Assessment overview
How this assessment usually works
A permanent vestibular disorder is assessed through the equilibrium method in AMA5 Chapter 11 as modified by NSW Chapter 6. The diagnosis, objective signs and effect on safe everyday movement must fit the same assessment class.
For vestibular and balance, the assessor gives a medical opinion about permanent impairment under the NSW workers compensation guidelines; the assessor does not decide legal liability. Once the body-system method and percentage are understood, separate advice may be needed about Section 66 compensation, weekly payments, medical-expense time limits or work injury damages.
Injuries and diagnoses assessed in this body system
The referral and report should identify the accepted diagnosis precisely. Similar symptoms can use different assessment methods depending on the injured structure.
- permanent peripheral vestibular dysfunction after head trauma, acoustic trauma, infection or accepted inner-ear injury
- benign paroxysmal positional vertigo where the condition and objective signs remain stable and permanent
- labyrinthine, vestibular-nerve or bilateral vestibular loss affecting equilibrium
- central balance disorder, noting that a brain or spinal neurological method may apply instead of the ENT equilibrium table
When a permanent impairment assessment can occur
For vestibular and balance, assessment should occur only after maximum medical improvement (MMI). NSW Guidelines paragraph 1.15 describes a condition that is well stabilised and unlikely to change substantially during the next year, with or without treatment.
For vestibular and balance, if adequate treatment or rehabilitation could materially change the impairment, paragraph 1.16 says the assessment should be deferred. The report should explain why the timing is appropriate.
For vestibular and balance, vestibular symptoms can fluctuate and may improve with repositioning treatment, medication, vestibular rehabilitation or recovery from acute injury. The report should explain why the residual balance disorder is stable.
The NSW and AMA5 assessment method
The NSW Workers Compensation Guidelines prevail over AMA5 wherever the two differ. The method is a medical assessment framework, not a self-scoring exercise.
NSW paragraph 6.3 directs equilibrium assessment to AMA5 section 11.2b and Table 11-4. The table uses classes based on the supported vestibular disorder, objective findings and interference with activities.
NSW adds that a positive Hallpike test is a sign and an objective finding for Class 2, without limiting other valid objective evidence. A positive test helps establish the class criterion; it does not by itself fix the exact WPI within that class.
The assessor must distinguish an ear or vestibular equilibrium disorder from gait loss caused by brain, spinal cord, lower-limb or medication problems. The same loss should not be rated twice under different systems.
The proprietary AMA5 Table 11-4 ranges have not been reproduced because the supplied ENT companion did not contain the controlling table. The report should cite the class, table and exact point it actually applies.
What the assessor actually measures
For vestibular and balance, the percentage should be traceable to relevant, stable and reproducible findings.
- history and pattern of vertigo, oscillopsia, imbalance, falls and positional provocation
- Hallpike or other positional testing, nystagmus and the consistency of bedside findings
- audiovestibular testing such as videonystagmography, caloric, rotary-chair or vestibular-evoked testing where clinically indicated
- standing, walking, turning, uneven-ground and low-light function attributable specifically to the vestibular disorder
- use of an aid, supervision, treatment response and whether another neurological, visual or musculoskeletal condition explains the balance loss
How the measurements are converted to WPI
Match the stable vestibular diagnosis and objective findings to the appropriate AMA5 Table 11-4 class as modified by NSW paragraph 6.3.
Select the precise WPI within the supported class from the frequency, persistence and functional effect of the equilibrium disorder, explaining why the point is not lower or higher.
Assess a separate neurological, visual or hearing impairment under its own controlling method only if it represents a distinct loss and combination is permitted.
Verified category and table examples
These short examples show how the published method works. They do not predict an individual assessment.
| Finding or category | Published value or method | Source |
|---|---|---|
| Positive Hallpike test | A sign and objective finding for equilibrium Class 2 | NSW Guidelines paragraph 6.3 modifying AMA5 Table 11-4 |
Worked illustrations
How the assessment method can operate
These paraphrased illustrations explain the published method. They are not estimates of another worker's WPI.
Illustration: positional vertigo needs more than a symptom history
Assumed findings: After an accepted head injury, a worker has stable recurrent positional vertigo. Repeated examination reproduces the symptoms with nystagmus and a positive Hallpike test, while the neurological and lower-limb examinations do not explain the balance loss.
