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In the Real World

Lawyer Ross Goodridge exposes the defficincies in the new medical assessment guidelines for workers compensation by looking at real case studies.

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"Common law rights will also be retained for seriously injured workers. Workers currently need to show fault to access common law and have a 25 per cent loss under the table of disabilities. Under the bill, workers still need to demonstrate fault and a 25 per cent impairment, which is determined using the impairment guidelines." The Hon J Della Bosca - Hansard 29 March 2001

The above statement is how the proposed changes to Worker's Compensation rights were presented to Parliament.

The statement is absolutely untrue in 3 respects:

(1) The legislation requires a GREATER THAN 25% impairment.

(2) The impairment is not to be assessed under " the table of disabilities" or "the impairment guidelines" but rather under a particular American system that is much harsher.

(3) Seriously injured workers DO NOT retain common law rights. Look at the examples below. (Remember NO common law unless greater than 25% impairment under the American system.)

CONSIDER

A 29-year-old spare parts salesman - impact injuries to both legs resulting in 14 operations, the last being 20 months after the accident

Injuries: Permanently limited to semi-sedentary work prospects, permanent requirement to use brace on right leg to prevent collapsing while walking. Uses sleeping tablets every night to assist in sleeping. Consumes 6 to 12 pain-relieving tablets every day. Limited capacity to engage in social activities, loss of confidence, physiotherapy was complicated by an episode of sepsis and osteomyelitis.

Impairment - 18% whole person under the American system.

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A 26-year-old enrolled nurse - injured whilst transferring patient

Injuries: Disc lesion to L5/S1 level resulting in a permanent incapacity to lift more than 5 kg or undertake any employment or activity that involves bending, pushing or pulling. The injury has resulted in constant pain.

Interference with abilities to undertake housework, domestic chores. Reduced capacity to enjoy and participate in sexual activity.

Impairment - 12% whole person under the American system.

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A 26-year-old plumber / 1st grade rugby league player - employer refused to shore up trench which collapsed on the plumbers

Injuries: Severe injury to foot including loss of 3rd and 4th toes. loss of football career. Loss of ability to work as plumber. Loss of ability to engage in simple social and domestic activities. Unable to walk without a limp. Unable to stand for long periods of time.

Impairment - less than 25% under the American system.

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24-year-old truck driver - married with children ~ fell 4 metres into concrete pit due to no safety rail -

Injuries

Brain injury.

Shoulder injury requiring surgery - with a possibility of future shoulder replacement.

Loss of grip strength in both arms.

Severe restrictions in movement, so much so that his Wife had to bathe him for 6 months.

Unlikely to ever work again.

Impairment - less than 25% under the American system.

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15-year-old boy carrying double bed mattress over head - tripped whilst stepping over work material on workshop floor

Injuries

Severe injury to back requiring Spinal operation.

Permanently unfit for most work.

Impairment - less than 20% under the American system.

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40-year-old employee of rental company - married with children - sent to collect a washing machine single-handed

Injuries

Injured L4/5 and L5/S1 discs

No longer to lift or bend. In constant pain.

Unable to sleep comfortably. Unable to stand for long periods of time. Unable to sit for long periods of time.

Unlikely to ever work again.

Impairment - less than 20% under the American system.

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33-year-old coalminer - married with 2 children, aged 7 and 10 - suffered back injury working on machinery known by the employer to be faulty.

Injuries

Back injury leading to unrelenting pain in back and left leg.

Underwent spinal fusion surgery. 4 years later - further surgery to insert a spinal cord stimulator.

Unable to engage in any ordinary activity in life without substantial pain and discomfort.

Pain in back has lead to decimation of sex life.

Cared for daily by wife.

Impairment - less than 25% under the American system.

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25-year-old service station attendant - required by employer to climb through the ceiling to reach keys which had been accidentally locked by the employer in an internal room - ceiling collapsed

Injuries

Injury to neck. Injury to elbow. Numbness in both legs.

Difficulty dressing himself. Difficulty sleeping. Restricted capacity to work. Inability to stand for long periods of time. Inability to sit for long periods of time. Inability to undertake lifting above 10 kg. Experiences daily pain.

Impairment - less than 25% under the American system.

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43-year-old factory worker - part of right hand amputated when drawn into a machine not properly guarded by employer - unlikely to return to employment

Impairment - 18% under the American system.

