EXPRESSION OF INTEREST – Medical
The Medical Panels Office is currently recruiting
impairment assessors. Expressions of interest are sought from
medical practitioners in active clinical practice in Victoria.
Current members of Medical Panels who wish to be re-appointed should
also submit their interest and re-apply to Medical Panels.
Fees payable to panel members reflect the responsibility and
professional standing of the appointment. For further
information contact the Medical Panels office on 03 8256 1555 or see
for further details.
Website Consent Form
participants are reminded to send in their consent form regarding
inclusion in our new AMA 4 Guides website. Should you require
another copy of your form or further clarification, please contact
Dorothy Aban on 03 9280 8764, e-mail firstname.lastname@example.org or
fax to 03 9349 5248.
Module Completion – Send us your
A number of clinicians undertaking some
modules have not yet completed the case study assessments. We
are unable to supply certificates of completion until these
assessments have been carried out, and the committee would like to
urge you to complete the assessments to receive your final
The AMA 4 newsletter is not just a vital tool of
information – it’s also a forum. Participants are invited to share
their thoughts, issues and ideas on their AMA 4 training with our
readership. Please email us email@example.com if
you would like to share your experiences, and we will address these
topics in upcoming issues.
Stream 2 Given The Thumbs
According to recent evaluation by Stream 2
participants, the AMA 4 training modules are relevant, informed and
highly detailed. Feedback showed that the importance of accurate
assessments was emphasised in the course, as well as observing legal
guidelines and impressing a greater awareness of legislation.
Participants voted an overwhelming 100% satisfaction rate regarding
the relevance of the course to their understanding of legal
From tricky legislation to impact assessment in
action, we take a look at AMA 4 and the law.
||In The Courts
Spotlight On: The Wrongs
Qualified Impairment Assessors (an ‘approved
medical practitioner’) may be asked to carry out an assessment in
relation to a personal injury which comes under the purview of the
1958. Section VB and VBA of the Act are the
relevant sections. An Assessment under the Act is not
connected with assessments made for the purposes of accident
compensation or workers compensation.
Under the Act,
claimants are only able to access damages for ‘non-economic’ loss if
they have suffered significant injury. Significant injury is
defined in the case of psychiatric injury, as impairment of more
than 10%, and in the case of injury other than psychiatric, whole
person impairment of more than 5%. (The three other categories
of significant injury are the loss of a foetus, psychological or
psychiatric injury arising from the loss of a child as a result of
an injury to the mother or the foetus before, during or immediately
after the birth, or the loss of a breast.)
is defined as pain and suffering, loss of amenities of life or loss
of enjoyment of life.
The assessment is carried out using the
AMA4 Guides in the same way as for transport accident compensation
and workers compensation, including in relation to psychiatric
impairment, asthma and infectious diseases. The threshold in the
Wrongs Act in relation to hearing loss assessments is different from
those used for transport accidents and workers
A respondent who disagrees with an assessment
may refer a question in relation to the assessment to a medical
For further information Click
Here or download a full copy of the Wrongs
Transport Accident Commission v
The Supreme Court of Victoria dismissed
the appeal in Transport Accident Commission v Elworthy
regarding the combining of values to calculate impairment
percentages of the lower extremity. The court affirmed the
- Whole person values are to be used when combining multiple
lower extremity impairments.
- The maximum value of 40% whole person impairment cannot be
exceeded for one lower extremity
The plain words of the
Guides text must be followed and the use of the guides is to promote
precision, certainty and consistency.
Further details about the decision can be accessed here.
An expanded reference chart is available to attendees of the stream
1 and 2 training sessions to assist practitioners.
Mountain Pine Furniture P/L v Taylor – Watch This
We are currently in the process
of incorporating new changes to the Spinal module curriculum now the
appeal decision regarding the Mountain Pine Furniture P/L v
Taylor case has been handed down. We will provide all
participants with further updates as soon as this material is
completed. Please click here for a copy of the appeal decision.
The Transport Accident Act 1996,
the Accident Compensation Act 1985 and the Wrongs Act 1958 all
impact upon the determination of psychiatric impairment. With
confusion among examiners, plaintiffs, insurers and the courts,
these guidelines are timely, and provide a framework to improve
agreement between medical examiners.
For further information regarding these advisory annotations,
click here to download the
Our module practitioners discuss the finer points of
AMA 4, in theory and practice.
||Modules In Detail
Method Of Grading Motor And
Sensory Loss In Peripheral Nerve Lesions
Professor Richard Stark, Chair Neurology Spinal Reference
There is some confusion as to the correct method for choosing the
percentage figure for grading motor and sensory loss in peripheral
The correct procedure is to determine which grade or category of
loss is appropriate for each relevant nerve using Tables 20 and 21
of Chapter 4 of the text. After determining which Grade is correct,
the most appropriate percentage figure within the range offered for
that Grade is then applied.
