To apply for a Quality of Life Benefit, an injured person's first WPI assessment must be applied for via the MAI insurer managing the application. A referral will be made to one of two Authorised IME Providers for the MAI Scheme.
The MAI Commission has approved two Authorised IME Providers, MLCOA and Medico Legal Specialists (MLS) to conduct the independent medical examinations required for a Whole Person Impairment (WPI) assessment. An insurer is not permitted to select the IME, this being the responsibility of the Authorised IME Provider.
Under the Motor Accident Injuries (WPI Assessment) Guidelines 2019 (ACT guidelines), WPI assessments are required to be completed by suitably qualified and experienced assessors (see in particular clause 1.6(b) of Chapter 1). Training can be obtained from a professional association, another jurisdiction or a training provider. Unlike other jurisdictions there is no formal accreditation process undertaken by the MAI Commission.
All WPI reports produced for Quality of Life applications have a requirement for the assessor to certify that they have knowledge of the modifications to the fifth edition of the American Medical Association's Guides to the evaluation of Permanent Impairment (AMA5) made by the ACT guidelines, in addition to training in AMA5 for a given body system. Only medical specialists trained may undertake a WPI assessment for the purposes of the MAI Scheme.
The Scheme also provides that if the injured person disagrees with the first WPI report, they can arrange for a Private Medical Examiner to carry out a second assessment at their own expense. A person may ask an Authorised IME Provider to provide a report from a specialist of their choosing but should disclose the names of the first WPI assessors to remove any conflict of interests.
Where a Private Medical Examiner undertakes a WPI assessment they must include a statement with their report confirming they meet the training and other requirements of clause 1.6(b) of the ACT guidelines (see below for more details on the guidelines). The role of a Private Medical Examiner is limited to the production of second WPI reports within the MAI Scheme.
Process for an assessment
An application to the MAI insurer is required to start the process of assessment for the Quality of Life benefit. Do not obtain your own report as an insurer cannot consider it. They must follow the legislation in relation to this entitlement and specified process.
On receipt of the application an insurer is to consider if the injured person's injuries are stable and of a permanent nature. If they are stable and permanent the insurer must refer the person to an Authorised IME Provider for assessment. The IME Provider will review the referral, identify the IME(s) required for the assessment, and make contact with the injured person to make arrangements for the appointment(s). Contact details for the authorised IME Providers for the MAI Scheme are as follows:
MLCOA via (02) 6270 6270 or contactact@mlcoa.com.au.
MLS via (02) 8243 5600 or mlsbookings@mls.net.au.
An insurer can expect, depending on service category and complexity, to pay fees within a range of $2000 to $6000[i]. Other injury assessments, such as for the purpose of a recovery plan or to determine a person's fitness for work, may be referred to appropriately qualified medical professionals. The MAI Act does not require the Authorised IME Provider be used for such injury assessments.
[i] Figures based on average pricing for the 2024/25 year