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lump sum entitlement crps permanent disability

#1 User is offline   cookie281 

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Posted 13 November 2014 - 12:14 PM

Hey there,

Im trying to find if i would qualify for a lump sum for permant disibility and if so how to claim from an accredited employer/Wellnz. Below is the report from my specialist excluding names.
Injury: Fracture Tibia and Fibula – Right
Developed Complex Regional Pain Syndrome – Right Lower Limb.
Date of Injury: 23rd October 2013.

I have previously provided you with a progress report for ? regarding his Right leg fracture and associated Complex Regional Pain Syndrome.
Brodie returned to our clinic this week for reassessment and I have been asked to report further on his progress.

Mr ? is now 12 months post injury.
He has been engaged in Physical Rehabilitation with regular physiotherapy for six months to support graduated exercise and mobilization. His aim was to manage pain and increase physical function, including being able to walk without crutches.
His attendance and compliance has been excellent, despite ongoing pain. He has also attended regular psychology sessions for pain management.

Medical management of pain includes Gabapentin 1800mg daily, Clonidine Patches, and Paracetamol and Ibuprofen on an as needed basis.
Mr ? reports increased severity of pain and widening of his pain to include the right upper body as well as severe ongoing pain in the right lower leg.
He has facial and right rib cage pain regularly, and has increased difficulty with sleep, waking 6-8 times per night with this. The pain is rated 9/10.
He reports being unable to touch weight bear on his right foot, which has become increasingly sensitive, and causes a delayed and increased pain in the right half of his body described as burning and aching.
The right lower limb is more stiff particularly at the ankle joint, and swelling occurs on any form of mobilizing with crutches.

On examination the limb is swollen and erythemic with a mottled appearance.
The foot is hypersensitive with Allodynia and Hyperalgesia, and the skin shows trophic changes as well as thickening of the toenails.
The skin is sweaty, the temperature of the limb is normal.
The scar is well healed without evidence of breakdown.
Swelling of lower limb is present to the knee:
Calf diameter: 49cm (Left 45cm)
Knee diameter: 45 cm (Left 39cm)
Ankle: 32 cm (Left 28.5cm)
Movement:
Toes 0-15 degrees flexion only
Ankle 10 degrees dorsiflexion to 50 degrees plantarflexion (painful)
Knee 0 degrees extension to 90 degrees flexion

Gait: Walks with two elbow crutches, non- weight bearing
Able to touch heel on ground if sitting, however needs support such as cushion 4 days a week.

Questions:
Please comment on ? lower limb functionality. Has it improved from the last such assessment being 33%?
Mr ? has severe limitation of his right lower limb function with Lower Extremity Functional Rating at 9% at this assessment. As stated he is unable to put weight through the foot for any walking. He requires two crutches for walking.

Please comment on Mr ? work capacity now that further time has passed. Have any gains been made towards a return to some form of employment?
Mr ? does not currently demonstrate capacity to work in any role with significant levels of pain 9/10, and lower limb dysfunction. He also reports concentration difficulty and poor sleep with daytime somnolence.
There is a very low likelihood that pain management and rehabilitation will increase his capacity to be able to manage more than sedentary work in the foreseeable future (12 months). Complex Regional Pain Syndrome is a permanent condition, which can be fluctuant. It occasionally regresses and/or progresses without identifiable triggers. That being said, there is very little possibility of Mr ? returning to heavy farm work, which requires normal bilateral lower limb function to navigate uneven and unpredictable outdoor terrain.

If Mr ? is able to work in some capacity but with limitations or restrictions, please specify the degree and type of limitations you would place him on?
Mr ? is not currently capable of performing any work and is unlikely to be able to perform work of any capacity for the next six months. He may be able to perform sedentary work on a part time basis for up to 10 hours if his pain is better controlled. If the pain does settle, then he would be able to attend sedentary work but this would need flexibility to account for the ongoing potential fluctuation of his pain, which is unpredictable.

