A Guide to the Assessment of

Traumatic Injuries and Occupational

Diseases for Work Injury Compensation
 A Guide to the
Assessment of Traumatic Injuries
and Occupational Diseases for
Work Injury Compensation

FIFTH EDITION (REVISED)

Compiled by
Work Injury Compensation Medical Board
Ministry of Manpower
Singapore
First Edition — June 1978
Second Edition — June 1987
Third Edition — October 1990
Fourth Edition — February 1999
Fifth Edition — December 2006
Fifth Edition (Revised) — June 2011

© Work Injury Compensation Medical Board

Ministry of Manpower
Singapore

All rights reserved. No part of this publication may be reproduced in any form or by
any means, including photocopying and recording, without the written permission of the
copyright holder, application for which should be addressed to the publisher. Such written
permission must also be obtained before any part of this publication is stored in retrieval
system of any nature.
 (Revised)

Work Injury Compensation Medical Board

Prof V Prem Kumar, Chairman, Work Injury Compensation Medical Board and Senior Consultant,

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 PREFACE
TO THE FIFTH EDITION (2011) (REVISED)

The fourth edition (1999) saw a major revision of the guide of more than 25 years by the inclusion of
assessment of neurological disorders (mainly peripheral nervous system), specific injuries affecting the limbs
and spine (diagnosis based estimates) as well as the assessment of the hearing, respiratory, renal and hepatic
functions.

The fifth edition is another major revision which further expands the scope of the guide by adding new chapters
for the assessment of the disorders of the central nervous system, gastro digestive tract and visual function.
Significant updates and revisions have also been made to the existing chapters particularly on the assessment
of renal function, respiratory function and upper and lower limb function. These amendments were made
following feedback from specialists on the existing guide and to align with newer developments in the
assessment of such disorders.

This revision was made with guidance from the newly formed Work Injury Compensation Medical Board as well
as from the various specialists. We would like to thank all the contributors for making this revision possible.
We would also like to thank the Singapore Orthopaedic Association and the Singapore Society of Hand
Surgery for their valuable feedback in this revision.

The 5th edition of the guide should be used for the assessment of all work-related injuries and occupational
diseases with effect from 1st January 2007 (date of assessment). This will apply to all initial assessments done
on or after 1st January 2007 (irrespective of the date of injury). For objection cases (i.e. those requiring
re-assessment by the Work Injury Compensation Medical Board), where the initial assessment was based on
the 4th edition of the guide, the assessment should continue to be based on the 4th edition for consistency. The
5th edition may be referred to in such cases where there is no guidance given in the previous edition.

Even with the expanded scope, the guide would still not cover all injuries and all systems for practical reasons.
For injuries or systems not included in this guide (e.g. oral/maxillofacial, skin, psychological, etc), reference
should be made to the latest edition of the American Medical Association's Guides to the Evaluation of
Permanent Impairment.

Work Injury Compensation Medical Board

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For work injury compensation purposes under the Work Injury Compensation Act, medical
assessment of the degree of disability is required only for permanent incapacity and not for
temporary incapacity.

It is the residual incapacity which the assessing doctor considers to be

stable and not likely to progress or improve further at the time of the medical evaluation. A
reasonable timeframe for the stabilisation of medical conditions is three months, as long as no
further medical intervention is required or the conditions will not improve or deteriorate.

Under the Work Injury Compensation Act, the worker is entitled to be paid full earnings up to
14 days if not hospitalised and 60 days if hospitalised. He is further entitled to receive
two-thirds of his monthly earnings per month for up to one year. It should be noted a worker
with no permanent incapacity is still entitled to monetary benefits for temporary incapacity.

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 Example:
The inter-phalangeal joint of the thumb was found to have restriction of motion with a
flexion of 350.
The values in the guide are as follows:

Active Flexion from neutral (00) to % Incapacity

or arc of active flexion of:

300 4%
400 3%

Therefore, the permanent incapacity award should be 3.5% (i.e. intermediate value of
3% and 4%).

For ankylosis:

If a joint is ankylosed in a certain position, use a goniometer to measure the angle of

deviation from the neutral position of that joint in each direction. Consult the guide for
the percentage incapacity corresponding to the fixed angle measured in each direction.
The largest percentage incapacity is taken as the incapacity of the joint (NB. The
percentages for ankylosis are not added unlike restriction of motion).

Example:

A patient's wrist joint is ankylosed in 200 dorsiflexion and 100 radial deviation. The
percentage incapacity of the joint is 28 % (which is the largest percentage incapacity).

Position of ankylosis % incapacity

200 dorsiflexion 14 %
100 radial deviation 28 %

% incapacity of the joint 28 %

B. NEUROLOGICAL DISORDERS

Sensory loss of fingers (digital nerves)

1. Carry out a two point discrimination test to determine sensory quality on the palmar aspect
of the fingers.
2. Identify the digital nerve(s) involved.
3. For partial sensory loss, a value of 50% of the impairment values for total loss can be given.

Peripheral nerves and plexus

1. Identify the affected peripheral nerve or plexus.

2. Assess the loss of sensory (diminished sensation or pain) and motor (loss of power)
function (whether partial or total).
3. Give a proportion of the maximum percentage incapacity for sensory, motor or combined
deficits. For partial loss which interferes with activity, a value of 50% of the impairment
values can be given.

Deformities, pain, weakness, atrophy, restriction of motion have been taken into account in
the percentage incapacity for peripheral nerves. If restriction of motion results strictly from a
nerve lesion, the impairments from restriction of motion should not be applied in addition to
prevent duplication.

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different joints and injured parts. The total percentage incapacity is 37%, by
combining 11%, 10%, 9%, 4%, 4%, 3%, 3% (a simple addition would have given a
total of 42%). The total does not exceed that for the loss of one hand.

Assessment of Permanent Incapacity for middle finger

DIP joint ROM 10º = 6%

PIP joint ROM 20º = 6%
Reduced sensation over finger tip = 2.5%
Combined = 14.5%

(Note: For computation of permanent incapacity involving fractions, the whole

numbers should be combined first and fractions added back later. In this case,
combine 6%, 6% and 2% to give 14%; 0.5% is then added back to give 14.5%.)

Compare with amputation of middle finger

Loss of 3 phalanges = 12%

As the combined Permanent Incapacity of individual parts should not > whole body
part, the Permanent Incapacity awarded = 12%.