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22-year-old construction worker / labourer - within the first few days of working for the employer, an archway fell on head.

Injuries

Employee suffered crush injuries to foot and hand requiring skin grafting and cannulated screws placed in foot.

Permanent restriction in ability to undertake labouring work. Future employment prospects severely limited.

Impairment - 19% under the American system.

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33-year-old construction worker - fell from scaffolding which was improperly and inadequately installed - injury caused by employer's breach of Occupational Health and Safety Act, 1984 - CFMEU union member

Injuries

Fractured hip. Injury to back. Injury to right hand. Dependent upon pain-killing medication, daily. Unlikely to return to work.

Impairment - 16% under the American system.

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15-year-old school student working part-time at McDonald's Restaurant - allegedly required to lift 32 kg load in breach of Occupational Health & Safety Act by employer

Injuries

Injured back leading to spinal surgery at L4/5 and L5/S1 discs. Constant sciatica in left and right legs. Difficulty in sitting, standing. Experiences constant and unrelenting pain.

Impairment - 20% under the American system

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42-year-old female stores assistant injured when crushed by forklift whilst employed by Qantas

Injuries: Permanent injury to neck, thoracic spine, chest.

Inability to undertake second job employed at Star City Casino.

Impairment - approximately 10% under the American system

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34-year-old storeman required to man handle 44 gallon drum

Injuries: Injury to back requiring spinal surgery. Difficulty standing, sitting, bending or lifting. Limited prospect of ever returning to work.

Impairment - 15% under the American system

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37-year-old hardware shop employee - married with 3 children

Injuries: Injury to back causing sciatica in both legs. Constant and unrelenting pain exacerbated by any activity. Dependent upon pain-killing medication, daily.

Impairment - 15% under the American system

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65-year-old factory worker - injured when a 350 kg load, not properly secured by the employer, flung off a turntable and landed on employee

Injuries: Multiple factures of the 6th, 7th, 8th and 9th ribs on the left side of the chest wall. Injury to neck. Right-sided hydrocele caused by scrotal trauma. Injury to head. Injury to back. Injury to chest. Injury to left shoulder and arm. Bruising to left side of body. Bruising to left buttock. Depression. Interference with sex life. Impotence. Over 450 physiotherapy consultations and an ongoing need for physiotherapy 3 times per week for life.

Impairment - 16% under the American system

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18-year-old labourer hit by a felled tree

Injuries: Injuries to head and back requiring a Taylor Brace. Continuing inability to work in any suitable employment.

Impairment - 15% under the American system

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41-year-old labourer lifting injury

Injuries: Suffered L4/5 disc prolapse. Suffers depression. Back pain. Partial loss of use of both legs. Interference with ability to sleep. Inability to stand or sit for long periods. unfit to work again

Impairment - 15% under the American system

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45-year-old married machine operator whose hand was drawn into a machine which did not have a required fence or guard protecting the operator from the dangerous moving parts

Injuries: Employee suffered 15% permanent loss of use of right arm and 25% permanent impairment of back

Impairment - 18% under the American system

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17-year-old boilermaker's assistant and part-time disc jockey and part-time pizza restaurant worker - injured when required by employer to use a crane - worker had no relevant licence or experience.

Injuries: The load fell on the young worker's legs causing serious injury to the right ankle and left foot. Worker now had difficulty standing. Can only walk short distances. Future employment prospects are doubtful.

Impairment - 14% under the American system

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48-year-old employee tripped on string at work damaging both knees - now unable to do housework and cannot work

Impairment - 11% under the American system

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18-year-old employee in bakery

Injuries: Suffered impact injury to left knee resulting in reflex sympathetic dystrophy leading to 30% loss of leg. Has difficulty working and will have limited employment prospects for life

Impairment - 12% under the American system

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36-year-old sawmiller

Injuries: Injured right hand - now suffers wasting of right arm - certified fit for light duties - unable to work in sawmilling as no light duties exist in the industry

Impairment - 12% under the American system

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37-year-old operating room nurse

Injuries: Suffered severe injury to back leading to spinal surgery and depression with adjustment disorder - permanent impairment of back at 30% and 20% of left leg due to sciatica and referred nerve impingement

Impairment - 20% under the American system

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36-year-old council worker suffered severe injury to back when required to lift a concrete lid weighing approximately 100 kg.

