Overview
How this affects your claim in practice
First identify what the percentage actually is: an informal estimate, a worker-arranged report, an insurer assessment, a proposed principal assessment, a permanent impairment agreement or a PIC Medical Assessment Certificate. Each has a different legal status. Check whether every accepted injury was assessed, the correct NSW impairment method was used, deductions and combined values were explained, and the section 66 amount matches the final WPI and current indexed table. Do not sign an agreement or miss a PIC medical appeal period while assuming another assessment can simply be obtained later.
- An estimate is not a formal permanent impairment assessment.
- Separate a clinical WPI disagreement from an arithmetic error in the insurer offer.
- Physical and primary psychological WPI are assessed separately; secondary psychological impairment is not a separate section 66 assessment.
- Post-1 July 2026 principal-assessment rules restrict further assessments, so document status and timing matter.
- This guide covers ordinary, non-exempt NSW workers and excludes exempt workers and specialist schemes.
The document status determines the next step
The same percentage can have a very different effect depending on who produced it and whether it has become binding.
| Document or figure | What it usually means | What to check next |
|---|---|---|
| Online or informal estimate | A planning figure only, not a trained assessor's opinion. | Whether maximum medical improvement has been reached and an assessment is appropriate. |
| Worker-arranged impairment report | Medical evidence supporting a claim; it does not compel insurer agreement. | Accepted injuries, method, clinical findings, deductions, combination and report compliance. |
| Insurer report or written decision | The insurer's medical position or liability decision, which can be disputed. | Decision reasons, relied-on report, omitted injuries and the correct PIC pathway. |
| Principal assessment or permanent impairment agreement | A post-1 July 2026 assessment or agreement used across several statutory entitlements. | Whether independent legal advice occurred and whether the agreement accurately records the assessment. |
| PIC Medical Assessment Certificate | A binding medical assessment unless changed through an available statutory process. | Issue date, reasons, appeal grounds and the 28-day appeal period stated by PIC. |
Check the clinical findings and the assessment method separately
The NSW permanent impairment guidelines modify the applicable AMA method. A persuasive review identifies the body-system table or category, the measured findings and the step said to be wrong. Pain, surgery or imaging alone does not establish a higher WPI.
- Were all accepted injuries and relevant body systems included?
- Was the condition stable and maximum medical improvement addressed?
- Do examination findings satisfy the stated diagnosis, category or table criteria?
- Were range-of-motion measurements valid and repeatable where that method applies?
- Were objective neurological findings distinguished from radiating pain?
- Were pre-existing impairment deductions identified and supported?
- Were multiple combinable physical values combined rather than simply added?
A correct WPI can still be paired with a wrong monetary offer
Check the injury date, final WPI, applicable threshold, indexed compensation table and any eligible 5% increase to compensation attributable to permanent impairment of the back. The back increase is a monetary increase, not five extra WPI points, and it does not apply to unrelated compensation.
If the offer uses several body-system values, ask for the combination sequence and any allocation used for the back component. Do not invent a back allocation where the assessment or agreement does not provide a reliable basis.
Physical, primary psychological and secondary psychological impairment are not interchangeable
Physical WPI and primary psychological WPI use different medical methods and thresholds. They are not added into one WPI. Psychological consequences secondary to a physical injury do not attract a separate section 66 payment. A document should identify the injury class before percentages or dollar amounts are compared.
The post-1 July 2026 framework also creates special rules for primary psychological injuries and staged future changes. Do not transfer a physical-injury threshold or assessment method to a primary psychological claim.
Post-1 July 2026 principal assessments can affect several entitlements
SIRA states that, during the interim period from 1 July 2026 to mid-2027, an assessment agreed between the worker and insurer becomes the principal assessment used for weekly payments, treatment, lump sum compensation, commutations and work injury damages. The worker must obtain independent legal advice before the assessment and before entering a permanent impairment agreement.
A further assessment is not an ordinary second opinion. SIRA states that it is available only where the worker and insurer agree there has been an unexpected and material deterioration that was not expected and increases impairment by at least 10 percentage points. Age-related deterioration does not qualify. Different transitional rules may apply to a pre-reform assessment or agreement.
Insurer disagreement and PIC medical appeal are different stages
If the worker and insurer cannot agree on the degree of permanent impairment, the insurer must give a written decision and the disagreement may be referred to the Personal Injury Commission as a medical dispute. The application should contain the complete relevant material because later evidence can be restricted.
PIC states that a Medical Assessment Certificate is final and binding, subject to the statutory appeal process. An appeal must be lodged within 28 days after the certificate is issued and requires a proper appeal ground; dissatisfaction with the percentage alone is not enough. The medical appeal panel may confirm the certificate or issue a replacement.
Evidence to assemble before requesting a review
- The complete permanent impairment report, not only its final percentage.
- The insurer decision, offer and calculation sheet.
- Accepted-injury wording and any dispute notices about omitted conditions.
- Imaging, operative reports and treating evidence relevant to the assessed criteria.
- Prior injury, impairment claim and deduction material.
- Any permanent impairment agreement or earlier assessment.
- The PIC Medical Assessment Certificate and its issue notice, if applicable.
- A short issue list identifying the disputed medical method and any separate monetary error.
Illustrative review example
A worker receives an insurer report assessing the lumbar spine but not an accepted shoulder injury. The section 66 offer reproduces the spine percentage only. The worker first asks for a written decision about the omitted shoulder and obtains advice about whether the report assessed all injuries arising from the incident. The worker does not simply add a guessed shoulder percentage. This example explains issue identification and does not predict a WPI or payment.
Official sources
Sources are listed for transparency. This guide is general information only and is not legal advice.
- Workers Compensation Act 1987 (NSW), permanent impairment provisions
- Workplace Injury Management and Workers Compensation Act 1998 (NSW), medical assessment and appeal provisions
- SIRA: assessment of permanent impairment from 1 July 2026
- NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment
- SIRA Workers Compensation Benefits Guide
- Personal Injury Commission: medical disputes and appeals
Frequently asked questions
Can I get another WPI assessment if I disagree with the first one?
Not automatically. The answer depends on whether the first figure was an estimate, report, principal assessment, agreement or PIC certificate. Post-1 July 2026 further assessments are restricted, and PIC certificates have a separate appeal process.
How long do I have to appeal a PIC Medical Assessment Certificate?
PIC states that a medical assessment appeal must be lodged within 28 days after the certificate is issued. An appeal also needs a statutory ground, so obtain advice promptly and keep the issue notice.
Can I add physical and psychological WPI together?
No. Physical and primary psychological impairment are assessed separately. Secondary psychological impairment arising from a physical injury is not separately compensated under section 66.
Does surgery mean the WPI must be higher?
No. Surgery can be relevant to the applicable method and findings, but it does not create a universal percentage. The assessor must apply the NSW guidelines to the actual diagnosis and examination evidence.
Is the problem the WPI, the offer, or both?
Provide the full assessment report, insurer decision and offer, accepted-injury documents, any agreement and any PIC certificate. We can identify the document status, medical issue, calculation issue and available review pathway.