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I. AMPUTATIONS OF THE UPPER LIMB

Part amputated Percentage impairment

Loss of both limbs } ..................................100%

Loss of both hands }
Loss of all fingers and both thumbs }

Loss of arm at shoulder } .................................. 75%

Loss of arm between shoulder and elbow }
Loss of arm at elbow }

Loss of arm between wrist and elbow } ................................... 70%

Loss of hand at wrist }
Loss of four fingers and thumb of one hand }

Loss of four fingers ...................................................................................... 60%

Loss of thumb
Both phalanges and 1st metacarpal ........................................................ 36%
Both phalanges ........................................................................................................ 30%
One phalanx ............................................................................................................. 20%

Loss of index finger

Three phalanges and 2nd metacarpal ................................................................ 21%
Three phalanges ..................................................................................................... 14%
Two phalanges ........................................................................................................ 11%
One phalanx ................................................................................................................ 9%

Loss of middle finger

Three phalanges and 3rd metacarpal .................................................................. 15%
Three phalanges ..................................................................................................... 12%
Two phalanges ............................................................................................................ 9%
One phalanx ................................................................................................................ 7%

Loss of ring finger

Three phalanges and 4th metacarpal .................................................................. 10%
Three phalanges ........................................................................................................ 7%
Two phalanges ............................................................................................................ 6%
One phalanx ............................................................................................................... 5%

Loss of little finger

Three phalanges and 5th metacarpal ................................................................. 10%
Three phalanges ........................................................................................................ 7%
Two phalanges ............................................................................................................ 6%
One phalanx ................................................................................................................ 5%

Loss of metacarpals
First or second ............................................................................................................ 8%
Third, fourth or fifth ..................................................................................................... 3%

NB Where there is loss of two or more parts of the hand, the percentage shall not be more than the loss of the
whole hand.

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24
25
 4%

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Figure14: Impairment due to total transverse sensory loss of digits (numbers at tips of
digits) and total longitudinal sensory loss of radial and ulnar sides of digits
(numbers at sides of digits). For partial sensory loss the impairment would be
50% of these numbers.

)
l (R
dia
Ra 4%

7%
)
11% r (U
Ulna

2%
1% (U)
3% 2% (R)
(R) (U) 1%
2%
(U)
3% 2% (R)
(R) (U) 3%

5%
3%
5%

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2nd metacarpal 4%
3rd metacarpal 4%
4th metacarpal 2%
5th metacarpal 2%

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Loss of 2nd toe
Three phalanges and 2nd metatarsal 7%
Three phalanges 3%
Two phalanges 2%
One phalanx 1%

Loss of 3rd toe

Three phalanges and 3rd metatarsal 7%
Three phalanges 3%
Two phalanges 2%
One phalanx 1%

Loss of 4th toe

Three phalanges and 4th metatarsal 7%
Three phalanges 3%
Two phalanges 2%
One phalanx 1%

Loss of 5th toe

Three phalanges and 5th metatarsal 7%
Three phalanges 3%
Two phalanges 2%
One phalanx 1%

Loss of metatarsals
First 10%
Second, third, fourth or fifth 4%

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E. TOES (2ND TO 5TH)

E1. METATARSOPHALANGEAL JOINT

1 Restricted Motion

The percentage incapacity due to restriction of motion in various directions for the
same joint are added to give the total percentage incapacity.

a. Active extension from neutral (00) to % Incapacity

or arc of active extension of:

0 - 300 1%
0 - 400 0%

b. Active flexion from neutral (00) to % Incapacity

or arc of active flexion of:

0 - 100 1%
20 - 300 0%

2. Ankylosis

For ankylosis in various directions involving the same joint, the largest incapacity
is taken as the incapacity of that joint.

a. ankylosed in extension at: % Incapacity

0 - 200 2%
30 - 400 3%

b. ankylosed in flexion at: % Incapacity

0 - 200 2%
300 3%

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E2. PROXIMAL INTERPHALANGEAL JOINT (2nd to 5th toes)

1. Restricted motion

No functional value

2. Ankylosis

a. ankylosed in: % Incapacity

extension 3%
neutral (00) }position of function 2%
flexion 3%

E3. DISTAL INTERPHALANGEAL JOINT (2nd to 5th toes)

1. Restricted motion

No functional value

2. Ankylosis

a. ankylosed in: % Incapacity

extension 3%
neutral (00) }position of function 2%
flexion(hammer toe) 3%

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50
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2nd metatarsal 2%
3rd metatarsal 2%
4th metatarsal 2%

2nd toe 1%
3rd toe 1%
4th toe 1%
5th toe 1%

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Second metatarsal -
phalangeal
Third metatarsal -
phalangeal
Fourth metatarsal -
phalangeal
Fifth metatarsal -
phalangeal

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Additional compensation for Permanent Total Incapacity (100%)
Under the Third Schedule of the Work Injury Compensation Act, "where the injured employee
is certified by a medical practitioner to have suffered from permanent total incapacity,
additional compensation shall be paid amounting to one quarter of the amount which is
otherwise payable."

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The Diffusing Capacity of Carbon Monoxide (DLCO) is useful for evaluating patients with
restrictive disease and should be carried out as described by the ATS. The results should be
compared to predicted “normal” values.

Interpretations of FVC, FEV1 and DLCO are given in the table below. At least one of these
measures of pulmonary function should be abnormal to the degree described in a given class
definition if an impairment is to be rated in that class.

Cardiopulmonary Exercise Testing:

Cardiopulmonary exercise testing is sometimes useful in assessing whether a person's
complaint of dyspnoea is a result of respiratory or other conditions. They should be used
selectively and not done routinely on every case. Usually they are not done on individuals with
normal pulmonary function tests. They may be indicated in selected cases who are symptomatic
(e.g. when resting pulmonary function tests do not correlate with the individual's symptoms).
Note that there are medical contraindications such as unstable cardiac disease.

CRITERIA FOR EVALUATION PERMANENT INCAPACITY

The criteria for rating permanent incapacity is given in the table below. To be placed in a specific
class, an individual need not meet all the criteria of that class. Overlapping of the symptoms of
dyspnoea and of physiologic test results is inevitable. In determining the incapacity, the
examiner should give more weight to objective findings than to subjective symptoms. The final
incapacity may be expressed in terms of the nearest 5%.

A minimum degree of incapacity of 10% for radiologically definite asbestosis and silicosis cases
may be awarded even if they are asymptomatic and the pulmonary function tests are apparently
normal.

Occupational asthma cases who require daily maintenance medication to control their
symptoms despite having been transferred from further exposure to the causative agent for one
year or more and who in the opinion of the assessing physician are unlikely to improve further,
may be considered mildly impaired even though their FEV1. exceeds 80% predicted. These
cases could be awarded an incapacity of 5 - 20% depending on the minimum medication
required to maintain control as follows:

i) bronchodilators only : 5%
ii) low dose inhaled steroids : 10%
iii) high dose (>800 micrograms /day) inhaled steroid or
inhaled combination therapy
(e.g. inhaled long beta2agonist plus inhaled steroids) : 15%
iv) oral steroids : 20%

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Classification of Respiratory Incapacity

Tests of
Pulmonary 0% 10-25% 30-45% 50-100%
Function* (no impairment) (mild impairment) (moderate (severe
impairment) impairment)
FVC > 80% > 60% to < 80% > 51% to < 60% of < 50% of
of predicted and of predicted or predicted or predicted or

FEV1 > 80% of > 60% to < 80% of > 41% to < 60% of < 40% of
predicted and predicted or predicted or predicted or
DLCO > 80% of > 60% to < 80% > 41% to < 60% of < 40% of
predicted or of predicted or predicted or predicted or

Vo2 Max** > 25 > 20 and <25 >15 and <20 <15
mL/(kg.min)

* FVC is Forced Vital Capacity. FEV1 is Forced Expiratory Volume in the first second and DLCO is the diffusing
capacity of carbon monoxide.