Injuries: Underwent spinal surgery - now assessed at having 45% permanent impairment of back and 5% impairment of each leg due to radiculopathy

Impairment - 15% to 20% under the American system

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48-year-old truck driver injured when trolley fell from truck

Injuries: Now suffers 30% permanent impairment of pelvis, 15% permanent impairment of back. Unable to lift more than 5 kg. Unable to undertake any activity that involves pushing, pulling, sitting or standing for long periods of time. Suffers severe depression.

Impairment - 15% under the American system

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48-year-old assistant nurse injured whilst assisting a quadriplegic

Injuries: Now suffers severe back problems. Interfering with her ability to work, sleep, stand, sit and lift. No longer can enjoy sexual activity.

Impairment - 15% under the American system

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Furniture removalist injured by an unlicensed forklift operator at work

Injuries: Suffered fracture to the jaw and scapula. Injured neck and feet. Suffered a fracture to the thoracic spine and nerve damage. Reduced capacity to work for life.

Impairment - 16% under the American system

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35-year-old electrician injured in lifting incident - required to lift a cable drum

Injuries: Suffered significant protrusion at L4/5 disc level leading to spinal surgery. Suffers constant pain and has reduced enjoyment of all aspects of life.

Impairment - 15% under the American system

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24-year-old worker who suffered acute depression after a lifting injury caused substantial injury to back

Impairment - 12% under the American system.

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35-year-old storeman who underwent 2 spinal fusions resulting in total incapacity for work - the back condition after the two spinal fusions was assessed at 35% permanent impairment of his back together with a 12 % impairment of leg

Impairment - 22% under the American system

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40-year-old storeman injured back - required to undergo surgery twice in hospital for the L4/5 and L5/S1 levels - damages claimed in excess of $1,000,000

Impairment - 15% under the American system

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50-year-old health worker suffering back injury - requiring spinal fusion twice - first one for laminectomy then fusion - permanent inability to work

Impairment - 15% under the American system

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40-year-old recycler - married with children - required to lift 120 kg bale of cardboard - suffered severe injury to back at L5/S1 disc level causing protrusions with substantial sciatica in both legs. Inability to work or enjoy normal activities in life. In constant and severe pain.

Impairment - 16% under the American system

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17-year-old retail assistant - injured back in shop severe problems restricting ability to work for life

Impairment - whole of body impairment 10% under the American system.

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41-year-old hospital assistant injured when trays were dropped on legs - suffered a permanent 25% loss of left leg

Impairment - 5% to 10% under the American system.

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A 42-year-old man fell 30 feet and landed on his upper back. He complained of neck pain radiating down his right arm. Sixteen months later, after a maximum medical rehabilitation program and an optimal period for physiological recovery, an examination disclosed a 20% sensory loss in the C5 area and 50% loss of power of the muscles innervated by C5. These losses were stable and were determined to be permanent impairments.

Impairment - 16% impairment of the arm which is a 10% impairment of the whole person under the American system

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A 35-year-old forklift mechanic had a 2-year history of median nerve compression in the right hand with abnormal results of median nerve conduction studies and an abnormal electromyogram. Seven months after surgical decompression of the median nerve in the right carpal tunnel, followed by a change of occupation to salesman, the man's symptoms were infrequent, transient episodes of numbness in the thumb and index finger after 40 minutes of driving.

Examination showed a full range of movement of all joints and normal two-point discrimination sensory testing. Compared to the left hand, the right hand had a 60% strength loss index.

Impairment The upper extremity impairment due to a residual tunnel syndrome is 10% or 6% of the whole person under the American system.

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A 40 year old labourer with a total wrist replacement has flexion to 30� and extension to 20�; wrist implant arthroplasty = 30% impairment of the arm.

Impairment 30% of arm = 18% impairment of whole body under the American system.

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A 40-year-old woman had a comminuted midshaft tibial fracture that healed with 2.5 cm of shortening and 10� of varus angulation. The patient was advised of the risks of midshaft tibial osteotomy and lengthening, and she declined surgery.

Impairment - The lower-extremity impairment estimate for the varus angulation is 20%; the impairment estimate for 2.5 cm of shortening is 8%. The 25% and 8% lower extremity impairments are combined using the Combined Values Chart. The lower extremity impairment is 31%, which is a 12% whole-person impairment under the American system.