Is it a realistic goal for Mr ? to return to farm work in time?
Based on my assessment of Mr ? today and in conjunction with the knowledge of the clinical course of his Complex Regional Pain Syndrome over the last six months, it is unrealistic to work towards a return to farm work in the foreseeable future. His condition has led to minimal function of the right lower limb, and also decreased bone density and changes in the ankle joint which are likely to be aggravated by the heavy nature of farm work if Mr Cook was to return. Even in the very unlikely situation of complete resolution of his Complex Regional Pain Syndrome, there would be significant risk of further injury to the lower limb or recurrence of the pain condition.

Please identify Mr ? transferrable skills and how he might be placed for future employment that would not require him to retrain substantially?
Mr ? has had significant work history in untrained labour, and all these transferrable skills are into work that requires significant standing and labour such as sales in farm supplies, dispatch and receivables work.
Future work capacity is likely to be of a sedentary level, and these jobs would require further improvement of his condition with some retraining at least, for example Computer Work and Drafting. Mr ? is likely to require flexibility in work hours as his condition is likely to fluctuate.

Are you able to comment on Mr ? Pain Management?
Mr ? has had six months of multidisciplinary community based pain management and rehabilitation with psychologist, physiotherapist and medical specialist.
Despite this management high levels of pain persist, and currently evidenced based medication strategies are being applied. Mr ? uses pacing, breathing and scheduling techniques to assist in managing his daily activities, and continues with psychology sessions to manage emotional and social impacts of pain.

What is the likely prognosis for Mr ?
Complex Regional Pain Syndrome has no cure. The condition is considered permanent, although there is no certainty about prognosis. Some sufferers have relatively good function whereas others may be completely incapacitated. The current situation of continuance and deterioration despite intensive management predicts a poor functional prognosis for Mr ? in the next 12 to 24 months.

If anyone can give any advice it would be greatly appreciated.

Regards
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#2 User is offline   Huggy 

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Posted 13 November 2014 - 03:12 PM

I believe you need to reach a 10% threshold before being eligible for the minimum IA payment. By the looks of the report you have 9% impairment.
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#3 User is offline   cookie281 

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Posted 13 November 2014 - 05:43 PM

View PostHuggy, on 13 November 2014 - 03:12 PM, said:

I believe you need to reach a 10% threshold before being eligible for the minimum IA payment. By the looks of the report you have 9% impairment.


Hey there, you have it back to front, if I didn't have crps the function of my leg would be 100%. Since I have developed crps the function of my leg dropped to 33% of normal function and now 1 year on due to worsening symptoms the function of my leg has dropped to 9% of normal function.

Cheers
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#4 User is offline   Huggy 

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Posted 13 November 2014 - 05:58 PM

Impairment rating is done by the AMA guidelines, it is a very complicated formula. Perhaps KTH nay be able to assist with how the calculations are done.

The loss of a limb in the AMA guidelines may only get you a small percentage of impairment over the whole body.
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#5 User is offline   cookie281 

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Posted 13 November 2014 - 07:23 PM

View PostHuggy, on 13 November 2014 - 05:58 PM, said:

Impairment rating is done by the AMA guidelines, it is a very complicated formula. Perhaps KTH nay be able to assist with how the calculations are done.

The loss of a limb in the AMA guidelines may only get you a small percentage of impairment over the whole body.


Hey, I'm pretty sure the loss of a limb is 32% impairment but as crps has spread through the entire right side of my body it would be higher, not to mention the pain and mental issues ie: stress, depression, mood etc.

Cheers
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#6 User is offline   unit1of2 

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Posted 13 November 2014 - 09:21 PM

They don't pay out for pain....
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#7 User is offline   cookie281 

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Posted 13 November 2014 - 09:34 PM

View Postunit1of2, on 13 November 2014 - 09:21 PM, said:

They don't pay out for pain....


