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 vertebral fracture claim, the diagnosis is only the starting point. The records should connect x-ray, CT or MRI identifying the vertebral level and fracture pattern and hospital, orthopaedic or spinal specialist records with the worker's practical limits, including lifting, bending, sitting, standing, driving and shift tolerance and suitable duties that avoid repeated aggravation. If the insurer disputes whether the fracture was acute, old or osteoporotic, 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 paras 4.1 and 4.5: spinal impairment is assessed using the diagnosis-related estimates (DRE) method. The AMA5 spine range-of-motion model in sections 15.8-15.13 must not be used in NSW workers compensation.
- NSW Guidelines paras 4.14-4.15: alteration of motion segment integrity (AOMSI) is established from the permitted radiographic or structural findings and must relate to trauma, not developmental or degenerative change alone.
- NSW Guidelines paras 4.18, 4.20-4.21 and 4.27-4.29: the DRE category depends on supported clinical findings. Imaging alone, and radiating pain alone, do not establish radiculopathy; EMG is not the NSW category differentiator.
- NSW Guidelines paras 4.30-4.38 and Tables 4.2-4.3: special NSW rules apply to fractures, spinal surgery, pelvis, sacroiliac injury and coccyx injury.
- AMA5 Chapter 15 Tables 15-3, 15-4 and 15-5 provide the lumbar, thoracic and cervical DRE ranges, subject to the NSW modifications.
What injuries or conditions may be assessed?
Vertebral injury can include compression, burst, endplate, transverse-process, spinous-process or posterior-element fracture, with or without canal disruption, AOMSI or neurological compromise.
- Fracture type and residual deformity matter. A fracture label or pain severity does not identify the DRE category without the required imaging and neurological findings.
- For multilevel compression fractures, NSW adds the percentage loss of vertebral height at each level before selecting the fracture band.
Symptoms and findings that matter
Centred radiographs should measure vertebral-height loss at the most compressed point against the estimated normal height from adjacent normal vertebrae.
Red-flag neurological features such as bladder, bowel, saddle sensation, walking tolerance or spinal cord signs require specialist evidence before any WPI pathway is chosen.
For vertebral fracture, flexion means bending forward, extension bending backward, lateral flexion bending sideways, and rotation turning the neck or trunk. These observations help classify the injury but are not converted through the excluded AMA5 spine ROM model.
Possible radiculopathy in a vertebral fracture claim generally needs at least two supported criteria, including a major clinical sign such as reflex asymmetry, localised weakness, reproducible dermatomal sensory loss, a nerve-tension sign or muscle wasting.
Imaging for vertebral fracture should match the level, side and clinical pattern. A degenerative or disc finding can exist without establishing the accepted injury or a higher DRE category.
Where vertebral fracture has been treated surgically, the operation type, level count, repeat procedures and residual objective neurological findings must be documented separately.
What investigations are usually relevant
Investigations for vertebral fracture may include surgical notes, admission records and post-operative imaging are central where fusion, fracture fixation or decompression is alleged and MRI or CT showing the spinal level, disc, canal, foraminal or fracture findings. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- Neurological examination recording power, reflexes, sensation and nerve-root distribution.
- Operation reports and post-operative specialist reviews if surgery occurred.
- Certificates of capacity and duties evidence showing sitting, standing, bending, lifting, driving and attendance limits.
How WPI is assessed for this body part
Under NSW paragraph 4.30, total multilevel compression below 25% is DRE II, 25-50% is DRE III and more than 50% is DRE IV; verified radiculopathy moves the fracture assessment one category higher. The regional DRE range then controls the WPI.
NSW Guidelines Chapter 4 assesses vertebral fracture under the diagnosis-related estimates (DRE) method, using AMA5 Chapter 15 only as modified by NSW.
NSW paragraphs 4.5 and 4.13 exclude the AMA5 spine range-of-motion model. Multilevel disease, recurrence or surgery therefore does not switch a vertebral fracture assessment to ROM.
For vertebral fracture, DRE I is 0% WPI. DRE II requires qualifying findings beyond symptoms alone, while DRE III commonly concerns objective radiculopathy or another specifically listed fracture or post-decompression condition. Within one spinal region, competing findings select the highest valid DRE category; they are not added as separate WPI values.
A vertebral fracture assessment reaches DRE IV only where the evidence supports alteration of motion segment integrity (AOMSI), fusion or specified severe fracture findings. AOMSI is established from permitted structural or radiographic evidence, not ordinary bedside movement loss.
DRE V is reserved for its severe neurological and structural criteria. Persisting radiculopathy after fusion is handled through NSW Table 4.2 rather than automatically moving vertebral fracture to DRE V.
Any arm or leg symptoms attributed to vertebral fracture must match objective nerve-root findings. Radiating pain, an MRI label or one abnormal test does not by itself establish radiculopathy.
