There are many compensation lawyers but not all with enough experience and strong reputation . We have finally decided to go with Matthew and his team based on the independent website reviews .Looking back now we have made the right choice .There is lot of hurdles and having trustworthy lawyer with great communication skills on your side can make huge difference .My wife can now try to move on with the compensation she deserved.Thanks to Matthew ,Allison ,Emma,Rebecca and rest of the team. Thank you again.Daniel and Veerayaread more
K B.
07:35 28 Oct 21
When you work for an employer for a number of decades and suffer a debilitating injury, you expect compassion, support and belief that you are genuine. When you don’t get that and then also have to... deal with Workers Compensation Insurers it slowly breaks you.That's when you need amazing support like Matthew Garling and his team. From my first meeting with Matthew I was confident I was referred to the right guy. I couldn’t be more pleased with my outcome. Matthew is the Guru of workers compensation, he is professional, easy to work with, nothings a bother and most importantly he gets great results. Do not think twice about using Garling and Co Lawyers.Thank you Matthew, Renee, Allison and Kelli for your invaluable support.read more
Erin & Tom L.
04:25 21 Sep 21
Matthew and his team were so responsive throughout my entire claim. They made sure everything was explained clearly and always responded promptly to my questions. I can not thank them enough for... their support.read more
Moussa I.
14:23 20 Sep 21
Great attitude! they return my call every time I callI'm very confident I will reach something good with garling &co
Dulce L.
08:48 23 Aug 21
Garling & Co have been exceptional. Matthew was always professional attentive clear and concise, I felt up most confidence in his management dealing with my matter always had my best interest. i... highly recommend Garling & Co Lawyersread more
Melissa H
11:53 10 Aug 21
I am grateful to have had Matthew represent me on my motor vehicle compensation claim.After meeting with two lawyers previous to deciding on Garling and co, I was left unsure and confused as to... where I stood regarding my claim. Matthew and Allison were incredibly helpful, put my mind at ease, and took the worry and stress out of an already difficult situation.Through the settlement process they would always keep me informed and made time to answer all of my questions. I am really pleased with the outcome of the settlement.Thank you to the team at Garling and Coread more
Violeta C.
07:30 05 Aug 21
My experience with Garling & Co was great. Matthew was always professional, attentive and communicated in a clear manner. I felt confident in his management of my matter & always had my best interest... in mind.I have no reservation in recommending Matthew & the Garling & Co team.read more
Sonia C.
03:04 05 Aug 21
Ann F.
04:11 04 Aug 21
Professional and helpful
Sunita S.
04:00 04 Aug 21
Overall, I am very happy of their service and also the outcomes of my case.
READ ALL TESTIMONIALS

Would you like assistance with your claim?

Complete our free, no obligation confidential case assessment form and we’ll get back to you within 24 hours.

Alternatively, we are available to talk through phone and email. Please contact our experienced workers compensation lawyers to find out how we can help.

No Win No Fee

You won’t be required to pay any fees until we win your case.

Industry Experts

We’re industry experts with over 20 years of experience.

Maximum Compensation

Our team of expert injury lawyers will help you get maximum compensation.

Daniel F.
08:48 10 Nov 21
My wife suffered psychological injury.Never having similar experience she had to get legal advice.Workers compensation law is complex and she needed someone to help her navigate her way through.... There are many compensation lawyers but not all with enough experience and strong reputation . We have finally decided to go with Matthew and his team based on the independent website reviews .Looking back now we have made the right choice .There is lot of hurdles and having trustworthy lawyer with great communication skills on your side can make huge difference .My wife can now try to move on with the compensation she deserved.Thanks to Matthew ,Allison ,Emma,Rebecca and rest of the team. Thank you again.Daniel and Veerayaread more
K B.
07:35 28 Oct 21
When you work for an employer for a number of decades and suffer a debilitating injury, you expect compassion, support and belief that you are genuine. When you don’t get that and then also have to... deal with Workers Compensation Insurers it slowly breaks you.That's when you need amazing support like Matthew Garling and his team. From my first meeting with Matthew I was confident I was referred to the right guy. I couldn’t be more pleased with my outcome. Matthew is the Guru of workers compensation, he is professional, easy to work with, nothings a bother and most importantly he gets great results. Do not think twice about using Garling and Co Lawyers.Thank you Matthew, Renee, Allison and Kelli for your invaluable support.read more
Erin & Tom L.
04:25 21 Sep 21
Matthew and his team were so responsive throughout my entire claim. They made sure everything was explained clearly and always responded promptly to my questions. I can not thank them enough for... their support.read more
Moussa I.
14:23 20 Sep 21
Great attitude! they return my call every time I callI'm very confident I will reach something good with garling &co
Dulce L.
08:48 23 Aug 21
Garling & Co have been exceptional. Matthew was always professional attentive clear and concise, I felt up most confidence in his management dealing with my matter always had my best interest. i... highly recommend Garling & Co Lawyersread more
Melissa H
11:53 10 Aug 21
I am grateful to have had Matthew represent me on my motor vehicle compensation claim.After meeting with two lawyers previous to deciding on Garling and co, I was left unsure and confused as to... where I stood regarding my claim. Matthew and Allison were incredibly helpful, put my mind at ease, and took the worry and stress out of an already difficult situation.Through the settlement process they would always keep me informed and made time to answer all of my questions. I am really pleased with the outcome of the settlement.Thank you to the team at Garling and Coread more
Violeta C.
07:30 05 Aug 21
My experience with Garling & Co was great. Matthew was always professional, attentive and communicated in a clear manner. I felt confident in his management of my matter & always had my best interest... in mind.I have no reservation in recommending Matthew & the Garling & Co team.read more
Sonia C.
03:04 05 Aug 21
Ann F.
04:11 04 Aug 21
Professional and helpful
Sunita S.
04:00 04 Aug 21
Overall, I am very happy of their service and also the outcomes of my case.
Google Rating
5.0