August 31, 2013

I have heard, unofficially, that Victoria is planning to switch to AMA 5. As far as forensic psychiatrists in Victoria are concerned, in the short term it will probably make little difference as the GEPIC is likely to stay with the exception that those who are qualified to do assessments using AMA 4 chapter 4 The Nervous System will need retraining in the chapter on neurology in AMA 5. This is now chapter 13 and is entitled The Central and Peripheral Nervous System. I have summarised the sections relevant to us in AMA 4, AMA 5 and AMA 6, see link.

As in AMA 4, the most severe cerebral impairment is identified and this impairment rating becomes the impairment rating for brain dysfunction.

Table 4.2 ‘Mental Status Impairments’ is now table 13.6 and is linked to table 13.5 headed ‘Clinical Dementia Rating’. The percentages within each class remain the same but there are some minor changes in the wording. Table 4.3, ‘Emotional or Behavioural Impairments’is now table 13.8 ‘Criteria for Rating Impairment Due to Emotional or Behavioural Disorders’. The wording is identical.

 This is probably part of a move to rationalise the various systems of impairment assessment used in the different states, Commonwealth and territories. The organisation involved is the ‘Heads of Workers Compensation Authorities, Australia and New Zealand’
The charter of this organisation is to promote and implement best practice in workers compensation arrangements in Australia and New Zealand in the use of policy and legislative matters, regulation and scheme administration.
There may also be a link to a part of the National Disability Insurance Scheme that you may not be aware of, the National Injury Insurance Scheme. I will post more information about this as it comes to hand but, to give you some idea of what this is about I quote from the Canberra Times 28 August 2012 and the Productivity Commission report 2011. The Canberra Times article stated:
With the National Disability Insurance Scheme receiving much public attention, it is easy to forget the Productivity Commission’s other recommendation to establish a National Injury Insurance Scheme.
The NIIS is the forgotten little brother of the bigger, brighter and more popular NDIS, but that is no reason to ignore it…. The NIIS will provide no fault insurance coverage frustration to acquire a disability from catastrophic injury and require lifetime care and support. At an estimated cost of about 1.8 billion every year. The $22 billion a year NDIS, on the other hand, would cover people born with a disability such as autism, cerebral palsy all down syndrome or acquire a disability such as macular degeneration or hearing loss.
Unlike the NDIS, which would be a national scheme funded through core government revenue, the NIIS, as proposed by the commission, would be a federal scheme funded through insurance premiums, surcharges, levies and increased municipal rates-and would exclude experience at risk rating to help prevent injury. The NIIS is more like a proper insurance scheme compared to the NDIS, which is essentially an entitlement scheme.
The report from the Productivity Commission (2011) states:

 The National Injury Insurance Scheme (NIIS), should:

  • Provide an all encompassing system for managing the care and support needs of
all people experiencing catastrophic injury.
  • Primarily be funded from insurance premiums and, where appropriate, include
experience and risk-rating to help prevent injury.
  • Be structured as a federation of separate, state-based schemes.
  • To coordinate the federation of individual schemes, jurisdictions will need to
  • establish a small full-time secretariat that:
    • ensures consistency in eligibility, definitions and assessment
    • reports on services relative to the minimum benchmark of care and support services
    • manages a comprehensive database, facilitates sharing of data and ensures consistent
    • monitoring of performance, including actuarial valuations and client outcomes
      • works to eliminate any unwarranted variations in scheme design.
 What does all this mean? As I read it there is an intention for all the various transport accident, workers compensation and civil liability schemes to be rolled up into this scheme. Although it is said to be structured as a federation of separate, state-based schemes, the likelihood of that continuing is uncertain. We are in for interesting times.


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