Hey there, according the the ACC AMA4 causalgia, RSD and CRPS are covered pain conditions. Cheers
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#8 User is offline   Huggy 

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Posted 14 November 2014 - 01:48 AM

I don't think a limb could be 32% because if you then take 4 limbs at that percentage that would equate to 128% for 4 limbs yet alone percentages that have to be left over for other parts of the body.

The assessment you have had has come back with 9% and that may very well be the percentage of impairment you have and if so, then because its below the 10% entry level there will be no IA.

You need to put in a request to ACC for an IA, they will send you to an assessor who will score you by a percentage using the AMA guidelines and see what comes out of that.

Its a weird system, you could have 4 injuries for eg where the percentage for each injury is 10% and in my terms if you added that up it should come to 40% but it doesn't work like that, they would add up the 4 injuries according to the AMA guidelines and the 4 x 10% might only add up to 25% total impairment in accordance with the guidelines.
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#9 User is offline   cookie281 

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Posted 14 November 2014 - 11:54 AM

View PostHuggy, on 14 November 2014 - 01:48 AM, said:

I don't think a limb could be 32% because if you then take 4 limbs at that percentage that would equate to 128% for 4 limbs yet alone percentages that have to be left over for other parts of the body.

The assessment you have had has come back with 9% and that may very well be the percentage of impairment you have and if so, then because its below the 10% entry level there will be no IA.

You need to put in a request to ACC for an IA, they will send you to an assessor who will score you by a percentage using the AMA guidelines and see what comes out of that.

Its a weird system, you could have 4 injuries for eg where the percentage for each injury is 10% and in my terms if you added that up it should come to 40% but it doesn't work like that, they would add up the 4 injuries according to the AMA guidelines and the 4 x 10% might only add up to 25% total impairment in accordance with the guidelines.


Cheers for that I'll have to find out how to apply as I'm under Wellnz not acc and their very hard to deal with they don't answer the phone very often and there's no information on their website.
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#10 User is offline   Huggy 

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Posted 14 November 2014 - 12:11 PM

Put the claim for IA with WellNZ, they have to comply with the ACC act and have so many days to issue a decision, failure to issue a decision in a timely manner means you can apply for a review. That will cost them thousands if it has to go to review.
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#11 User is offline   keentohelp 

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Posted 14 November 2014 - 12:36 PM

View PostHuggy, on 13 November 2014 - 05:58 PM, said:

Impairment rating is done by the AMA guidelines, it is a very complicated formula. Perhaps KTH nay be able to assist with how the calculations are done.

The loss of a limb in the AMA guidelines may only get you a small percentage of impairment over the whole body.


I am unsure about being able to advise on calculations without seeing the specific file but would like to contribute two points.

1/ Seek an assessment, go through the process and then, if not happy with the outcome, seek assistance from someone with both experience in lump sum matters AND who possesses a copy of he assessment tool - the AMA guides.

I would note that there are some claimant representatives who happily (but foolishly) look to engage in lump sum matters without so much as a look at that fundamental tool.

2/ In requesting an assessment ensure you ask for one that includes ALL your covered injuries - the all is important.

If pain or any other 'mental' injury is evident but not covered in itself as a separately identifiable injury request cover for that 'mental' (or any other I suppose) injury BEFORE starting the lump sum process.
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#12 User is offline   Huggy 

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Posted 14 November 2014 - 12:43 PM

Cheers KTH

Not sure on the workings of it and knew you would have more insight into it.
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#13 User is offline   chroy 

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Posted 17 January 2015 - 09:27 AM

View Postcookie281, on 14 November 2014 - 11:54 AM, said:

Cheers for that I'll have to find out how to apply as I'm under Wellnz not acc and their very hard to deal with they don't answer the phone very often and there's no information on their website.


Yes sorry it's definately 10% or more before you qualify for IA. However, my husband has had the same injury in 1995 and his % was very high and has received IA since 1995 to current.
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