Skin impairment assessment
Skin scarring and WPI after a motor accident
Scars can follow lacerations, abrasion, surgery, grafting or wound infection after a crash. This page focuses on the permanent skin-assessment method rather than acute burn care. Under Part 6, a scar can be assessed at 0% and multiple scars are assessed for their overall effect on the skin organ rather than given separate percentages and added.
Accident mechanism and diagnosis
How can this injury happen in a motor accident?
Laceration or road abrasion
Glass, metal, gravel or road contact may leave irregular, adherent, pigmented or sensitive scars.
Surgical scar after crash injury
ORIF, abdominal surgery, grafting or decompression may create a scar, but the underlying injury and scar are assessed separately only where each causes distinct impairment.
Wound complication
Infection, dehiscence or tissue loss can widen a scar, require grafting or produce recurrent breakdown.
The injuries that may actually occur
- linear or irregular traumatic scar
- hypertrophic or keloid scar
- adherent scar or graft
- donor-site scar
- scar with recurrent ulceration or skin breakdown
- scar contracture affecting movement
Symptoms and functional effects to document
- itching, tenderness or altered sensation
- skin fragility, breakdown or infection
- tightness and clothing intolerance
- temperature, sun or chemical sensitivity
- self-care, work or activity limits caused by the skin condition
Urgent health warning
A scar or wound with spreading redness, fever, discharge, loss of circulation, new weakness or rapidly worsening breakdown requires medical assessment.
Medical evidence
What tests and findings matter?
A permanent scar assessment should record the complete skin picture, not just dimensions. Location, texture, contour, adherence, colour, symptoms, treatment and actual daily-life effect all matter.
| Test or record | What it can establish | What it cannot establish alone |
|---|---|---|
| Stable scar examination | Documents dimensions, contour, colour, texture, adherence, symptoms and skin integrity. | Length alone does not determine WPI. |
| TEMSKI assessment | Applies Table 6.18 factors by best fit to class 1 skin impairment. | TEMSKI is not a points checklist and its columns are not automatic percentages. |
| Treatment history | Shows pressure therapy, injections, laser, dressings, graft care and expected permanence. | Past treatment intensity does not replace examination of the current result. |
| Adjacent function testing | Measures joint, nerve or facial function where contracture or tissue damage has a separate effect. | The same restriction cannot be counted under both skin and another chapter. |
A separate legal classification
Threshold injury is not the same as WPI
A scar records that tissue was injured, but threshold status depends on the underlying accident injury and statutory definition. A superficial soft tissue wound may remain threshold; structural damage, deep burn or nerve injury may support a different result. Scar WPI does not decide that classification.
A non-threshold classification does not set a WPI percentage. Conversely, a low or zero WPI assessment does not necessarily decide the threshold-injury classification. Physical and psychiatric WPI are assessed separately and cannot be combined to determine whether impairment is greater than 10%.
Motor Accident Guidelines Part 6
How is permanent impairment assessed?
Clauses 6.258-6.266 use AMA4 Chapter 13. Table 2 requires consideration of signs and symptoms, activities-of-daily-living limitation and treatment. TEMSKI Table 6.18 extends class 1. The assessor selects the best-fitting category and explains the specific value.
| Assessment issue | CTP method | Important limit |
|---|---|---|
| Single or multiple body scars | Assess total skin-organ impairment using AMA4 Table 2 and TEMSKI where applicable. | Do not rate and add each scar separately. |
| Facial scar | Assess separately under clauses 6.189-6.191 using Chapter 13 and/or Chapter 9 section 9.2. | Facial and body scar ratings are then combined only as permitted. |
| Contracture or nerve loss | Use the applicable musculoskeletal or neurological method for a distinct deficit. | Remove overlap with skin ADL restriction. |
Verified Guidelines example or rule
Clause 6.261 confirms that a scar may be present and rated 0% WPI. Clauses 6.264-6.266 require TEMSKI to be applied by best fit and require reasons where a category contains a range.
What may result in 0% or no assessable WPI?
- a stable scar without qualifying symptoms, treatment or daily-life restriction
- a scar that is visible but causes no applicable skin impairment
- temporary wound-care needs before healing completes
- a surgical scar where only the underlying body-system impairment remains
What may support a higher assessment if verified?