** Cardiopulmonary Exercise Testing should only be done when indicated. Vo2max is the maximum oxygen
consumption.

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It can be staged as follows:

Stages of Chronic Kidney Disease*

2
Stage Description GFR, mL/min per 1.73 m

1 Kidney damage with normal or increased ≥ 90

GFR
2 Kidney damage with mild decreased GFR 60–89

3 Moderately decreased GFR 30–59

4 Severely decreased GFR 15–29

5 Kidney failure <15

* National Kidney Foundation: K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation,
classification, and stratification. Am J Kidney Dis 39:S1- S246, 2002 (suppl 1)

CRITERIA FOR EVALUATING PERMANENT INCAPACITY

The criteria for rating permanent incapacity is given in the table below. To be placed in a specific
class, an individual need not meet all the criteria of that class. Overlapping of classes is
inevitable. In determining the class of impairment, the assessing physician should give more
weight to objective findings eg. abnormal biochemical test results, anaemia, oedema, etc. than to
subjective findings eg. loss of appetite, impaired physical stamina. In the event that the creatinine
clearance, serum creatinine levels or chronic kidney disease staging fall into different classes,
the higher class of impairment will be taken.The final impairment value may be expressed to the
nearest 5%.

If the kidney damage is from a potential number of causes e.g.diabetes mellitus,

glomerulonephritis, it should be assumed that each potential injurious factor is responsible for
part of the damage.

A provisional award is to be given during the first assessment with a re-assessment

six months later. A final award is given after the incapacity has stabilised and no further
deterioration or improvement is likely in the future, despite all practicable medical or surgical
treatment has been given.

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Classification of Renal Incapacity

Percentage 0-10% 11-30% 31-60% 61-100%

Incapacity

Objective Objective Objective

Signs and Symptoms clinical clinical clinical
evidence of evidence of evidence of
dysfunction dysfunction dysfunction

None or Necessitating Incompletely Persisting

intermittent not continuous controlled by despite
requiring surveillance surgical or surgical or
treatment and frequent continuous continuous
treatment medical medical
treatment treatment
Investigations

Serum Creatinine
(µmol/L)
Male 111-138 139-178 179-283 > 284

Female 86-113 114-153 154-268 > 269

or or or or
Creatinine Clearance 60 - 69 or 45 - 59 or 30 - 44 or < 30 or
(ml/min)
Stages of Chronic Stage 1 Stage 2 Stage 3 Stage 4 and 5
Kidney Disease *

* As defined in the text and according to the table given earlier

NB: The individual with a solitary kidney, regardless of cause, should be rated as having 10% permanent incapacity.
The value is to be combined with any other permanent incapacity pertinent to the case under consideration.

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Pancreatic History of acute pancreatitis Abdominal masses, Ultrasound pancreas and Degree of fat Alcohol pancreatitis
Disease (documented) fistulae; previous biliary tract maldigestion and
gallstones; evidence of malabsorption Chronic relapsing
Refer to Frequency; duration; associated weight loss; jaundice Consider transduodenal pancreatitis
criteria for jaundice, nausea, anorexia; ultrasound, CT scan, Presence of diabetes
upper alcohol intake, adequacy of pain ERCP, measure of mellitus Pancreatitis secondary
digestive control steatorrhea, plain film of to biliary tract disease
track abdomen for calcification Need for pain
GI bleeding (consider splenic control, including Cystic fibrosis
vein thrombosis) Sweat Na+ to exclude celiac plexus and/or
cystic fibrosis splanchnic block
Associated chronic lung disease
(think of cystic fibrosis)

Large History of previous colon Abdominal masses Sigmoidoscopy; Uncontrolable Inflammatory bowel
Intestine surgery (length remaining, colonoscopy diarrhoea; intractable disease; ulcerative
Disease nature of anastomoses) Perianal disease constipation colitis; Crohn’s disease;
Possible barium studies; colectomy with
Refer to Bleeding; need for transfusions Fistulae arthropathy mucosal biopsies Megacolon ileostomy or ileoanal
criteria for pouch anastomosis
colon, Stool frequency, pattern Defeacation studies;
rectum and (nocturnal incontinence) motility; possible EMG of
anus sphincter activity
Abdominal pain

Weight loss

Limited activity

Liver disease Alcohol intake (past, present) Cutaneous and ocular Nutritional status, CNS tolerance to Alocholic liver disease;
signs of chronic liver including haemoglobin, haemorrhage cirrhosis; hepatoma;
Refer to Previous use of hepatotoxic disease protein, PTT posthepatitic cirrhosis
criteria for drugs Fluid and salt (previous HBV, HCV);
liver Disease Ascites; oedema; skin Platelets overload haemochromatosis;
Presence of ascites, oedema pigmentation Wilson’s disease
jaundice, iron overload (multiple (haemochromatosis) Etiologic studies, including Possible pancreatic
transfusions) complete hepatitis serology insufficiency Primary biliary cirrhosis
Evidence of previous markers
History of GI haemorrhage surgery in region of Secondary Sclerosing cholangitis
liver Renal function development of
Pruritus; primary biliary hepatoma Toxic hepatitis
cirrhosis Keyser-Fleischer rings HIV studies
in eyes Intractable Liver angiosarcoma
Limited physical activity Diabetes if prothrombin time
Evidence of ulcerative haemochromatosis (serum prolongation; platelet
colitis iron and ferritin saturation deficiency;
antitrypsin) leukopenia
Xanthomata
Antimitochondrial
antibody; exclude genetic
and infiltrative diseases
(eg, amyloidosis,
sarcoidosis, polycystic
disease)

Copper studies

Biliary Tract Previous biliary tract surgery Previous attempts at Ultrasound studies Persistent Biliary tract structure;
Disease dissolution therapy and hyperbilirubinemia impacted stones;
Episodes of cholecystitis, biliary or lithotripsy ERCP after obstruction sclerosing cholangitis
Refer to colic, jaundice relieved
criteria for Jaundice Transhepatic Primary biliary cirrhosis
biliary tract Family history of bilirubin cholangiography if needed Findings at surgery
Disease metabolism disorder Presence of scratch
marks Prothrombin time
Bleeding; pruritus
Splenomegaly

Abdominal fistula

Hernia Discomfort, pain associated Abdominal protrusion X-ray; CT scan Possible Abdominal wall hernia;
with postural changes or swelling incarceration or umbilical hernia;
Refer to strangulation of incisional hernia;
criteria for Limited physical activity bowel or omentum inguinal hernia; femoral
herniation hernia

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CRITERIA FOR EVALUATING PERMANENT INCAPACITY

Upper Digestive Tract (Oesophagus, Stomach and Duodenum, Small Intestine and
Pancreas)

Criteria for Rating Permanent Impairment Due to Upper Digestive Tract Disease
0-9% 10-24% 25-49% 50-75%