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A 37-year-old female clerk had onset of right arm pain and the medical workup and clinical tests showed a large herniated nucleus pulpous between C5 and C6 and C6 radiculopathy. Excision of the herniated disc with fusion surgery was performed because of the patient's radiculopathy, and the symptoms resolved. The woman later was classified as having had a category III impairment.

Impairment - Cervicothoracic category III, 15% whole-person impairment under the American system.

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A 27-year-old female clerk, who previously was in good health and had normal vision, experienced a progressive loss of vision in the left eye during a 6-month period. During the next 6 months there was slight return of visual acuity, but she no longer could read with that eye or see television images.

Results of a physical examination were normal, as were results of basic laboratory tests. The woman's visual acuity was 20/200 at near and far with the left eye and 20/20 with the right eye. The findings on neurologic examination were otherwise normal.

Impairment - The woman's whole-person impairment was estimated to be 23% under the American system.

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A 55-year-old farmhand had onset of diplopia 4 months before examination and almost immediately his symptoms stabilised. The persistent condition interfered with his workplace responsibilities, recreational pursuits, and his hobby of stamp collecting.

Results of physical examination and laboratory tests were normal except for the neurologic system. There was diplopia on forward fixation of gaze, and the patient was unable to abduct the right eye.

Impairment - The diplopia impairment was estimated, by means of the criteria to be a 20% impairment of the visual system, or a 19% whole-person impairment under the American system.

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A 60-year-old woman with diabetes mellitus developed a persistent painful numbness of the right leg during a 6-month period. This sensation involved the lateral aspect of the lower leg and extended in a more severe fashion down to the dorsum of the foot.

A physical examination disclosed the following abnormalities: a decrease in perception of pinpoint, cold, and light touch on the dorsum of the foot extending to the upper lateral calf area; painful paraesthesia and dysesthesias of the foot; and mild weakness of dorsiflexion of the foot with a mild foot drop, characteristic of a peroneal nerve neuropathy.

Impairment - A 6% whole-person impairment combined with a 1% whole-person impairment is a 7% whole-person impairment under the American system.

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A 21-year-old man suffered a ruptured spleen in an automobile crash. A splenectomy was performed. The post-operative course was uneventful. Within 2 months the patient returned to his usual daily activities. He was examined for permanent impairment 8 months after hospital discharge.

Impairment - 0% impairment under the American system.

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A 16-year-old otherwise healthy girl during a vacation job suffers the total loss of vision of one eye when a nail gun is fired into the eye. The employer had been warned on at least 5 prior occasions that the nail gun was dangerous. The vacation worker was not provided with any eye protection during the job.

Impairment - 24% under the American system.

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A 22-year-old university student studying medicine during a holiday job suffered an impact injury to the throat from the tongs of negligently driven forklift. The impact of the injury caused a 70% permanent speech impairment.

Impairment - whole-person 24% under the American system.

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Ten years earlier, a 56-year-old truck driver had developed a pararectal abscess that had drained spontaneously. During the ensuing 3 years, infection had recurred, with opening of fistulous tracts in four other areas surrounding the anus. Surgical repair was undertaken in two stages, but this necessitated incision and excision of substantial portions of the anal sphincter muscle. Recovery was delayed by wound infections. Eventually, the perineum healed, but the patient had no fecal control. Despite daily rectal irrigation he soiled himself occasionally.

An examination disclosed complete functional loss of the anal sphincter mechanism.

Impairment - 25% impairment of the whole person under the American system.

(this case does not involve negligence, however, the assessment is instructive)

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A 35-year-old plumber had had acute viral hepatitis 10 years earlier, with a protracted convalescence. Recently the disease had been quiescent; the patient had no visible icterus, ascites, or evidence of gastrointestinal tract bleeding. The man's strength and nutritional state were satisfactory, although his stamina was limited.

Impairment - 15% impairment of the whole person under the American system.

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A 35-year-old farm worker was thrown against the steering wheel of his truck when it slid off a road. A few weeks later, while seeming to recover from his injuries, he noted increasing abdominal pain and distention. An expanding cyst of pancreas was demonstrated by serial ultrasonography. Subtotal pancreatectomy was required to remove the cyst and allay the associated inflammatory reaction.

