From Numbers to Narratives: The Evolution of Medicolegal assessments for psychiatric injuries in Australia

For many years, psychiatric compensation claims relied on whole person impairment percentages as the only way to consider and award compensation to victims of a compensable injury. Scales like the GEPIC in Victoria and the AMA Guides were sought after by lawyers and insurers, offering a seemingly objective way to measure psychiatric injury. And this is still the case for many compensation claims involving Workcover or the TAC.

One of the main shortfalls is that it doesn’t capture the full story of how someone actually functions in daily life, and across a timespan since the injury occurred. The scales also tended to treat psychiatric illness as fixed and permanent, when in reality the diagnosis may be permanent, but the person experiences relapses and remittances over time. And for survivors of historical abuse or complex trauma, the tools can be too limiting and often fall short — their lifelong difficulties in relationships, trust, and identity are not considered as part of the domains. The domains are narrow and include an assessment of thinking, perception and judgement instead.

Psychiatrists are experts at formulating cases, considering and explaining that have influenced and shaped the presentation of the person in a moment in time. Predisposing factors are scrutinised and highlighted, as well as factors that may perpetuate the presentation and severity of a psychiatric diagnosis. Prognosis is also considered, as well as protective factors that a person may have that improves this. The raw number was only part of the evidence — the reasoning behind it mattered even more.

As an independent medical expert who specialises in historical abuse matters, I am rarely asked to provide a whole person impairment (WPI), unless the legal jurisdiction requires it. Claims arising in Queensland require me to provide an WPI using the AMA5 guides but cases in Victoria or Tasmania don’t.

Consider the case of a woman in her early 60s who disclosed, for the first time, abuse she experienced at age 12. For most of her adult life she worked, raised a family, and kept the memories locked away. On the surface she appeared resilient, but she struggled with trust in relationships, persistent anxiety, and bouts of depression that didn’t really respond to primary treatment. When she finally came forward, the impairment rating scale placed her in the “moderate” range.

But the narrative told a very different story. The abuse had shaped every decade of her life: her difficulty forming stable relationships, her reluctance to seek promotions at work for fear of exposure, her chronic sleep disturbance, and her profound sense of shame. None of this complexity was captured by the number. It was only through the trauma-informed account — the way the abuse rippled across her lifespan — that the true extent of her injury could be appreciated.

Fast forward to today, and the landscape looks different again. Most schemes still require impairment ratings — Victoria still uses GEPIC, and in New South Wales the PIRS scale applies under the Motor Accidents Injuries Act. However, the strongest psychiatric reports are those that weave together structured ratings with a detailed account of how the injury has altered a person’s work, relationships, and daily life. In historical abuse cases, a trauma-informed lens is especially important: the patterns of delayed disclosure, chronicity, and cumulative harm tell a story that no rating scale alone can really relay. 

There are also ongoing debates about which framework to use. Some jurisdictions continue with AMA5, while others look to AMA6, which places greater emphasis on function and adaptation.

For psychiatrists, the message is clear. We can’t rely on the scale alone and can provide much more complexity and sophistication to the whole picture, as revealed at the time of the assessment as well as with consideration to supplied documents and records. With these skills we can explain causation, function, and prognosis, and highlight the limitations of the rating tools themselves. For lawyers, the shift is equally significant: the impairment percentage is no longer the whole story. The expert narrative is often the decisive factor in court.

The takeaway? Psychiatric impairment ratings still matter — but they are only the beginning of the conversation. Numbers can open the door, but it is the story behind them that helps courts and compensation schemes understand the true impact of psychiatric injury.

💬 I’d be interested to hear from both psychiatrists and lawyers: how do you see impairment ratings evolving in your work? Are they still serving a useful purpose, or is it time to move toward more functional and narrative-based models? And does it still depend on the type of case?