Symptoms or signs of Symptoms and signs of upper Symptoms and signs of Symptoms and signs of
upper digestive tract digestive tract disease, or upper digestive tract upper digestive tract
disease, or anatomic loss anatomic loss or alteration and disease, or anatomic loss or disease, or anatomic loss or
or alteration and alteration and alteration and

continuous treatment not requires appropriate dietary appropriate dietary symptoms uncontrolled by
required and restrictions and drugs for restrictions and drugs do not treatment or
control of symptoms, signs, or completely control
nutritional deficiency and symptoms, signs or
nutritional state or

maintains weight at weight loss below desirable 10%-20% weight loss greater than 20% weight
desirable level* or weight but does not exceed below desirable weight due loss below the desirable
10% to upper digestive tract weight due to upper
no sequelae after disorder digestive tract disorder
surgical procedures

* Refer to Asian Classification to define weight category (MOH Clinical Practice Guidelines 5/2004: Obesity)

Colonic, Rectal and Anal Disorders

Criteria for Rating Permanent Impairment Due to Colonic and Rectal Disorders

0-9% 10-24% 25-49% 50-75%

Signs and symptoms of Objective evidence of colonic Objective evidence of Objective evidence of
colonic or rectal disease or rectal disease or anatomic colonic or rectal disease or colonic or rectal disease or
infrequent and of brief loss or alteration and anatomic loss or alteration anatomic loss or alteration
duration and and and

limitation of activities, mild gastrointestinal moderate to severe persistent disturbances of

special diet, or medication symptoms with occasional exacerbations with bowel function present at
not required and disturbances of bowel disturbance of bowel habit, rest with severe persistent
function, accompanied by accompanied by periodic or pain and
moderate pain and continual pain and

no systemic minimal restriction of diet or restriction of activity, complete limitation of

manifestations present, mild symptomatic therapy special diet, and drugs activity, continued
and weight and nutritional may be necessary and required during attacks and restriction of diet, and
state can be maintained at medication do not entirely
desirable level or control symptoms and

no sequelae after surgical no impairment of nutrition constitutional constitutional

procedures results manifestations (fever, manifestations (fever,
anaemia, or weight loss) weight loss, or anaemia)
present or

no prolonged remission

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Criteria for Rating Permanent Impairment Due to Anal Disease
0-9% 10-19% 20-35%
Signs of organic anal disease or Signs of organic anal disease or Signs of organic anal disease and
anatomic loss or alteration or anatomic loss or alteration and anatomic loss or alteration and

mild incontinence involving gas or moderate but partial faecal complete faecal incontinence or
liquid stool or incontinence requiring continual
treatment or

anal symptoms mild, intermittent, continual anal symptoms inc ompletely signs of organic anal disease and severe
and controlled by treatment controlled by treatment anal symptoms unresponsive or
amenable to therapy

Liver and Biliary Tract Disease

Criteria for Rating Permanent Impairment Due to Liver Disease

0-14% 15-29% 30-49% 50-95%
Persistent liver disease (ie Objective clinical evidence Objective evidence of Objective evidence of
persistently abnormal of chronic liver disease*; no progressive chronic liver progressive chronic liver
biochemical tests); no liver disease symptoms and disease or history of disease or persistent jaundice
symptoms of liver disease no history of ascites, jaundice, ascites, or or bleeding oesophageal or
and no history of ascites, jaundice, or bleeding bleeding oesophageal or gastric varices, with central
jaundice, or bleeding oesophageal varices within gastric varices within past nervous system manifestations
oesophageal varices within 3 years and year and of hepatic insufficiency or
3 years and presence of hepatic tumours
and
good nutrition and strength good nutrition and strength Possibly affected nutrition poor nutritional state
and and and strength or

biochemical studies indicate biochemical studies indicate intermittent hepatic

minimal disturbance in more severe liver damage encephalopathy
function (with normal (with normal PT/PTT )
PT/PTT)

*Objective clinical evidence of chronic liver disease includes spider naevi, palmar erythema, hepatosplenomegaly,
signs of portal hypertension.

Criteria for Rating Permanent Impairment Due to Biliary Tract Disease

0-14% 15-29% 30-49% 50-95%

Occasional biliary tract Recurrent biliary tract Irreparable biliary tract Persistent jaundice;
dysfunction episode impairment, irrespective of obstruction with recurrent progressive liver disease due
treatment cholangitis to common bile duct
obstruction

Herniation

Criteria for Rating Permanent Impairment Due to Herniation

0-9% 10-19% 20-30%
Palpable defect in supporting structures Palpable defect in supporting structures of Palpable defect in supporting
of abdominal wall and abdominal wall and structures of abdominal wall
and
slight protrusion at site of defect with frequent or persistent protrusion at site of persistent, irreducible, or
increased abdominal pressure; readily defect with increased abdominal pressure; irreparable protrusion at site of
reducible or manually reducible or defect and

occasional mild discomfort at site of frequent discomfort, precluding heavy limitation in activities of daily
defect but not precluding most lifting but not hampering some activities of living
activities of daily living daily living

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Cases of noise induced deafness may be classified into:

1. Noise Induced Deafness (early)

These are cases which have an occupational history of exposure to noise of 5 years or more.
However, the audiogram shows an average hearing loss (AHL) at 1,2 and 3 kHz of less than 50
dB in the better ear. These cases require notification to the Ministry of Manpower but are not
compensable for permanent disability.

2. Noise Induced Deafness (advanced)

These are cases which have an occupational history of exposure to noise of 10 years or
more and an audiogram with an AHL at 1,2 and 3 kHz of 50 dB or more in the better ear (air
conduction). Such cases are compensable for permanent disability.

Assessment of noise induced deafness

1. The assessment is always based on the better ear. Refer to the column for NID in the table
below.
2. Correction should be made for presbycusis for workers who are aged 50 years or more (less
half percent for each year above 50).

Example:

A 54 year old shipyard worker has been exposed to high noise levels as a steelworker in various
shipyards for the past 25 years. His audiogram showed a bilateral sensorineural hearing loss
more pronounced in the higher frequencies. His hearing thresholds ranged from 65 to 90 dB in
all the frequencies tested. A repeat audiogram showed similar results. His AHL (1-3 kHz) was
75dB in the left ear and 60 dB in the right ear.

1. A diagnosis of noise induced deafness (advanced) was made.

2. The AHL (1-3 kHz) of the better ear which was 60 dB.
3. Based on the table below, using the column for NID, the percentage incapacity is 15%.
4. Correct for presbycusis: minus 2% (4 years above 50)
5. Final incapacity award is 13%.

Hearing Loss Resulting from Injuries or Accidents

The assessment of hearing loss resulting from injuries or accidents is different from that of noise
induced deafness. Unilateral hearing loss can be compensated in this case. For bilateral hearing
loss, each ear is evaluated separately. The resulting percentage incapacity can be different
depending on whether the case is assessed as a case of noise induced deafness or resulting
from an accident or injury.

It is therefore very important that the correct diagnosis be made. There should be a definite
history of an incident and pre-incident audiogram records should be evaluated (where available).

