The South African Government has appointed Soma Initiative, South Africa’s market leader in Health Risk Management as the exclusive Health Risk Manager to assess the purported disability of military veterans in terms of the Military Pensions Act. It is anticipated that over 90% of the estimated 56 000 military veterans to be evaluated will claim disability on psychiatric grounds. After a comprehensive review of assessment methodologies, Soma Initiative selected Expertlist's advanced web-based software, e-PIRS, as the optimal means of rating psychiatric impairment quickly, reliably and efficiently. The e-PIRS system was developed by the author of the Psychiatric Impairment Rating Scale (PIRS), and is based upon the method now included in the American Medical Association's Guides to The Evaluation of Permanent Impairment, 6th Edition.
The Psychiatric Impairment Rating Scale (PIRS) is used to determine the rate of impairment arising from psychiatric conditions. It rates ability to function in various areas of daily living, namely self-care and personal hygiene, recreational activities, travel, relationships, concentration, persistence and pace, and employability. The PIRS function descriptors are based on observable manifestations of psychiatric disorders. Subjectivity by claimants and assessors is in this manner minimised and the detailed descriptors improve the reliability of, and provide a clear explanation for, the final rating.
The Psychiatric Impairment Rating Scale (PIRS) was developed in 1999, at the request of the New South Wales Motor Accidents Authority, Australia. Dr Julian Parmegiani chaired the committee that developed the PIRS. The committee was composed of four senior forensic psychiatrists, an occupational physician and a rehabilitation specialist. The PIRS was designed specifically to rate psychiatric impairment in a medico-legal setting. The PIRS has proved an effective and reliable instrument, and is now the most widely used instrument internationally in the assessment of psychiatric impairment. It is used to measure psychiatric impairment arising from work accidents, motor vehicle accidents, medical negligence as well as other injuries.
The e-PIRS is a web-based questionnaire, based on the PIRS methodology and philosophy. While it is not a substitute for a thorough clinical examination, the result can help a claimant or an insurer to make a decision about a psychiatric injury claim. For example, many compensation systems exclude small claims by using thresholds. When the e-PIRS indicates a low impairment rating, significant additional expenses can be avoided. Conversely, when there is doubt, e-PIRS can help to identify significant impairment and provide a basis for further specialist examinations. While the e-PIRS relies on complex algorithms, the results produced are clear and easily understood.
The PIRS does not purport to determine causality of psychiatric injuries. This is a complex area that requires a thorough clinical assessment of numerous sources and types of information, and at times the evaluation of conflicting evidence. Further, the PIRS does not assess whether psychiatric injuries have reached maximum medical improvement (stabilisation), or the likely impact of specialist psychiatric treatment.
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