Only certain medical specialists can undertake a whole person impairment (WPI) assessment for the purposes of the MAI Scheme, being an Independent Medical Examiner and a Private Medical Examiner.
The Motor Accident Injuries Act 2019 provides that the MAI Commission can authorise an Independent Medical Examiner (IME) Provider who provides the Independent Medical Examiner(s) for a WPI assessment. The MAI Commission has authorised MLCOA as a IME Provider.
A Private Medical Examiner has a limited role within the MAI Scheme and can be engaged by an injured person to carry out a WPI assessment after an IME WPI assessment has occurred. An injured person's first WPI assessment must be arranged by their insurer through the authorised IME Provider. 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.
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).
Process for an assessment
An injured person makes an application for the Quality of Life benefit. Following receipt of the application and the insurer considers a person's injuries are stable and of a permanent nature they must refer the person to MLCOA. MLCOA will review the referral and identify the IME (s) required for the assessment. MLCOA will contact the injured person and make the arrangements for the appointment. Contact can be made with MLCOA via (02) 6270 6270 or contactact@mlcoa.com.au. An insurer can expect, depending on service category and complexity, to pay fees within a range of $1200 to $7000.
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). This includes a requirement for an 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 and the Safe Work template. Training can be obtained from a professional association, another jurisdiction or a training provider of your choice. Unlike some jurisdictions there is not a formal accreditation process undertaken by the regulator, the MAI Commission.
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.