Assessment of hearing loss resulting from injuries or accidents

1. The assessment is based on the affected ear or ears depending on whether one or both ears
were affected.
2. Refer to the column for injuries or accidents in the table below.
3. Where both ears are affected (and this is not a case of NID), the total incapacity for hearing
loss would be the sum of the incapacity for each ear.

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Example:

A 30 year old worker suffered a sudden loss of hearing and tinnitus in his left ear after a blast
injury occurred at his workplace. An audiogram conducted two weeks after the incident showed
a AHL (1-3 kHz) of 60 dB in his left ear and a AHL (1-3 kHz) of 25 dB in his right ear. A repeat
audiogram done six months later showed a AHL of 50 dB in his left ear.

1. The diagnosis of hearing loss due to a blast injury was made.

2. Assessment was made after the condition had stabilised.
3. The affected ear had a AHL (1-3 kHz) of 50 dB.
3. Based on the table below, using the column for injuries and accidents, the incapacity
was 3%.

Example:

A 48 year old worker suffered a sudden loss of hearing and tinnitus in both his ears after a blast
injury at work. He had a AHL (1-3 kHz) of 90 dB in his left ear and a AHL (1-3 kHz) of 60 dB in his
right ear. Prior to the accident, his medical records showed that his AHL (1-3 kHz) was 40 dB in
his left ear and 35 dB in his right ear.

1. A diagnosis of blast injury of both ears was made.

2. For the blast injury of the left ear, the incapacity was 30%.
3. For the blast injury of the right ear, the incapacity was 8%.
4. The total incapacity was 30 + 8 = 38%.

Assessment of hearing loss

Hearing threshold (dBA) Injuries or Accidents Noise induced deafness

(AHL :1,2 and 3 kHz ) (affected ear) (better ear)
% Incapacity % Incapacity
50 3 5
55 5 10
60 8 15
65 10 20
70 13 25
75 15 30
80 20 40
85 25 50
90 30 60

NB. For sudden hearing loss resulting from accidents or injuries, assess each affected ear and add the
percentage incapacities to get the total percentage incapacity. For noise induced deafness, assess the better ear

68
69
Additional compensation for Permanent Total Incapacity (100%)
Under the Third Schedule of the Work Injury Compensation Act, "where the injured employee
is certified by a medical practitioner to have suffered from permanent total incapacity, additional
compensation shall be paid amounting to one quarter of the amount which is otherwise
payable."

70
CRITERIA FOR EVALUATING PERMANENT INCAPACITY

Cerebral Impairments

GROUP 1

A. Disturbances of Consciousness and Awareness

Individuals experiencing disturbances in consciousness may be suffering from a range of

symptoms from episodes of altered awareness to being in a persistent vegetative state or
unresponsive coma. These conditions are evaluated based on the neurological examination and
ancillary testing such as computed tomography (CT) Scan, magnetic resonance imaging (MRI),
Single-photon emission computed tomography (SPECT), electroencephalogram (EEG),
evoked potentials, and vestibular testing. The examination and tests will provide the extent of the
underlying pathology and help examiners form a prognosis for patient management.

Criteria for evaluating impairment of consciousness and awareness

Brief repetitive or persistent alteration of state of consciousness and 5 - 25%

minimal limitation in performance of activities of daily living

Brief repetitive or persistent alteration of state of consciousness and 26 - 99%

moderate limitation in performance of activities of daily living

Prolonged impairment of state of consciousness, which diminishes 100%

capabilities in personal care and activities of daily living

Coma requiring total medical support, or semi-coma with complete 100%

dependency and subsistence on nursing care

B. Episodic Neurological impairment e.g. epileptic seizures

In assessing permanent impairment due to this, ensure that the individual's condition has
reached maximal medical improvement and is unlikely to change significantly.

71
Criteria for evaluating impairment due to episodic loss of consciousness or awareness

Paroxysmal disorder with predictable characteristics and unpredictable

occurrence that does not limit usual activities but there is a risk to the 10% - 25%
individual or limits daily activities or occupations

Paroxysmal disorder that interferes with some daily activities 26% - 99%

Severe paroxysmal disorder of such frequency that it limits activities to

those that are supervised, protected or restricted, and
additional neurological symptoms or signs of focal or generalized nature 100%

Uncontrolled paroxysmal disorder of such frequency and constancy that it 100%

severely limits the individual’s daily activities

C. Arousal and Sleep Disorders

Arousal and sleep disorders include disorders related to initiating and maintaining sleep;
excessive somnolence, including sleep-induced respiratory impairment; and sleep-wake
schedules.

Neurological disorders associated with increased daytime sleepiness include central sleep
apnoea syndrome, narcolepsy, idiopathic hypersomnia, periodic limb movement disorder,
restless leg syndrome, depression, brain tumours, posttraumatic hypersomnolence, multiple
sclerosis, encephalitis, and postencephalopathy, Alzheimer's disease, Parkinson's disease,
multisystem atrophy and neuromuscular disorders with sleep apnoea. It is expected that the
diagnosis of excessive daytime sleepiness has been supported by formal studies in a sleep
laboratory. The clinician can evaluate sleepiness with the Epworth Sleepiness Scale, which
assesses the likelihood of dozing (Never = 0 to high chance =3) in different situations.

Criteria for evaluating impairment due to sleep and arousal disorders

Reduced daytime alertness; sleep pattern such that individual can 10% - 25%
perform most activities of daily living

Reduced daytime alertness; interferes with ability to perform some 26% - 99%
activities of daily living

Reduced daytime alertness; ability to perform activities of daily living 100%

significantly limited

Severe reduction of daytime alertness; individual unable to care for 100%

self in any situation or manner

72
GROUP 2

Mental status, Cognition and Highest Integrative Function

Mental status and integrative functions include the general effects of organic brain syndrome;
dementia; and some specific, focal, and neurological deficiencies. Referral for
neuropsychologist for assessment is required as impairment has to be confirmed and quantified
by neuropsychologist.

Criteria for evaluating impairment related to mental status

Fully capable of selfcare,

- but has some of the following:
Consistent slight forgetfulness; partial recollection of events; fully oriented
except for slight difficulty with time relationships; slight impairment in
solving problems, similarities and differences; life at home, hobbies and 5 -10%
intellectual interests slightly impaired.

Suffers from a combination of several of the following :

Moderate memory loss, more marked for recent events; defect interferes with
everyday activities; moderate difficulty with time relationships, oriented for
place at examination, may have geographic disorientation elsewhere;
moderate difficulty in solving problems, similarities and differences; social 11 - 99%
judgment usually maintained; mild but definite impairment of function at
home; more difficult chores abandoned, more complicated hobbies and
interests abandoned; needs prompting in personal care.

Suffers from a combination of several of the following :

Severe memory loss, only highly learned material retained, new material
rapidly lost; severe difficulty with time relationships; usually disconnected to
time, often to place; severely impaired in solving problems, similarities and 100%
differences; social judgment usually impaired; only simple chores preserved;
very restricted interests, poorly maintained; needs assistance in dressing,
hygiene, keeping of personal effects.