Fifteen months later, despite treatment with pancreatic enzyme supplements, the man had intermittent diarrhoea and steatorrhoea, and his stamina was notably diminished. He was 1.9 m tall and weighted 74.5 kg, whereas his previous weight had been 81.7 kg. He still experienced occasional epigastric and back pain. Tests showed no evidence of impaired glucose tolerance or diabetes.

Impairment - 20% impairment of the whole person under the American system.

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A 28-year-old man with progressive chronic glomerulonephritis developed marked azotemia and oliguria requiring haemodialysis. Successful renal transplantation with a kidney from his mother resulted in good renal function with a creatinine clearance of 108 L / 24 h. The patient received maintenance treatment with azathioprine and prednisone and required close observation for development of osteoporosis.

Impairment - 25% impairment of the whole person due to renal disease and the need for continuous medication under the American system.

(this case does not involve negligence, however, the assessment is instructive)

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A 23-year-old man experienced considerable laceration of the ventral surface of the penis that created a surgically uncorrectable fistula. He was able to perform most activities of daily living, but he could not void normally. He could ejaculate during sexual intercourse, but was unable to make his wife pregnant.

Impairment - 15% impairment due to the urethral fistula and 10% impairment due to impaired sexual function, which combine to a 24% whole-person impairment under the American system.

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A 32-year-old deliveryman suffered a compressive injury to the penile shaft. Healing occurred with partial cicatrisation of the left mid-corpus cavernosum. A bow-string curvature of the left occurred during erections. Sensation and ejaculation were normal, but pain resulted if intercourse were not undertaken carefully.

Impairment - 9% impairment of the whole person, which takes into consideration the patient's age under the American system.

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A 28-year-old salesman suffered a fractured pelvis with wide separation of the symphysis pubis, perivesical and periprostatic haematomas, and a tear of the prostatomembranous urethra. The injuries were corrected with reconstructive surgery, and there was no subsequent urinary difficulty. Erection and intercourse were possible, but penile sensation and ejaculation were absent.

Impairment - 15% impairment of the whole person, which includes consideration of the patient's age under the American system.

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A 38-year-old policeman had an injury resulting in loss of all scrotal skin. Split-thickness skin graft reconstruction gave a good cosmetic result. At examination there was no evidence of testicular malfunction, but testicular mobility was affected, and the patient experienced discomfort during exercise and in certain positions.

Impairment - 5% impairment of the whole person, which consider the patient's age under the American system.

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A 50-year-old fireman suffered extensive burns of the lower extremities, genitals and abdomen. Skin grafting to the abdomen and lower extremities was satisfactory; however, it was necessary to transplant the testicles to subcutaneous pouches in the thighs to permit adequate skin coverage of the scrotal area.

Impairment - 15% impairment of the whole person under the American system.

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A 34-year-old married woman developed a rectovaginal fistula after vaginal delivery of her second child. This was corrected surgically, but the woman developed severe vaginal stenosis. She required intermittent dilatation of the vagina under anaesthesia and the continuous use of vaginal creams. These measures made sexual intercourse possible, but it was painful and the patient lacked sexual sensation and enjoyment. A third pregnancy ended with a caesarean section because vaginal delivery was deemed hazardous.

Impairment - 20% impairment of the whole person, which includes consideration for the patient's age under the American system.

(this case does not involve negligence, however, the assessment is instructive)

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A 27-year-old woman who had borne two children developed increasing pain secondary to severe pelvic endometriosis. She had a laparotomy for resection of bilateral ovarian endometriomas, resection and fulguration of peritoneal implants, and presacral neurectomy. A normal pregnancy ensued that resulted in the birth of a healthy infant. After breast-feeding for 14 months, the patient developed pelvic pain secondary to recurrent endometriosis. This required intermittent medical therapy for suppression of the chronic, recurring pain.

Impairment - 20% impairment of whole person under the American system.

(this case does not involve negligence, however, the assessment is instructive)

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A 65-year old man had severe hypothyroidism of 16 months' duration, with pronounced mental slowing, loss of memory, and apathy. He also had severe coronary artery disease with angina pectoris that could be precipitated by walking only 50 feet. The total thyroxine level was 0.5 mg/dL, and that of thyrotropin was 100 mU/mL. Repeated trials and careful adjustment of doses of levothyroxine indicated that a dose larger than 0.05 mg/d caused aggravated angina. Significant debility due to hypothyroidism persisted.

