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 hip fracture claim, the diagnosis is only the starting point. The records should connect initial and healed-position X-rays or CT identifying the exact fracture and hospital, orthopaedic and operation records with the worker's practical limits, including standing, walking, stairs, kneeling, squatting, driving and load carrying and safe duties that avoid unsafe mobility demands. If the insurer disputes whether the fracture is acute, work-related or affected by underlying bone disease, 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 3 applies AMA5 Chapter 17 only as modified by NSW. Paragraphs 3.2-3.7 require the most specific valid method, selection of the highest valid evaluation where more than one method applies, common units before combination, and a 40% WPI lower-limb maximum.
- NSW Guidelines para 1.24: activities of daily living must not be used to increase or reduce a calculated lower-extremity impairment. Functional examples explain the measurement; they are not an extra percentage.
- NSW Guidelines paras 3.8-3.15 and corrected AMA5 Tables 17-4 and 17-6: true leg length, gait, unilateral atrophy and manual muscle testing each have their own measurement and non-combination requirements.
- NSW Guidelines paras 3.16-3.18: inconsistent range-of-motion findings are invalid; values from different movement planes within one joint are added; joint ankylosis uses the corrected NSW optimum-position table and positional additions.
- NSW Guidelines paras 3.19-3.24: arthritis means radiological cartilage loss for impairment purposes. It cannot be assumed from pain, and the arthritis method cannot be combined with gait, atrophy, strength or range of motion.
- NSW Guidelines paras 3.10-3.15 and 3.32-3.35: gait is a last resort; gait, atrophy, muscle testing and peripheral-nerve methods can duplicate lower-limb function and must follow Table 17-2 non-combination rules; CRPS uses the NSW Chapter 17 method rather than AMA5 Chapter 18 pain.
- NSW Guidelines paras 3.26-3.30 and Tables 3.2-3.4: NSW modifies diagnosis-based estimates, tibial plateau fracture, patello-femoral and ankle replacement, tibia-os calcis angle and persistent plantar fasciitis. Hip and total-knee replacements use AMA5 Tables 17-33 to 17-35 subject to the NSW corrections.
What injuries or conditions may be assessed?
Hip-region fractures include femoral neck, intertrochanteric, subtrochanteric, femoral-head and acetabular fractures. Pelvic fractures use a different NSW table.
- Residual issues can include shortening, malalignment, avascular necrosis, cartilage loss, reduced hip motion, fixation consequences or replacement surgery.
- NSW says the AMA5 femoral-neck malunion diagnosis row is not used; the assessor must use another valid method supported by the healed result.
Symptoms and findings that matter
The fracture pattern, healed alignment, true bilateral limb length, hip motion, radiological cartilage interval and any replacement result determine the available method.
For hip fracture, range of motion is normally measured three times in each relevant plane and the greatest valid result is used. If repeated readings or findings between examinations are materially inconsistent, ROM is not a valid impairment parameter.
If true leg length is relevant to hip fracture, manual measurement is an exception to the greatest-reading rule: three readings are averaged. The opposite joint or limb is also compared where it provides a valid baseline.
Where hip fracture is assessed through manual muscle weakness, the examiner uses the six Medical Research Council grades from 0 to 5. Those grades are ordinal rather than evenly spaced, and the NSW method uses AMA5 Table 17-8; electrodiagnostic results do not replace the manual muscle test.
An impairment report for hip fracture may need a diagnosis-based estimate, radiological cartilage-loss method, replacement score, true limb-length difference, unilateral atrophy, muscle grade, named-nerve deficit or gait method instead of, or in a limited case alongside, ROM.
What investigations are usually relevant
Investigations for hip fracture may include weight-bearing X-rays, CT, MRI, ultrasound or operation records identifying the actual joint, fracture, tendon, ligament, cartilage, prosthesis or nerve condition and repeat goniometer measurements, stability tests, alignment findings and comparison with the unaffected side where that comparison is valid. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- Orthopaedic, rehabilitation and physiotherapy records showing whether the condition has reached maximum medical improvement.