Suffers from a combination of several of the following :

Severe memory loss, only fragments remain. oriented in person only; unable 100%
to make judgments or solve problems; no significant function at home;
requires much help with personal care; frequent incontinence

GROUP 3

Communicative Impairments: Dysphasia and Aphasia

Aphasia is a condition in which language function is defective or absent. It includes a lack of

comprehension with deficits in vision, hearing, and language (both spoken and written) and also
the inability to implement discernible and appropriate language symbols by voice, action, writing
or pantomime. Dysphasia is a language impairment that is less severe than aphasia. Dysphasia
and aphasia are different from dysarthria, which is imperfect articulation of speech due to
disordered muscle control, and dysphonia which is an impairment of sound production that
causes difficulty speaking and understanding.

73
Criteria for evaluating impairment due to dysphasia or aphasia

Minimal disturbance in comprehension and production of language 10% - 25%

symbols of daily living

Moderate impairment in comprehension and production of language

symbols of daily living 26% - 99%

Able to comprehend nonverbal communication; production of unintelligible or

inappropriate language for daily activities or 100%
Complete inability to communicate or comprehend language symbols

GROUP 4

Impairment Due to Emotional or Behavioral Disorders

Emotional disturbances originating in verifiable neurological impairments (e.g. stroke, head

injury) are assessed here. Psychiatric features may also exist with primary neurological
disorders, and can range from irritability to outbursts of rage or panic and from aggression to
withdrawal. Psychiatric impairments may include depression, manic states, emotional
fluctuations, socially unacceptable behavior, involuntary laughing or crying, impulsitivity, general
disinhibition with obsessive and scatological behavior, etc. These disorders should be confirmed
and assessed by a psychiatrist. (Psychiatric manifestations and impairments that do not have
documented neurological impairments are not evaluated under this heading.)

Criteria for evaluating impairment due to emotional or behavioral disorders

Mild limitation of activities and daily living and daily social and interpersonal 10 - 25%
functioning

Moderate limitation of some activities of daily living and daily social and 26% - 99%
interpersonal functioning

Severe limitation in performing most activities of daily living, impeding

useful action in most daily social and interpersonal functioning, or
Severe limitation of all daily activities, requiring total dependence on 100%
another person

74
Other Neurological Impairments

GROUP 5

A. Cranial Nerve Impairments

Criteria for evaluating Impairment of Olfaction

The maximum impairment from anosmia is 5%

Criteria for evaluating Impairment of Optic Nerves

Refer to the chapter on assessment of Visual function.

Criteria for evaluating Impairment of Facial Nerves

Complete loss of taste of anterior tongue, or mild unilateral facial weakness 1 - 4%

Mild to moderate bilateral facial weakness or severe unilateral facial weakness 5 -19%
with 75% or greater facial involvement and with inability to control eyelid
closure

Severe bilateral facial paralysis with 75% or greater facial involvement and 20 - 45%
with inability to control eyelid closure

Criteria for evaluating Impairment of Equilibrium due to Vestibulocochlear Nerve

Dysfunction

Assessment by an ENT specialist is required to confirm cause of disequilibrium. For

impairment of hearing refer to chapter on assessment of hearing.

Minimal equilibrium impairment, limitation required only of activities in 25 - 50%

hazardous surroundings

Moderate equilibrium impairment, limitation required of all daily activities

except simple ones for self-care or 51 - 100%
Moderately severe equilibrium impairment, limitation required of all daily
activities including those for self-care

Severe equilibrium impairment, such that assistance is required for self-care 100%
and ambulation, and confinement may be needed

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 

 



For paralyzed limbs or part of a limb, the First Schedule of the Act states that “total permanent loss
of use of a member shall be treated as loss of that member.” Rate each limb as per amputation

of
limbs. Total impairment cannot exceed 100%. If both upper limbs are involved (i.e. 100%),

additional 25% to be provided for under the Third Schedule of the Act.












 

 

 

 

 


 


 

 

 

 

 
 76 


76
Lesser degrees of respiratory impairment are evaluated under the Chapter on “Assessment
of Respiratory Function”.

E. Injury of the Peripheral Nervous System

Refer to the chapters on the “Assessment of the Upper Limb” and “Assessment of the Lower
Limb”.

F. Headache following Neurological Injury

Post-concussional syndrome may follow a concussion and produces symptoms of headache,

poor concentration, mild memory loss, irritability, trouble sleeping, bad dreams, and sometimes
mild personality changes. It does not produce any abnormalities on physical examination or on
any tests such as CT scan or MRI. These symptoms usually resolve completely during the
course of weeks to months. Usually there is gradual improvement during this period. In a small
minority the symptoms seem intractable despite treatment.

Accurate objective evaluation is confounded by absence of any abnormality on physical

examination or on any tests, impending litigation, potential compensation or other psychological
or social factors.

Intractable cases should be referred to a pain clinic for assessment and treatment first before
determining that maximum medical improvement has been achieved. During the period of
treatment the patient must necessarily be compliant with medication prescribed by his
caregivers.

The medical examiner has to confirm that the symptoms are consistent with established
conditions, consistent with anatomic location and physiology and consistent with inter-observer
assessment over time and situation. For example, a person with a positive straight leg raising
test at 45 degrees will not be able to sit with the legs outstretched and touch his or her toes. The
examiner should also look out for pain behaviors that are exaggerated and discordant with his or
her presumed medical condition. Exaggerated, discordant pain behaviors tend to cast doubt on
the validity of the information that people provide regarding their condition.

The impairment rating should not factor in other impairments that have already been evaluated in
other areas.

For brachial plexus avulsion pain and “phantom limb”, impairment percentages already include
allowances for the pain that may occur with these conditions and it is not necessary to give
additional awards for pain.

77
78
Non-perception of light, light perception, hand movements, counting fingers

79
Any loss of contrast acuity or acuity under glare in addition to loss of 10%
best corrected visual acuity

Visual field loss

If visual acuity and visual fields are normal in the fellow eye, compensation
should first be based on the visual acuity in the affected eye

Remaining horizontal field of vision

<20 degrees 50%
20 to 30 degrees 45%
30 to 40 degrees 40%
40 to 50 degrees 35%
50 to 60 degrees 30%
60 to 70 degrees 25%
70 to 80 degrees 20%
80 to 90 degrees 15%
90 to 100 degrees 10%
100 to 110 degrees 5%
110 to <120 degrees 2.5%

Colour vision
Any loss of ability to differentiate colour that is in addition to loss of visual acuity 10%

Astigmatism and aniseikonia

If cylinder is above–3.50D and /or if significant aniseikonia is present 10%

Criteria for evaluating permanent impairment for diplopia (applies to both eyes)

Diplopia
Diplopia which is expected not to be reasonably corrected by prisms or surgery 40%

Diplopia which is expected to be reasonably corrected by surgery occurring

• within the central 30 degrees (i.e. 15 degrees in any direction of fixation) 30%
• between 30 and 60 degrees 15%
• beyond 60 degrees 7.5%

Specific Ophthalmic Conditions arising from Injury

(to be awarded in addition to visual loss to a maximum award of 50% per eye)

Glaucoma 5%
Cataract /lens subluxation 3%
Corneal opacity /scar /decompensation 5%
Orbital deformities (Enophthalmos /hypoglobus /hyperglobus) 5%
Traumatic mydriasis and other pupillary or iris abnormalities 1%

80
1. A Guide to the Work Injury Compensation Benefits and Claim Process, 2008,
Ministry of Manpower and Workplace Safety and Health Council.