Thus a patient with Grade 4 power in the distribution of the
median nerve above mid-forearm would, from Table 12 of Chapter 3,
have between 1% and 25% graded loss. The allocation for complete
motor loss of this nerve is, from Table 15, 44% upper limb. The
calculated impairment could therefore be anything between 0.44%
(rounded to zero) and 11% of upper limb. While this may seem a wide
range, Grade 4 power may range clinically from a barely detectable
reduction of power to power just sufficient to overcome minimal
resistance as well as gravity.
The example at the foot of the first column of page 49 appears to
be the source of some confusion. In that example, the examiner
chooses the maximum figure in the range (25% for Grade 4 power).
Some have interpreted this to mean that the maximum figure should
always be chosen. This interpretation is clearly incorrect for 3
- As indicated above, there can be a great difference in
clinical effect between loss of power (or sensation) at the bottom
end versus the top end of a defined grade.
- If the Guides did not intend the ranges to be used, why were
they provided (rather than a single percentage figure for each
- There are examples provided in which less than the maximum
figure for a grade is used. For example on page 51 a sensory grade
of 20% (not the maximum 25%) is used and on page 53 a motor grade
of 40% (not the maximum 50%) is used.
The Neurology Reference Group has always taught that the full
range of percentages for each grade is available for use and
confirms this opinion.
Quick Tips For Impairment
When examining and measuring for shoulder
movements: asking the patient to move both shoulders provides
stability to the shoulder girdle, and assists in accurate
measurement of shoulder movement.
Provocation testing such as a straight leg raising test is of no
value for a back impairment assessment and should be avoided.
When measuring and recording range of movements for the upper
extremity using the provided charts in the guides is useful, and
will help the examiner avoid missing impairments.
When grading Peripheral Nerve Disorder using Tables 11 and
12 (Chapter 3 pages 48-49), be aware that the grading for
sensory deficit is from 1 to 5 for increasing severity, and from 5
to 0 for increasing severity, with the grading for motor deficit
Grip strength: although grip strength impairment is not
frequently used there are some injuries (such as significant forearm
muscle trauma) where using the Jamar dynamometer may be relevant.
After testing with the standard grip technique, checking the results
with the rapid alternate hand technique i.e. quickly gripping with
alternate hands, will demonstrate a more accurate
reading.provided by Dr John Malios, AMA 4 Guides Committee
CHECKLIST: THIRD PARTY
Unfortunately, complaints about third party
examinations are relatively common. They can mention that the
independent impairment assessor was rude or dismissive, demonstrated
a lack of respect for privacy, and at worst, an exacerbation of
With prior expectations built up during clinical consultations,
it is sometimes a surprise to the patient to be treated differently
during an M-L assessment. The following practical safeguards are
recommended to establish an environment during such examinations
that minimises the risk of complaints to the third party or the
1. Explain, explain, explain: A minute of
explanation can save hours of correspondence with the insurer or the
Board. Be sure to discuss beforehand the extent of the examination,
including questioning and physical examination.
2. Practical safeguards: Extend the same
courtesy and respect you would normally show your clinical patients.
Provide facilities for privacy, and do not record conversations
without the patient’s consent.
3. Get organised: Restrict your report to your
area of expertise. Allocate enough time for the assessment, and
record the time you spent. Avoid causing unnecessary pain, and
explain in advance what you plan to do.-Summarised from the
Core Module presentation given by Dr Robert Adler, Deputy President
Medical Practitioners Board of Victoria.
Calendar Of Upcoming
Places are filling up fast for the winter/spring
AMA 4 modules. Register your interest here.
Lower Extremities (Stream 2) Fully
6th September at 6:30pm
Visual System (Stream 2)
11th September at 6:30pm
Hand & Upper Extremities (Stream 2)
11th September at 6:30pm
Spine (stream 2) Fully Booked
19th September at 6:30pm
Core (Stream 1) Fully Booked
20th October at 8:30pm
Core (stream 2) Fully Booked
20th October at 11:30am
Psychiatry (stream 1) Fully
22nd October at 6:30pm
Ear Nose & Throat (stream 1)
1st November at 6:30pm
Respiratory (Stream 2)
1st November at 6:30pm
Psychiatry (Stream 2) Fully
26th November at 6:30pm
Digestive (Stream 2)
27th November at
The 2008 program will be available soon. Register your interest
here to receive the