- recurrent breakdown or substantial treatment needs
- marked sensitivity, adherence or skin intolerance affecting daily activity
- widespread or multiple scars with a greater total skin-organ effect
- distinct facial disfigurement, contracture or nerve injury assessed by the applicable method
Combination and overlap rules
- Multiple scars are assessed together as one skin-organ effect.
- Facial scars are assessed separately from scars elsewhere.
- A scar and underlying joint, nerve or organ injury may both be assessed only for distinct, non-overlapping impairment.
What does not establish impairment by itself?
- scar length alone
- the fact surgery occurred
- an acute wound photo
- subjective dislike of appearance without the applicable method
Crash-specific examples
Several healed surgical scars after fracture fixation
The scars are not each rated and added. Their total skin effect is assessed, while the fracture-related limb impairment uses its separate method.
Adherent scar crossing the elbow
The scar method addresses skin symptoms and treatment. A measured elbow restriction may be assessed separately only after overlap is considered.
Claim file preparation
Evidence checklist
Practical next steps
What should you do next with a skin scarring and wpi claim?
Start with the insurer's most recent written decision and identify what is actually disputed: treatment, weekly payments or work capacity, threshold injury, permanent impairment, causation, or damages. These are separate questions and may require different evidence and review procedures. Record the date of the decision and every review deadline shown before gathering further material.
- 01
Preserve the claim and the decision under review
Keep the claim number, accident date, insurer letter, certificate of fitness and any internal review or Personal Injury Commission correspondence together. Do not assume that a treatment approval or payment of statutory benefits decides fault, damages eligibility or WPI.
- 02
Obtain evidence that answers the disputed issue
For this injury, the useful starting material includes dated photographs from injury to stable result and wound, infection and surgical records. Clinical testing may include Stable scar examination and TEMSKI assessment. Ask the treating practitioner to record the diagnosis, accident causation, objective findings, treatment response and current functional limits rather than symptoms alone.
- 03
Use the correct review process
Compare the insurer's reasons with the records it relied on. A threshold-injury decision, treatment refusal, weekly-payment decision and WPI assessment do not all follow the same review process. The decision letter should identify available internal review or dispute steps and the applicable deadline.
If the decision, medical material or deadline is unclear, send the key documents for a focused review before lodging a broad objection. See the CTP disputes guide or contact NSW CTP Claim. Advice depends on the facts, evidence and current law; a review cannot guarantee a claim outcome.
Assessment source
Skin scarring assessment under NSW CTP
Assessment source: Motor Accident Guidelines Part 6, clauses 6.258-6.267; AMA4 Chapter 13, Table 2 (page 280); TEMSKI Table 6.18.
Threshold injury: Threshold classification follows the underlying injury; a scar rating is a separate permanent-impairment question.
What the assessor checks
- skin signs and symptoms
- activities-of-daily-living effect
- treatment needs
- TEMSKI best fit
- overlap with facial, joint or nerve impairment
What does not establish the result by itself
- a scar merely existing
- length alone
- surgery alone
- multiple scars counted separately
Official sources
Related NSW CTP guides
Free claim check
Review the diagnosis, insurer decision and evidence together
Send the accident date, insurer decision, relevant hospital or specialist reports, and any deadline shown. NSW CTP Claim is a specialised service of Stephen Young Lawyers. Legal services are provided by Stephen Young Lawyers.
Frequently asked questions
- Can a scar be assessed at 0% WPI?
- Yes. Clause 6.261 expressly permits a 0% rating.
- Are several scars added together?
- No. Clause 6.263 requires assessment of their total effect on the skin organ.
- What is TEMSKI?
- It is Table 6.18 in the Motor Accident Guidelines, extending AMA4 class 1 skin assessment. It is applied by best fit, not as a points score.
- Is a facial scar assessed the same way?
- Facial scarring is assessed separately and may use Chapter 13 and/or the AMA4 Chapter 9 face method.
- Can a scar and nerve injury both be rated?
- Potentially, where each creates a distinct impairment and the same functional loss is not counted twice.