The ICF and Accident Compensation in Australia

1
The ICF and Accident Compensation in Australia

• John Walsh

2
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

3
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)

4
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, scheme-specific 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

5
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

6
Role of ICF, and problems

• ICF cant 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

7
Beginnings of a way forward..1

• AIHW publication of Functioning and Related
  Health Outcomes Module (FRHOM) provides template
  and impetus for Schemes to move forward

8
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..

9
Beginnings of a way forward..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.