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Assessment of disability under the Social Security Industrial Injuries Benefit Scheme.

This paper outlines the principles involved in the assessment of disability under the State Industrial Injuries Scheme provisions in the UK. There are some differences when considering the respiratory diseases and these are mentioned. Assessment of disablement is not easy and medical boards have some leeway on reaching a decision. Assessment is largely ultimately a matter of clinical judgement. Assessments of disablement for Industrial Injuries purposes are carried out by Adjudicating Medical Authorities (AMA). These are independent statutory authorities consisting of one, or two or more, doctors. When examined by an AMA the individual is compared with a person of the same age and sex whose physical and mental condition is normal. Special circumstances such as loss of earnings or the effect of the disablement on hobbies can not be considered in the assessment of disablement. Prescribed degrees of disablement for certain conditions such as amputations at various levels are laid down in Social Security (General Benefit) Regulations (see Appendix 1 attached) but the AMA has the discretion to increase or reduce these assessments where it would be fair to do so. In addition, the AMA has for guidance, notes on types of assessment for certain injuries which have been given by Medical Appeal Tribunals (MAT). The MAT is the tribunal to which an appeal against an AMA decision may be made. Appendix 2 describes these assessments. In assessing disablement the AMA will attempt to equate the level of disablement to the types of assessment in appendices 1 and 2. For example, the AMA will ask itself, how does this man's knee injury equate to an ankylosis of the knee or does it equate to an amputation of the leg, and if so, at what level? There are clearly many cases such as disablement from cardiac, respiratory abdominal and psychiatric conditions, where the guides in appendices 1 and 2 cannot be applied. The doctors who carry out assessments of disablement are given intensive training on the factors to be taken into account in assessing what constitutes a proper level of assessment as based upon the medical evidence. A rough guide to assessment is shown below.