Impairment - 20% impairment resulting from hypothyroidism, which is to be combined with an appropriate value for the cardiovascular impairment to determine impairment of the whole person. however, if the cardiovascular disease were treated, for instance, by angioplasty or bypass surgery, it might be possible to replace the thyroid hormone level fully, in which case the degree of impairment would need to be re-evaluated. (this case does not involve negligence, however, the assessment is instructive)

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Several years ago, a 55-year-old man had developed the signs and symptoms of non-insulin-dependent (type II) diabetes mellitus. Examination at that time disclosed no retinopathy or proteinuria. Although he lost weight on a prescribed diet, the plasma glucose level could not be maintained within normal limits on that diet. When the patient was on a restricted diet and was staking an oral agent, his fasting serum glucose level was 120 mg/dL, and his glycohemoglobin level was 9.5%.

Impairment - 5% impairment of the whole person under the American system.

(this case does not involve negligence, however, the assessment is instructive)

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A 27-year-old man who worked for a small paint manufacturing company developed acute contact dermatitis of the hands and arms. He related the onset of the illness and exacerbations to the preparation of batches of latex pain. Patch testing revealed a strong allergic reaction to 0.1% petrolatum mixture of a non-mercurial preservative, 2-n-4-isothiazolin-3-1, which was used by the company in its latex paints. The patient was unable to avoid latex paint completely, and his dermatitis continued. When he left the company to seek other employment, the dermatitis resolved.

Impairment - 0% impairment of the whole person under the

American system.

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A 28-year-old woman developed an eczematous eruption beneath the wedding ring on the fourth finger of her left hand shortly after the birth of her first child 6 years earlier. The eruption gradually spread to involve areas on several fingers of both hands, despite treatment and avoidance of the use of jewellery. The eruption persisted for several months, then subsided slowly. A severe flare-up of hand dermatitis occurred after the birth of a second child 2 years later.

At present, a chronic, low-grade dermatitis persisted despite special precautions. Intermittent treatment was required to control the dermatitis. The patient had no history of eczema, hay fever, or asthma, and no family history of atopy. Her general heath was good, but the chronic hand dermatitis caused intermittent discomfort and limitation in the performance of some activities of daily living, such as dishwashing, childcare, and grasping.

Results of a physical examination and basic laboratory studies were normal except for scarring and lichenification. Patch tests performed with various food, household, cosmetic and diagnostic and therapeutic materials were non-reactive.

Impairment - 10% impairment of the whole person under the American system.

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A 25-year-old man who had a family history of "eczema" and "hay fever" had had a recurrent pruritic eruption since the age of 1 month, when it was characterised by oozing lesions of the face, scalp, neck, and upper extremities. A diagnosis of infantile eczema was made shortly after onset. As a boy he had had periods of relatively complete remission, but even during these periods, lichenified patches in his antecubital, popliteal, and neck areas persisted. Exacerbations were severe during high school years and increased in frequency during college.

For the past several years, the man had suffered exacerbations approximately once per month, lasting 7 to 10 days and involving the shoulders, arms, hands, legs, and trunk. The exacerbations could be brought on by cold weather, sudden changes in environmental temperature, or stressful situations at home. During the exacerbations, the eczema limited some activities of daily living, and he had difficulty sleeping, washing dishes, and concentrating on his work as an accountant. During remissions, the lichenified dermatitis persisted in the antecubital and popliteal fossae and at the sides of the neck, but this was a minimal annoyance and did not significantly limit daily activities.

The eczema required intermittent application of topical steroid creams during relative remissions. When it flared up, constant application of topical steroids was required, as were antihistamines and oatmeal starch baths. Systemic steroids were required once per year to induce remissions.

Results of a physical examination with basic laboratory studies were normal, except that lichenified areas appeared at the lateral aspects of the neck and in the creases of the arms and legs.

Impairment - 15% impairment of the whole person under the American system.

(this case does not involve negligence, however, the assessment is instructive)

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A 30-year-old male was employed in a rare-metals refining plant. He was inadvertently splashed with concentrated liquid zirconium chloride over the face, scalp, and neck. He was immediately washed and then taken to the hospital, where he remained for 2 days. Healing and epithelialisation occurred without complications. He returned to work 22 days after the episode.