- Certificates of capacity and duties evidence about walking, standing, stairs, kneeling, squatting, driving, lifting and uneven ground. These explain claim impact but do not alter the WPI calculation.
How WPI is assessed for this body part
For hip fracture, NSW Guidelines Chapter 3 applies AMA5 Chapter 17 subject to NSW corrections. The most specific valid method is used, and where more than one valid method applies the highest valid evaluation is generally selected unless Table 17-2 permits a combination.
If ROM is valid for hip fracture, values in different planes of the same joint are added. Regional values in the same limb are expressed in the same unit and combined before conversion to WPI.
For hip fracture, hip flexion brings the knee towards the chest; extension moves the leg behind the body; abduction and adduction move it away from and towards the midline; internal and external rotation turn the thigh inward and outward.
Arthritis in an assessment of hip fracture requires radiologically measured cartilage loss. For a knee, only the most impaired compartment is used. Arthritis cannot be combined with gait, atrophy, strength or ROM for the same loss.
For hip fracture, gait remains a last-resort standalone method. Atrophy, manual muscle testing, peripheral nerve impairment and gait can duplicate strength loss and cannot be stacked. A diagnosis-based estimate is combined only where Table 17-2 permits it.
The calculation for hip fracture cannot be changed because of activities of daily living under NSW paragraph 1.24. Functional descriptions help explain the evidence but are not an uplift or deduction.
Table and value examples
True discrepancy 0-1.9 cm
0% WPI (0% LEI)The NSW table begins at a verified true discrepancy of 2 cm.
Source: NSW-corrected AMA5 Table 17-4
True discrepancy 2-2.9 cm
3% WPI (8% LEI)Clinical measurement must identify the method. If measured manually, three readings are averaged rather than taking the largest.
Source: NSW-corrected AMA5 Table 17-4
True discrepancy 3-3.9 cm
5% WPI (13% LEI)True structural shortening must be distinguished from apparent shortening caused by pelvic tilt or contracture.
Source: NSW-corrected AMA5 Table 17-4
True discrepancy 4-4.9 cm
7% WPI (18% LEI)This NSW correction replaces the lower value in the base AMA5 table.
Source: NSW-corrected AMA5 Table 17-4
True discrepancy 5 cm or more
8% WPI (19% LEI)The discrepancy still needs reliable bilateral measurement and a causal link to the accepted injury.
Source: NSW-corrected AMA5 Table 17-4
Femoral osteotomy with a good result
10% WPI (25% LEI)A poor osteotomy result is assessed from the clinical examination or radiological arthritis instead. This is not a general value for every hip fracture or fixation procedure.
Source: NSW Guidelines para 3.28 correction to AMA5 Table 17-33
Hip ankylosed in the optimum position
20% WPI (50% LEI)Ankylosis means a fixed joint or arthrodesis for impairment purposes, not painful or restricted movement.
Source: NSW Guidelines Table 3.1
Worked assessment illustrations
These examples paraphrase the assessment reasoning in the source material. They explain method only and are not predicted outcomes.
Illustration 1
Hip fracture: true leg shortening after a healed femur fracture
Assumed facts: Assume a work-related proximal femur fracture has healed with genuine structural shortening rather than apparent shortening from pelvic tilt. The unaffected leg measures 82 cm. Three manual readings of the affected leg are 78 cm, 77 cm and 79 cm, giving an average of 78 cm and a true difference of 4 cm.
Method: For this hip fracture illustration, Manual limb length uses the average of three readings. A 4 cm discrepancy falls within the NSW-corrected 4-4.9 cm row in Table 17-4.
Illustrative outcome: This shows how the selected hip fracture method is applied without an ADL adjustment. The corrected NSW row is 7% WPI (18% LEI). This deliberately differs from the older base AMA5 example because the NSW correction prevails. It is an illustration, not an estimate for a particular worker.