2. Guides to the Evaluation of Permanent Impairment, Sixth Edition, 2008,

American Medical Association, ed. Robert D. Rondinelli.

3. Work Injury Compensation Act (Chapter 354), 2008.

81
 41 2 COMBINED VALUES CHART
42 3 4
43 4 5 6
The values are derived from the formula: A+B (1–A) = combined value of A and B, where A and B are the
44 5 6 7 8
decimal equivalents of the impairment ratings. In the chart all values are expressed as percents. To combine any two
5 6 7 8 9 10
impairment values, locate the larger of the values on the side of the chart and read along that row until you come to the
46 7 8 9 10 11 12
column indicated by the smaller value at the bottom of the chart. At the intersection of the row and the column is the
47 8 9 10 11 12 13 14
combined value.
48 9 10 11 12 13 14 14 15
For example, to combine 35% and 20% read down the side of the chart until you come to the larger value, 35%.
49 10 11 12 13 14 14 15 16 17
Then read across the 35% row until you come to the column indicated by 20% at the bottom of the chart. At the intersection
10 11 12 13 14 15 15 16 17 18 19
11 12 13 14 15 15 16 17 18 19 20 21
of the row and column is the number 48. Therefore, 35% combined with 20% is 48%. Due to the construction of this chart the
12 13 14 15 16 16 17 18 19 20 21 22 23 larger impairment value must be identified at the side of the chart.
13 14 15 16 16 17 18 19 20 21 22 23 23 24 If three or more impairment values are to be combined, select the two highest values and find their combined
14 15 16 17 17 18 19 20 21 22 23 23 24 25 26 value as above. Then use that value and the third value to locate the combined value of all. This process can be repeated
15 16 17 18 18 19 20 21 22 23 24 24 25 26 27 28 indefinitely, the final value in each instance being the combination of all the previous values. In each step of this
16 17 18 19 19 20 21 22 23 24 24 25 26 27 28 29 29 process the larger impairment value must be identified at the side of the chart. Refer to Page 9 (Part III – Use of Combined
17 18 19 19 20 21 22 23 24 24 25 26 27 28 29 29 30 31 Values Chart) for example.
18 19 20 20 21 22 23 24 25 25 26 27 28 29 29 30 31 32 33
19 20 21 21 22 23 24 25 25 26 27 28 29 30 30 31 32 33 34 34
20 21 22 22 23 24 25 26 26 27 28 29 30 30 31 32 33 34 34 35 36
21 22 23 23 24 25 26 27 27 28 29 30 30 31 32 33 34 34 35 36 37 38
22 23 24 24 25 26 27 27 28 29 30 31 31 32 33 34 34 35 36 37 38 38 39
23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 35 35 36 37 38 38 39 40 41
24 25 25 26 27 28 28 29 30 31 31 32 33 34 35 35 36 37 38 38 39 40 41 41 42
25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44
26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45
27 28 28 29 30 31 31 32 33 34 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47