Cervical, thoracic and lumbar DRE ranges
Select the supported DRE category before reading the regional range. A diagnosis, scan or pain score does not automatically select the top value.
| Category | Lumbar | Thoracic | Cervical | What the category means in practice |
|---|---|---|---|---|
| DRE I | 0% WPI | 0% WPI | 0% WPI | Symptoms may be reported, but the examination does not show the objective findings required for a higher DRE category. |
| DRE II | 5-8% WPI | 5-8% WPI | 5-8% WPI | A qualifying injury with findings such as guarding, spasm, asymmetric movement loss or non-verifiable radicular complaints, but without the objective radiculopathy or AOMSI required for a higher category. Certain lesser fractures also fall here. |
| DRE III | 10-13% WPI | 15-18% WPI | 15-18% WPI | Commonly applies where objective radiculopathy is established, or where a specified fracture or NSW post-decompression rule places the injury in this category. |
| DRE IV | 20-23% WPI | 20-23% WPI | 25-28% WPI | Commonly concerns AOMSI or a severe compression fracture without the neurological features of DRE V. NSW also places successful and unsuccessful spinal fusion in DRE IV. |
| DRE V | 25-28% WPI | 25-28% WPI | 35-38% WPI | The severe AMA5 category generally requires radiculopathy with AOMSI, or a qualifying severe fracture with neurological compromise. NSW does not move a fusion to DRE V merely because radiculopathy persists after surgery. |
Sources: NSW Guidelines Chapter 4; AMA5 Chapter 15, Tables 15-3, 15-4 and 15-5, as modified by NSW.
Worked assessment illustrations
These examples paraphrase the assessment reasoning in the source material. They explain method only and are not predicted outcomes.
Illustration 1
Two-level lumbar vertebral compression fracture
Assumed facts: At maximum medical improvement, centred imaging records 20% loss of vertebral height at one lumbar level and 15% at the next, measured against the adjacent normal vertebrae.
Method: NSW paragraph 4.30 adds the percentage height loss at each involved vertebra. The assumed total is 35%, which falls within the 25-50% band and therefore lumbar DRE III, before considering whether verified radiculopathy changes the category.
Illustrative outcome: Lumbar DRE III is 10-13% WPI. The fracture measurements, image quality and any neurological findings must be verified by the assessor. This illustration is not an estimate for any individual claim.
Source: NSW Guidelines paras 4.12 and 4.30; AMA5 Table 15-3
What usually does not increase WPI
Back or neck pain alone, without an assessable spinal diagnosis or objective findings, usually does not increase WPI.
Degenerative scan wording by itself is not a rating; the assessment must link the accepted injury to clinical findings.
Radiating pain without objective radiculopathy usually should not be treated as radiculopathy for WPI.
A work capacity restriction is not the same as a permanent impairment percentage.
Evidence checklist
The records for vertebral fracture should include MRI/CT/X-ray reports and the actual spinal level relied on and neurological examination findings: power, reflexes, sensation and nerve tension tests. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Specialist reports explaining diagnosis, causation, treatment and maximum medical improvement.
- Operation reports, if decompression, fusion or other spinal surgery occurred.
- Duties evidence showing lifting, bending, twisting, sitting, standing, vibration or driving demands.
How this injury commonly happens at work
Work-related vertebral fracture can arise through falling from height or stairs and a vehicle, forklift or machinery impact. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related vertebral fracture can arise through being struck or crushed by a heavy object and a high-load manual handling incident where fracture is medically confirmed. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For vertebral fracture, an insurer may dispute whether the fracture was acute, old or osteoporotic and whether work caused or aggravated the fracture. The written decision should be answered with evidence directed to those reasons.
Further disputes about vertebral fracture may concern whether deformity, neurological consequences or continuing treatment are accepted and whether work capacity has been overstated after apparent bony healing. 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 vertebral fracture may involve brace or activity restriction, specialist monitoring, rehabilitation or fixation where clinically supported and assessment of neurological or deformity consequences where present. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for vertebral fracture should address lifting, bending, sitting, standing, driving and shift tolerance and suitable duties that avoid repeated aggravation. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For vertebral fracture, capacity evidence should address capacity certificates that match the actual job demands and weekly payment decisions based on realistic work ability. 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 vertebral fracture, a claim review can help to identify the exact disputed issue before responding and organise medical, imaging and work-task evidence. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For vertebral fracture, a claim review can help to check weekly payment and work capacity decisions and consider treatment, WPI and 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 vertebral fracture claims
How can work cause or aggravate vertebral fracture?
For vertebral fracture, the relevant work history may include falling from height or stairs, a vehicle, forklift or machinery impact, and being struck or crushed by a heavy object. 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 vertebral fracture?
For vertebral fracture, under NSW paragraph 4.30, total multilevel compression below 25% is DRE II, 25-50% is DRE III and more than 50% is DRE IV; verified radiculopathy moves the fracture assessment one category higher. The regional DRE range then controls the WPI. Centred radiographs should measure vertebral-height loss at the most compressed point against the estimated normal height from adjacent normal vertebrae. 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 vertebral fracture assessment?
A vertebral fracture assessment commonly needs MRI/CT/X-ray reports and the actual spinal level relied on, neurological examination findings: power, reflexes, sensation and nerve tension tests, specialist reports explaining diagnosis, causation, treatment and maximum medical improvement, and operation reports, if decompression, fusion or other spinal surgery occurred. 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 vertebral fracture?
For vertebral fracture, common issues include whether the fracture was acute, old or osteoporotic, whether work caused or aggravated the fracture, and whether deformity, neurological consequences or continuing treatment are accepted. 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 vertebral fracture affect weekly payments and suitable duties?
Capacity evidence for vertebral fracture may need to address lifting, bending, sitting, standing, driving and shift tolerance, suitable duties that avoid repeated aggravation, and capacity certificates that match the actual job demands. 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 vertebral fracture by itself?
For vertebral fracture, back or neck pain alone, without an assessable spinal diagnosis or objective findings, usually does not increase WPI. 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.
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