Months after the incident, the man noted that depigmentation of the splashed areas had begun to occur. He noted that the depigmented areas sunburned easily, causing considerable discomfort and restricting his ability to work outdoors or pursue other outdoor activities. Regular application of a sunscreen was necessary. Whenever the patient operated a hot kiln or approached a furnace, the heat caused a marked stinging sensation within the affected skin areas, which was so intense that he had to stop all activities for 10 to 15 minutes until the pain subsided. Also, muscle twitching occurred within affected areas. Similar episodes might be provoked by hot showers or extremely warm days. Occasional muscle twitching and severe discomfort might occur within the affected areas and wake the patient from sleep once or twice a week. The patient experienced considerable embarrassment when attempting to explain his disfigurement, and he avoided many kinds of social activities in which he previously had participated.

A physical examination I year later showed that there had been no change in the patient's pigment loss, hyperaesthesia, and intolerance to sunlight and warmth. There were well-demarcated areas of depigmentation on the right side of the face, extending from behind the right ear to the centre of the face, and from the midtemple area of the scalp to the chin. There were smaller areas of depigmentation on the left side of the neck and behind the right ear. The maximum dimensions of the depigmented areas on the right side of the face were 16 x 11 cm. There were narrow collars of hyperpigmentation around the depigmented areas. Neurologic examination indicated that all of the depigmented areas were hypersensitive to cold, heat, pinprick, and touch, and for some of these areas, low-temperature stimuli were mistakenly identified as "hot" and "burning".

Impairment - 20% impairment of the whole person under the American system.

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A 40-year-old woman purchased a sculptured-nail kit consisting of liquid methylmethacrylate monomer and powdered methylmethacrylate polymer. When mixed and applied to the fingernails according to directions, the chemicals formed a paste, which hardened to clear plastic resembling artificial nails. The woman's nails initially were normal, but she eventually developed swelling and redness of the eponychial and paronychial areas with severe pain and paraesthesia of all fingers. She lost the nails on all 10 fingers. When the acute inflammatory process subsided, the woman underwent patch testing and a positive result was found to 5% methylmethacrylate monomer in olive oil.

The patient was observed for several years, during which time none other fingernails regrew. The nail beds were exposed and keratinised, and the paronychial areas continued to be swollen and tender. The paraesthesia persisted, although the woman long before had stopped using the sculptured nail kit. She complained of difficulty grasping, cold sensitivity, burning, tingling, and a "pins and needles" sensation, especially when picking up small objects such as coins. The woman also had difficulty with other non-specialised hand activities, which aggravated the symptoms and increased the paraesthesia of the fingers. She typically applied adhesive bandages over petroleum jelly to her nail beds and wore gloves most of her waking hours. She was anxious and depressed and required an occasional psychiatric consultation.

Impairment - 20% impairment under the American system.

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I considered presenting this as a quiz to all Members of Parliament asking each Member to tick the cases they thought not serious injuries and afterwards providing the assessments. As instructive as this may have been I will not trivialise the injured in this way. Surely fairness speaks for itself.

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  Issue 92 contents

»	Costa To Join Della�s List
»	Compo Campaign Gathers Steam
»	Della�s List: Dissident MPs Targeted
»	Day of Mourning to be Compo Focus
»	Small Steps in Negotiations � But Hard Yards Still to Come
»	Important First Step for E-Mail Privacy
»	Outraged Cleaners Continue AXA Axings Protests
»	Grenadier Picket Ends � But Legacy Lives On
»	Entitlement Dramas in Health and Printing
»	Nurses Still Waiting on Olympics Bonus
»	IRC Delays Hit Eight Month Barrier
»	Claims of Dirty Tricks Conspiracy at Mobil
»	Sydney Water Workers On Strike
»	MUA Rides Anti-pollution Wave
»	Governments Urged On Child Slavery
»	Time To Act on Pay Discrimination
»	Construction Union Supports Folk Festival
»	Activists Notebook

»	The Soapbox
»	The Locker Room
»	Trades Hall
»	Tool Shed

»	Workers Comp: The People Speak
»	Dellas List: Rhiannon-V-McDonald
»	Crosby Responds to Douls
»	English Teacher Ripped Off
»	Protocol of Cabinet Solidarity??
»	Tom Collins Goes Off
»	Vote One: Tony Abbott

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