82
28 29 29 30 31 32 32 33 34 34 35 36 37 37 38 39 40 40 41 42 42 43 44 45 45 46 47 47 48
29 30 30 31 32 33 33 34 35 35 36 37 38 38 39 40 40 41 42 42 43 44 45 45 46 47 47 48 49 50
30 31 31 32 33 34 34 35 36 36 37 38 38 39 40 41 41 42 43 43 44 45 45 46 47 48 48 49 50 50 51
31 32 32 33 34 34 35 36 37 37 38 39 39 40 41 41 42 43 43 44 45 45 46 47 48 48 49 50 50 51 52 52
32 33 33 34 35 35 36 37 37 38 39 39 40 41 42 42 43 44 44 45 46 46 47 48 48 49 50 50 51 52 52 53 54
33 34 34 35 36 36 37 38 38 39 40 40 41 42 42 43 44 44 45 46 46 47 48 48 49 50 50 51 52 52 53 54 54 55
34 35 35 36 37 37 38 39 39 40 41 41 42 43 43 44 45 45 46 47 47 48 49 49 50 51 51 52 52 53 54 54 55 56 56
35 36 36 37 38 38 39 40 40 41 42 42 43 43 44 45 45 46 47 47 48 49 49 50 51 51 52 53 53 54 55 55 56 56 57 58
36 37 37 38 39 39 40 40 41 42 42 43 44 44 45 46 46 47 48 48 49 49 50 51 51 52 53 53 54 55 55 56 56 57 58 58 59
37 38 38 39 40 40 41 41 42 43 43 44 45 45 46 46 47 48 48 49 50 50 51 51 52 53 53 54 55 55 56 57 57 58 58 59 60 60
38 39 39 40 40 41 42 42 43 44 44 45 45 46 47 47 48 49 49 50 50 51 52 52 53 54 54 55 55 56 57 57 58 58 59 60 60 61 62
39 40 40 41 41 42 43 43 44 44 45 46 46 47 48 48 49 49 50 51 51 52 52 53 54 54 55 55 56 57 57 58 59 59 60 60 61 62 62 63
40 41 41 42 42 43 44 44 45 45 46 47 47 48 48 49 50 50 51 51 52 53 53 54 54 55 56 56 57 57 58 59 59 60 60 61 62 62 63 63 64
41 42 42 43 43 44 45 45 46 46 47 47 48 49 49 50 50 51 52 52 53 53 54 55 55 56 56 57 58 58 59 59 60 60 61 62 62 63 63 64 65 65
42 43 43 44 44 45 45 46 47 47 48 48 49 50 50 51 51 52 52 53 54 54 55 55 56 57 57 58 58 59 59 60 61 61 62 62 63 63 64 65 65 66 66
43 44 44 45 45 46 46 47 48 48 49 49 50 50 51 52 52 53 53 54 54 55 56 56 57 57 58 58 59 60 60 61 61 62 62 63 64 64 65 65 66 66 67 68
44 45 45 46 46 47 47 48 48 49 50 50 51 51 52 52 53 54 54 55 55 56 56 57 57 58 59 59 60 60 61 61 62 62 63 64 64 65 65 66 66 67 68 68 69
45 46 46 47 47 48 48 49 49 50 51 51 52 52 53 53 54 54 55 55 56 57 57 58 58 59 59 60 60 61 62 62 63 63 64 64 65 65 66 66 67 68 68 69 69 70
46 47 47 48 48 49 49 50 50 51 51 52 52 53 54 54 55 55 56 56 57 57 58 58 59 60 60 61 61 62 62 63 63 64 64 65 65 66 67 67 68 68 69 69 70 70 71
47 48 48 49 49 50 50 51 51 52 52 53 53 54 54 55 55 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 66 66 67 67 68 68 69 69 70 70 71 71 72
48 49 49 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73
49 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74
50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75
1 42 43 4 5 56 57 58 59 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 73 74 74 75 75
52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76
53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76 77
54 54 55 55 56 56 57 57 58 58 59 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 75 75 76 76 77 77
55 55 56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76 77 77 78
56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 63 64 64 65 65 66 66 67 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 74 75 75 76 76 77 77 78 78
57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 72 73 73 74 74 75 75 75 76 76 77 77 78 78 79
58 58 59 59 60 60 61 61 61 62 62 63 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 74 74 75 75 76 76 76 77 77 78 78 79 79
59 59 60 60 61 61 61 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 73 73 73 74 74 75 75 75 76 76 77 77 77 78 78 79 79 80
60 60 61 61 62 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 74 74 74 75 75 76 76 76 77 77 78 78 78 79 79 80 80
61 61 62 62 63 63 63 64 64 65 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 73 73 73 74 74 75 75 75 75 76 76 77 77 77 78 78 79 79 79 80 80 81
62 62 63 63 64 64 64 65 65 65 66 66 67 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 76 77 77 78 78 78 79 79 79 80 80 81 81
63 63 64 64 64 65 65 66 66 66 67 67 67 68 68 69 69 69 70 70 70 71 71 72 72 73 73 73 74 74 74 74 75 75 76 76 76 77 77 77 78 78 79 79 79 80 80 80 81 81 82
64 64 65 65 65 66 66 67 67 67 68 68 68 69 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 81 81 82 82 82
65 65 66 66 66 67 67 67 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 83
66 66 67 67 67 68 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 82 83 83
67 67 68 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 82 83 83 83 84
68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 80 80 81 81 81 82 82 82 83 83 83 84 84
69 69 70 70 70 71 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 80 80 81 81 81 82 82 82 83 83 83 84 84 85 85
70 70 71 71 71 72 72 72 72 73 73 73 74 74 74 75 75 75 75 76 76 76 77 77 77 78 78 78 78 79 79 79 80 80 80 81 81 81 81 82 82 82 83 83 83 84 84 84 84 85 85
71 71 72 72 72 72 73 73 73 74 74 74 74 75 75 75 76 76 76 77 77 77 77 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 83 83 83 83 84 84 84 85 85 85 86
72 72 73 73 73 73 74 74 74 75 75 75 75 76 76 76 76 77 77 77 78 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 82 83 83 83 83 84 84 84 85 85 85 85 86 86
73 73 74 74 74 74 75 75 75 75 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 83 83 84 84 84 84 85 85 85 85 86 86 86 87
74 74 75 75 75 75 76 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 82 83 83 83 84 84 84 84 84 85 85 85 85 86 86 86 86 87 87
75 75 76 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 84 84 84 84 84 85 85 85 86 86 86 86 87 87 87 87 88
76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87 87 87 88 88 88
77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 86 87 87 87 87 88 88 88 88 89
78 78 78 79 79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 84 84 84 84 84 84 85 85 85 85 86 86 86 86 87 87 87 87 87 88 88 88 88 89 89 89
79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 86 86 86 86 86 87 87 87 87 87 88 88 88 88 88 89 89 89 89 90
80 80 80 81 81 81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 88 88 88 88 88 89 89 89 89 89 90 90 90
81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 91
82 82 82 83 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 89 89 89 89 89 90 90 90 90 90 90 91 91 91
83 83 83 84 84 84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 91 91 91 91 91 92
84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 91 91 91 91 91 91 92 92 92 92
85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91 91 91 91 92 92 92 92 92 92 93
86 86 86 86 87 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 89 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 92 92 92 92 92 92 92 93 93 93 93
87 87 87 87 88 88 88 88 88 88 88 88 89 89 89 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 94
88 88 88 88 88 89 89 89 89 89 89 89 89 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 94 94 94 94 94
89 89 89 89 89 90 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 95
90 90 90 90 90 91 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95
91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 96
92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96
93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97
94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97
95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98
96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98
97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99
98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99
99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
 COMBINED VALUES CHART (continued)
51 76
52 76 77
53 77 77 78
54 77 78 78 79
55 78 78 79 79 80
56 78 79 79 80 80 81
57 79 79 80 80 81 81 82
58 79 80 80 81 81 82 82 82
59 80 80 81 81 82 82 82 83 83
60 80 81 81 82 82 82 83 83 84 84
61 81 81 82 82 82 83 83 84 84 84 85
62 81 82 82 83 83 83 84 84 84 85 85 86
63 82 82 83 83 83 84 84 84 85 85 86 86 86
64 82 83 83 83 84 84 85 85 85 86 86 86 87 87
65 83 83 84 84 84 85 85 85 86 86 86 87 87 87 88
66 83 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88
67 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88 89 89
68 84 85 85 85 86 86 86 87 87 87 88 88 88 88 89 89 89 90
69 85 85 85 86 86 86 87 87 87 88 88 88 89 89 89 89 90 90 90
70 85 86 86 86 87 87 87 87 88 88 88 89 89 89 90 90 90 90 90 91
71 86 86 86 87 87 87 88 88 88 88 89 89 89 90 90 90 90 91 91 91 92
72 86 87 87 87 87 88 88 88 89 89 89 89 90 90 90 90 91 91 91 92 92 92
73 87 87 87 88 88 88 88 89 89 89 89 90 90 90 91 91 91 91 92 92 92 92 93
74 87 88 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93
75 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94

84
76 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94
77 89 89 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94 94 95
78 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95
79 90 90 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95 95 96
80 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 95 95 95 95 95 96 96 96
81 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96
82 91 91 92 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96 96 97 97
83 92 92 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 97 97 97 97
84 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97
85 93 93 93 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98
86 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 98 98 98 98
87 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98 98 98 98 98 98
88 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 99
89 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 99 99 99
90 95 95 95 95 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99
91 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99
92 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99
93 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100
94 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100
95 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100
96 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100
97 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100
98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99
WORK INJURY COMPENSATION ACT, 2008

Percentage of loss
of earning capacity

85
22. Loss of foot ....................................................................................................... 55%
23. Loss of toes
all of one foot ................................................................................................ 20%
great, both phalanges ................................................................................... 14%
great, one phalanx ........................................................................................ 3%
other than great, if more than one toe lost, each .......................................... 3%
24. Loss of sight of one eye .................................................................................... 50%
25. Loss of hearing, one ear ................................................................................... 30%
26. Total loss of hearing .......................................................................................... 60%

NB:

(1) Total permanent loss of the use of a member shall be treated as loss of such a member.
(2) Where there is loss of two or more parts of the hand, the percentage shall not be more than the loss of the whole
hand.
(3) Loss of remaining arm, leg or eye if one has already been lost, shall be the difference between the
compensation for the total incapacity, and compensation already paid or that which would have been paid for the
previous loss of limb or eye.

86
A Guide to the Assessment of
Traumatic Injuries and Occupational
Diseases for Work Injury Compensation