Source: NSW Guidelines paras 3.8-3.9 and corrected AMA5 Table 17-4; paraphrased from the AMA5 Chapter 17 example
What usually does not increase WPI
Pain, tenderness, swelling or difficulty walking does not create a percentage without a valid lower-limb method.
A scan label, surgery name or recommendation for surgery is not a fixed WPI result.
Work restrictions, weekly payments and inability to resume the pre-injury job are important claim issues but are not themselves impairment measurements.
Activities of daily living cannot be used to increase or reduce the calculated lower-extremity rating.
Evidence checklist
The records for hip fracture should include the accepted injury description, date and any insurer decision limiting the body part or diagnosis and imaging and operation reports, including the relevant side, level, compartment and procedure. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Repeat movement, stability, alignment, circumference, limb-length or neurological measurements required by the selected method.
- A calculation worksheet identifying the table, regional unit, permitted combinations, conversion and rounding.
How this injury commonly happens at work
Work-related hip fracture can arise through a fall from height or stairs landing on the hip and a vehicle, forklift or machinery impact. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related hip fracture can arise through a heavy direct blow or crush event and a work incident causing a femoral neck, intertrochanteric, subtrochanteric, femoral-head or acetabular fracture. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For hip fracture, an insurer may dispute whether the fracture is acute, work-related or affected by underlying bone disease and whether shortening, reduced motion or arthritis is measured under the correct method. The written decision should be answered with evidence directed to those reasons.
Further disputes about hip fracture may concern whether the femoral-neck malunion row has been wrongly used despite the NSW exclusion and whether later replacement or ongoing restrictions relate to the accepted fracture. 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 hip fracture may involve fracture fixation or conservative care, protected weight bearing, rehabilitation and orthopaedic follow-up where clinically supported. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for hip fracture should address standing, walking, stairs, kneeling, squatting, driving and load carrying and safe duties that avoid unsafe mobility demands. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For hip fracture, capacity evidence should address travel to work and medication effects where relevant and weekly payment decisions where partial capacity is overstated. 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 hip fracture, a claim review can help to clarify diagnosis and mechanism of injury and compare work duties with medical restrictions. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For hip fracture, a claim review can help to respond to treatment or work capacity disputes and prepare WPI evidence when the condition becomes stable. 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 hip fracture claims
How can work cause or aggravate hip fracture?
For hip fracture, the relevant work history may include a fall from height or stairs landing on the hip, a vehicle, forklift or machinery impact, and a heavy direct blow or crush event. 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 hip fracture?
For hip fracture, NSW Guidelines Chapter 3 applies AMA5 Chapter 17 subject to NSW corrections. The most specific valid method is used, and where more than one valid method applies the highest valid evaluation is generally selected unless Table 17-2 permits a combination. The fracture pattern, healed alignment, true bilateral limb length, hip motion, radiological cartilage interval and any replacement result determine the available method. 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 hip fracture assessment?
A hip fracture assessment commonly needs the accepted injury description, date and any insurer decision limiting the body part or diagnosis, imaging and operation reports, including the relevant side, level, compartment and procedure, repeat movement, stability, alignment, circumference, limb-length or neurological measurements required by the selected method, and a calculation worksheet identifying the table, regional unit, permitted combinations, conversion and rounding. 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 hip fracture?
For hip fracture, common issues include whether the fracture is acute, work-related or affected by underlying bone disease, whether shortening, reduced motion or arthritis is measured under the correct method, and whether the femoral-neck malunion row has been wrongly used despite the NSW exclusion. 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 hip fracture affect weekly payments and suitable duties?
Capacity evidence for hip fracture may need to address standing, walking, stairs, kneeling, squatting, driving and load carrying, safe duties that avoid unsafe mobility demands, and travel to work and medication effects where relevant. 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.
Does hip fracture automatically receive a fixed WPI percentage?
No. For hip fracture, one verified example is true discrepancy 0-1.9 cm: 0% WPI (0% LEI), under NSW-corrected AMA5 Table 17-4. That value applies only when its stated criteria are met. Pain, tenderness, swelling or difficulty walking does not create a percentage without a valid lower-limb method.
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.