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How this assessment usually works
Head, brain and neurological assessments often need careful correlation between clinical history, neurological examination, cognitive or vestibular symptoms, imaging and the worker's real function. A normal scan does not always answer every impairment question, but symptoms still need objective clinical support.
The assessor does not decide legal liability. The assessment is a medical opinion about permanent impairment under the NSW workers compensation guidelines. The legal importance is what the percentage does to Section 66, weekly payments, medical expense time limits, settlement strategy or work injury damages preparation.
Step 1
Accepted injury
Check the accepted injury wording, body system and mechanism before looking at the percentage.
Step 2
Medical method
Check whether the correct NSW guideline method, clinical findings and records were used.
Step 3
Claim effect
Check what the WPI percentage changes before accepting a report or settlement position.
How the assessment pathway is usually built
A useful WPI report should show its working. For head, brain and neurological, the pathway usually needs these steps before anyone relies on the percentage.
Identify whether the issue is brain injury, cranial nerve, vestibular disorder, spinal cord injury, peripheral nerve injury, station/gait, movement disorder, sleep/arousal issue or neuromuscular problem.
Check whether the condition belongs in AMA5 Chapter 13 or should instead be assessed through the spine, upper-limb or lower-limb pathway.
Separate cognitive, neurological, vestibular, psychological, pain and medication effects. They can overlap, but they are not the same impairment pathway.
Confirm stability. Ongoing neurological recovery, active vestibular therapy, medication adjustment or neuropsychological rehabilitation can affect timing.
Review whether the report relies on objective clinical findings, early hospital records, neuroimaging, neuropsychology or specialist evidence rather than a brief symptom list.
Assessment method points from the NSW guideline
These points are not a self-calculation tool. They are practical checks for whether the WPI report is using the right body-system method and reasoning.
Neurological assessment may involve AMA5 Chapter 13 with NSW modifications, but peripheral nerve injuries often need the relevant upper limb, lower limb or spine pathway.
Chapter 13 covers cerebral functions, cranial nerves, station and gait, movement disorders, upper-extremity disorders related to central impairment, brain stem, spinal cord and peripheral nervous system issues.
Spinal cord injury is assessed using the AMA5 spine pathway and combined with the corresponding spinal impairment where required.
Radiculopathy is usually handled through the spine and relevant nerve-deficit methodology rather than treated as a broad neurological complaint.
Brain injury reports should avoid double-rating the same functional problem across cognition, communication, consciousness, emotional or behavioural categories.
A normal scan does not automatically end the question, but ongoing symptoms need clinical support, consistency and functional explanation.
Sleep or arousal problems should be approached carefully and normally need appropriate specialist testing before they are treated as permanent neurological impairment.
Psychological symptoms after head injury may be important evidence, but primary psychiatric impairment and neurological impairment are different assessment questions.
What can change the WPI percentage
The final percentage can move because of method selection, objective findings, surgery, pre-existing deduction, or how multiple impairments are combined. These are the practical pressure points for this injury type.
- The affected neurological function: cognition, communication, consciousness, cranial nerve, station/gait, movement, spinal cord or peripheral nerve.
- Whether the assessor avoids double-rating the same functional loss across more than one neurological category.
- Neuropsychological testing, vestibular assessment, neurology opinion and early hospital documentation where relevant.
- Whether spinal cord injury is combined with the corresponding spinal impairment where the guideline requires it.
- Functional effects on safety-critical work, machinery, driving, heights, screens, concentration and reliable attendance, while keeping WPI distinct from capacity.
What the assessor usually checks
- whether the accepted injury is concussion, TBI, vestibular injury, nerve injury or another neurological condition
- neurologist, neuropsychologist, ENT, vestibular or rehabilitation evidence where relevant
- cognitive, balance, sensory, motor and fatigue impacts on daily function and work
- whether symptoms are stable enough for assessment
- whether psychological symptoms are primary, secondary or part of another assessed pathway
Evidence that may help
A useful WPI report depends on the material the assessor receives. These records often matter for head, brain and neurological:
- hospital, emergency, GP and specialist records close to the incident
- neurology, neuropsychology, ENT, vestibular therapy or rehabilitation reports
- symptom diaries recording headaches, concentration, balance, fatigue and memory problems
- certificates of capacity dealing with driving, machinery, heights, screens, noise and cognitive load
- incident reports, witness accounts and work duties records
Common insurer or report disputes
- the insurer says symptoms are subjective or unrelated
- cognitive problems are treated as stress rather than neurological sequelae
- the report ignores fatigue, dizziness or work-safety restrictions
- assessment occurs before symptoms have stabilised
- physical and psychological consequences are confused without clear reasoning
Report cautions before relying on the percentage
Report red flags
- The report says “concussion resolved” without dealing with ongoing vestibular, cognitive, sleep or neurological records.
- Cognitive impairment is mixed with depression, pain medication or poor sleep without explaining the difference.
- Peripheral nerve symptoms are discussed without identifying the nerve, sensory/motor findings or relevant body-system chapter.
- The report uses a work-capacity conclusion as if it were the WPI method.
Method and reliance checks
- Does the report separate neurological impairment from psychological symptoms and work-capacity opinion?
- Were early hospital records, neurology reports, neuropsychology reports or vestibular records available?
- Does it explain fatigue, dizziness, concentration and safety limits with reference to clinical findings?
- Is the impairment stable enough for assessment?
- Does the report explain why a peripheral nerve problem is rated in Chapter 13 or in an extremity chapter?
- If cognition is assessed, does the report explain testing, reliability and functional translation rather than simply repeating complaints?
- Concussion and post-concussion symptoms can be complex; the report should not rely only on a brief examination snapshot.
- Cognitive symptoms can overlap with pain, medication, poor sleep and psychological distress, so the medical reasoning matters.
- Driving, heights, machinery and screen tolerance may be work-capacity issues even where the WPI number is modest.
Guideline notes
- NSW neurological assessment refers to AMA5 Chapter 13 with modifications.
- Peripheral nervous system assessment is often handled through the affected body-system chapter.
Questions to ask when the report comes back
How this connects to thresholds and strategy
SIRA says permanent impairment compensation generally requires 11% or more permanent impairment for physical injury, and 15% or more for primary psychological injury. Secondary psychological injury is treated differently. Those thresholds are not a payout promise; they are eligibility and strategy checkpoints that need to be applied to the accepted injury and current evidence.
A low WPI opinion may also affect weekly-payment planning, treatment time-limit issues, dispute posture, and whether work injury damages threshold advice is required. The safest approach is to review the method, evidence and consequences before signing or letting the insurer rely on a weak assessment.
Questions workers often ask
Is head, brain and neurological assessed the same way as every other injury?
No. NSW permanent impairment assessment depends on the accepted injury, body system, medical evidence, maximum medical improvement and any NSW-specific guideline modification. The assessment method for head, brain and neurological should be checked against the injury actually accepted in the claim.
Can I calculate the WPI percentage myself?
No. A trained permanent impairment assessor must perform the assessment. A worker can still check whether the report used the correct injury description, records, body system, causation assumptions and deduction reasoning.
What if the insurer report seems too low?
Ask for the report and the material sent to the assessor. For head, brain and neurological, compare the report against treating records, imaging, specialist material, work duties and certificates of capacity before accepting the percentage or relying on it for settlement strategy.
Does maximum medical improvement matter?
Yes. SIRA guidance says permanent impairment assessment should occur when the condition has stabilised and is unlikely to change substantially in the next year with or without treatment. If treatment is incomplete, the timing may need review.
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.