Overview for NSW injured workers
Start with the dispute, not just the diagnosis
May be relevant when
Benefits to check
Legal help is useful when
How this affects your claim in practice
In a concussion claim, the diagnosis is only the starting point. The records should connect emergency records, CT or MRI where performed and neurology, vestibular or neuropsychology reports where relevant with the worker's practical limits, including cognitive load, balance, driving, machinery, screen work, fatigue and pain tolerance and risk-sensitive duties where symptoms may affect safety. If the insurer disputes whether symptoms are ongoing and work-related, the response should address that reason directly.
Assessment source
- NSW Guidelines for the Evaluation of Permanent Impairment, paras 1.8-1.12: NSW Guidelines control the assessment method and AMA5 is used only where adopted and not modified.
- NSW Guidelines para 1.12: AMA5 Chapter 18 pain is excluded; chronic pain is assessed through the underlying diagnosed condition, while CRPS is assessed under the relevant NSW method.
- NSW Guidelines para 1.15: assessment should usually wait until maximum medical improvement, meaning the condition is stable and unlikely to change substantially in the next year.
- NSW Guidelines Chapter 5 applies AMA5 Chapter 13 subject to NSW modifications. Paragraph 5.4 requires supported consciousness, cognition, communication and neurologically based emotional or behavioural impairments to be evaluated and combined without double-rating.
- NSW Guidelines para 5.9: a TBI cerebral assessment requires a severe or high-energy head impact and at least one significant medically verified Glasgow Coma Scale abnormality, post-traumatic amnesia period or intracranial CT/MRI pathology.
- NSW Guidelines paras 5.2-5.3: spinal cord injury uses AMA5 Chapter 15 Table 15-6, while peripheral nerves use the relevant upper-extremity, lower-extremity or spine provisions.
What injuries or conditions may be assessed?
Concussion is a mild traumatic brain injury that may cause a temporary disturbance of awareness, memory, balance or thinking. Most symptoms improve, while a smaller group reports persistent difficulties.
- The permanent impairment question is whether a stable measurable neurological function remains, not whether concussion was diagnosed during the acute period.
Symptoms and findings that matter
The record should document the acute mechanism, any loss or alteration of consciousness, post-traumatic amnesia, GCS observations and contemporaneous neurological examination.
Persistent cognitive or communication complaints require clinical correlation; a symptom questionnaire without functional assessment does not select an AMA5 class.
What investigations are usually relevant
Investigations for concussion may include ambulance, emergency and hospital records, including Glasgow Coma Scale, post-traumatic amnesia and acute neurological observations where relevant and neurologist, rehabilitation physician, neuropsychologist, speech pathologist, vestibular, urology or other specialty reports matched to the function in issue. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- CT/MRI, neuropsychological testing, vestibular testing or EMG/NCS interpreted with the clinical examination rather than in isolation.
- Functional records showing memory, communication, community independence, self-care, seizure safety, gait, sensory or motor consequences.
How WPI is assessed for this body part
Concussion has no fixed WPI. The NSW paragraph 5.9 TBI evidence threshold and the applicable stable function under AMA5 Chapter 13 must both be addressed before a cerebral value is considered.
Dizziness may require a vestibular assessment, while primary psychiatric injury uses PIRS. Those methods should not be merged into a generic concussion percentage.
Worked assessment illustrations
These examples paraphrase the assessment reasoning in the source material. They explain method only and are not predicted outcomes.
Illustration 1
Concussion symptoms with no stable class established
Assumed facts: Assume a worker reports headache, fatigue and concentration difficulty months after a concussion, but there is no clinically supported permanent cognitive, communication, gait or cranial-nerve class.
Method: Symptoms are considered medically, but WPI requires the criteria and functional findings of an applicable NSW/AMA table rather than a symptom count.
Illustrative outcome: The example does not support a fixed neurological percentage on symptoms alone. Further clinical evidence may alter the assessment in a real case.
Source: NSW Guidelines paras 5.4, 5.8-5.9; AMA5 Chapter 13
What usually does not increase WPI
For concussion, symptoms, a diagnostic label or imaging alone do not establish a cerebral impairment class.
Headache, dizziness, pain, radiating symptoms or a diagnosis label alone do not establish neurological WPI.
An abnormal scan or test does not supply a percentage unless it matches the clinical findings and the applicable functional method.
Self-reported memory or concentration problems need clinical assessment and, where available, properly contextualised neuropsychological evidence.
Primary psychiatric PIRS and secondary psychological symptoms must not be inserted into a neurological cerebral calculation.
Evidence checklist
The records for concussion should include specialist report identifying the lesion, affected function, applicable table or class and maximum medical improvement and early incident and hospital records, imaging and objective test results relevant to the claimed condition. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Neuropsychological, speech, OT, gait, vestibular, sensory or motor findings that translate the condition into daily function.