Method and arithmetic: NSW paragraph 6.3 allows the positive Hallpike result to satisfy an objective-finding element for AMA5 Table 11-4 Class 2. The assessor still has to place the worker within the class using the documented frequency and functional effect.
What the illustration shows: The positive test does not create an automatic percentage, and dizziness alone would not establish the same class. This paraphrased illustration is not an estimate.
Method source: NSW Guidelines paragraph 6.3; AMA5 section 11.2b and Table 11-4
What does not establish WPI by itself
These matters can remain medically and practically important, but they do not replace the measurements or category requirements in the applicable method.
- dizziness, nausea, fear of falling or imbalance without a stable vestibular diagnosis and objective examination
- one inconsistent positional test without a coherent clinical pattern
- a positive test treated as an automatic WPI point rather than one class criterion
- balance loss caused by another body system counted again as vestibular impairment
Evidence checklist
The assessor should receive enough material to test the accepted injury, stability, measurable impairment and any deduction.
- the accepted injury or disease description and any insurer liability decisions
- contemporaneous GP, hospital and treating-specialist records
- relevant investigations, pathology, procedure reports and treatment history
- earlier impairment assessments and evidence about any pre-existing impairment
- a current clinical opinion explaining stability and whether material improvement remains likely
- ENT, neurologist or vestibular-specialist reports identifying the cause and stable diagnosis
- Hallpike, nystagmus and formal audiovestibular test results where clinically obtained
- vestibular-rehabilitation, falls, aid and functional records showing the residual equilibrium effect
- neurological, visual and musculoskeletal material needed to distinguish other causes of imbalance
Common insurer or report disputes
A disagreement about vestibular and balance WPI may concern the accepted diagnosis, the body-system findings, the selected method, a deduction or the way another impairment was handled. The report should identify the disputed step rather than leave the percentage unexplained.
- dizziness is treated as impairment without a stable diagnosis or objective sign
- a positive test is used without explaining frequency or functional effect
- the same gait loss is rated under both vestibular and neurological methods
- the report quotes a class but does not explain the precise result within it
Sources for this assessment guide
The public NSW Guidelines control where they modify AMA5. AMA5 table references below identify the method without reproducing the proprietary table in full.
- NSW Guidelines Chapter 6, paragraph 6.3: equilibrium method and positive Hallpike clarification.
- AMA5 Chapter 11, section 11.2b and Table 11-4: equilibrium class structure and selection of WPI, subject to NSW modification.
Questions to ask when the report comes back
These questions help identify whether the report explains its method and evidence. They do not replace medical or legal advice about the particular assessment.
- What permanent vestibular diagnosis has been accepted?
- Which objective signs support the AMA5 equilibrium class?
- How does the condition affect safe standing, walking and travel?
- Has overlapping neurological or lower-limb impairment been avoided?
How this connects to thresholds and strategy
In a vestibular and balance claim, SIRA's permanent impairment thresholds must be applied to the accepted injury and the supported body-system percentage. The general thresholds are 11% or more permanent impairment for physical injury and 15% or more for primary psychological injury; secondary psychological injury is treated differently. A threshold is an eligibility checkpoint, not a promised payment.
A low vestibular and balance WPI opinion may affect weekly-payment planning, treatment time-limit issues, dispute posture and whether work injury damages threshold advice is required. Before the opinion is relied on, check the relevant measurements, body-system method, deduction and practical consequences.
Questions workers often ask
Is dizziness by itself enough to establish vestibular WPI?
No. The assessment needs a stable accepted diagnosis, objective signs and the functional evidence required by the selected equilibrium class.
Why can a Hallpike test matter?
NSW Guidelines paragraph 6.3 recognises a positive Hallpike test as an objective sign for AMA5 Table 11-4 Class 2. It does not automatically determine the final percentage.
Can balance loss be assessed twice?
The same functional loss should not be counted under both an ENT equilibrium method and a neurological or lower-limb method.
When should a vestibular condition be assessed?
After maximum medical improvement, when treatment and rehabilitation are unlikely to produce a substantial change during the next year.
General information only
This information is general in nature and is not legal advice. You should obtain advice about your own circumstances before relying on a WPI percentage, accepting a lump sum offer, or responding to an insurer decision.
Reviewed by NSW Work Injury Claims - a branch of Stephen Young Lawyers.
Related injury and impairment pages
Need a WPI assessment checked?
If the percentage does not match the accepted injury, treatment history, imaging, surgery, work duties or current restrictions, get the report checked before accepting the insurer position.