Eligibility for CISS details

The Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016 sets out eligibility criteria that must be met
in order to receive Catastrophic Injuries Support provisions.

• For motor vehicle accidents the injury must have occurred on or after 1 July 2016.
• For workplace accidents the injury must have occurred on or after 1 July 2024.

Spinal cord injury
The criteria for a spinal cord injury are:
The injury results in permanent neurological deficit as evidenced by an ASIA Impairment Scale score of A to D conducted as part of a medical assessment.

Traumatic brain injury
1. The criteria for a traumatic brain injury suffered by a person who has reached eight years of age at the time of medical assessment are — either or both of the following:

• A recorded post-traumatic amnesia of seven days or more measured using the Westmead Post-Traumatic Amnesia Scale or a similar clinically accepted, validated scale for post-traumatic amnesia;
• A significant brain imaging abnormality or evidence of a very significant impact to the head causing coma for longer than one hour; 
  and
• A score of five or less on any item on the FIMTM or WeeFIM® due to the injury.

2. The criteria for a traumatic brain injury suffered by a person who has reached three years of age but is under eight years of age at the time of medical assessment are —
one or more of the following:

• A Glasgow Coma Scale score of less than nine (assessed after resuscitation or on admission to the emergency department of a hospital);
• A recorded post-traumatic amnesia of seven days or more measured using the Westmead Post-Traumatic Amnesia Scale or a similar clinically accepted, validated scale for post-traumatic amnesia;
• A significant brain imaging abnormality or evidence of a very significant impact to the head causing coma for longer than one hour;
  and
• A score two less than the age norm on any item on the WeeFIM® due to the injury.

3. The criteria for a traumatic brain injury suffered by a person who is under three years of age at the time of medical assessment are:

• A medical certificate from a paediatric rehabilitation physician or specialist that states the person is expected to develop/show signs of a permanent impairment due to the injury resulting in a significant adverse impact on the person’s normal development.

Amputations
The criteria for an injury resulting in amputation, or the equivalent impairment, are:

• A brachial plexus or lumbosacral avulsion equivalent to an amputation;
  or one amputation of either of the following types:
  • Forequarter amputation or shoulder disarticulation;
  • Amputation of a lower limb at or above 65% of the femur;

  or

• More than one amputation of either or both of the following types:
  • Amputation of a lower limb at or above 50% of the tibia;
  • Amputation of an upper limb at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.

Burns
1. The criteria for a burns injury suffered by a person who has reached eight years of age at the time of medical assessment are —

• the criteria set out in sub-regulation (4); and
• A score of five or less on any item on the FIMTM or WeeFIM® due to the injury.

2. The criteria for a burns injury suffered by a person who has reached three years of age but is under eight years of age at the time of medical assessment are —

• the criteria set out in sub-regulation (4); and
• a score two less than the age norm on any item on the WeeFIM® due to the injury.

3. The criteria for a burns injury suffered by a person who is under three years of age at the time of medical assessment are —

• the criteria set out in sub-regulation (4); and
• a medical certificate from a paediatric specialist that states the person is expected to develop/show signs of a permanent impairment  due to the injury resulting in a significant adverse impact on the person’s normal development.

4. For sub-regulations (1)(a), (2)(a) and (3)(a), the criteria are:

• Full thickness burns greater than 40% of total body surface area or, for a person under 16 years of age, greater than 30% of total body surface area; or
• Inhalation burns causing long-term respiratory impairment (as assessed by a respiratory physician); or
  Full thickness burns to the hands, face or genital area.

Permanent blindness

The criteria for an injury resulting in blindness are — permanent legal blindness as demonstrated by:

1. Visual acuity on the Snellen Scale after correction by suitable lenses being less than 6/60 in both eyes; or
2. Field of vision being constricted to ten degrees or less of arc around central fixation in the better eye irrespective of corrected visual acuity (equivalent to 1/100 white test object); or
3. A combination of visual defects resulting in the same degree of visual loss described in subparagraph (i) or (ii).

For a downloadable version of this page click here.