- Medication, rehabilitation and longitudinal records showing stability, recurrence and consistency.
- Work and home evidence about memory, communication, supervision, balance, sensation, strength, driving and safety limits.
How this injury commonly happens at work
Work-related concussion can arise through falls, struck-by incidents, vehicle incidents or sudden head impacts and workplace violence or machinery incidents. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related concussion can arise through incidents followed by dizziness, headache, memory or balance symptoms. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For concussion, an insurer may dispute whether symptoms are ongoing and work-related and whether normal imaging rules out functional impairment. The written decision should be answered with evidence directed to those reasons.
Further disputes about concussion may concern whether safety-sensitive work is appropriate. The decision notice should identify which issue is relied on and the evidence said to support it.
Treatment and surgery issues
Depending on the diagnosis and treating opinion, management of concussion may involve neurology, vestibular rehabilitation, cognitive rehabilitation, graded activity and medication review where supported. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for concussion should address cognitive load, balance, driving, machinery, screen work, fatigue and pain tolerance and risk-sensitive duties where symptoms may affect safety. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For concussion, capacity evidence should address graded duties based on treating restrictions and weekly payments where functional limits are disputed. The question is whether those activities can be performed safely, reliably and for the proposed hours—not whether a task can be attempted once.
How NSW Work Injury Claim can help
For concussion, a claim review can help to organise incident, medical and symptom evidence and separate treatment, capacity and impairment issues. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For concussion, a claim review can help to identify gaps in IME or insurer reasoning and consider dispute options where the evidence supports them. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
Common questions about concussion claims
How can work cause or aggravate concussion?
For concussion, the relevant work history may include falls, struck-by incidents, vehicle incidents or sudden head impacts, workplace violence or machinery incidents, and incidents followed by dizziness, headache, memory or balance symptoms. A claim still depends on the actual chronology and medical evidence. The records should identify what changed, when symptoms began or worsened, and how the diagnosed condition affects the worker's duties.
How is WPI assessed for concussion?
For concussion, concussion has no fixed WPI. The NSW paragraph 5.9 TBI evidence threshold and the applicable stable function under AMA5 Chapter 13 must both be addressed before a cerebral value is considered. The record should document the acute mechanism, any loss or alteration of consciousness, post-traumatic amnesia, GCS observations and contemporaneous neurological examination. The assessor must apply the NSW Guidelines to the accepted, stable condition; the diagnosis or an operation does not by itself determine a percentage.
Which records are most useful for a concussion assessment?
A concussion assessment commonly needs specialist report identifying the lesion, affected function, applicable table or class and maximum medical improvement, early incident and hospital records, imaging and objective test results relevant to the claimed condition, neuropsychological, speech, OT, gait, vestibular, sensory or motor findings that translate the condition into daily function, and medication, rehabilitation and longitudinal records showing stability, recurrence and consistency. Those records are most useful when they describe the same diagnosis, examination findings, treatment history and practical work restrictions.
What does an insurer commonly dispute about concussion?
For concussion, common issues include whether symptoms are ongoing and work-related, whether normal imaging rules out functional impairment, and whether safety-sensitive work is appropriate. The response should address the insurer's stated reason with the relevant chronology, clinical findings, investigations and duties evidence rather than relying on the diagnosis alone.
How can concussion affect weekly payments and suitable duties?
Capacity evidence for concussion may need to address cognitive load, balance, driving, machinery, screen work, fatigue and pain tolerance, risk-sensitive duties where symptoms may affect safety, and graded duties based on treating restrictions. A certificate should describe what the worker can do safely and sustainably. Proposed duties should then be checked against those restrictions and the real demands of the job.
What does not establish WPI for concussion by itself?
For concussion, symptoms, a diagnostic label or imaging alone do not establish a cerebral impairment class. WPI depends on the accepted injury, objective findings and the method required by the NSW Guidelines after the condition has stabilised.
Request a calm claim position review
If you have received an insurer decision or you are unsure how your injury evidence fits together, we can help you identify the issue, organise the documents and consider the next step. Where ILARS funding is approved, eligible legal costs and necessary disbursements may be covered.
Related NSW workers compensation guides
- Treatment denied
- Head, brain and neurological WPI assessment
- Traumatic brain injury
- Seizure disorder after neurological injury
- Cranial nerve injury
- Balance and neurological gait disorder
- Peripheral nerve injury
- Complex regional pain syndrome
- Neurological bladder, bowel and sexual dysfunction
- Workers compensation claims
- Weekly payments
- Claim denied
- Work capacity decisions
- IME guide
- WPI assessment guide