How Activities of Daily Living Assessments Support Injured Workers with Mental Health Injuries and a 15%+ WPI

In the realm of personal injury and workers’ compensation, plaintiff lawyers often encounter clients with serious mental health conditions whose daily functional impairments are not fully captured by clinical diagnoses or Whole Person Impairment (WPI) ratings. While a WPI rating of 15% or more indicates significant permanent impairment, it may not comprehensively reflect the impact on a client’s daily life. This is where an Activities of Daily Living (ADL) assessment becomes crucial.

An ADL assessment quantifies the real-world effects of mental illness on an individual’s ability to function independently, providing essential evidence for two key legal outcomes: gratuitous care claims and the justification for structured occupational therapy interventions. This article explores the importance of these assessments, especially for clients with serious mental health conditions, and how they can strengthen cases for compensation and ongoing rehabilitation support.

Bridging the Gap Between Diagnosis and Daily Functioning

Clients with a 15%+ WPI related to psychological injury, stemming from workplace trauma, bullying and harassment, cumulative stress, or other causes, often experience chronic functional impairments not fully captured by diagnostic labels such as PTSD, major depressive disorder, or generalized anxiety disorder.

These impairments frequently manifest as:

  • Reduced motivation and energy to perform basic tasks like showering, preparing meals, or attending appointments
  • Cognitive dysfunction, including difficulty concentrating, planning, or organizing tasks
  • Emotional dysregulation, making social interactions or leaving the house overwhelming
  • Avoidance behaviors linked to trauma or anxiety, leading to isolation and functional decline
  • Poor sleep, further impairing daytime functioning and motivation

According to the Royal Australian and New Zealand College of Psychiatrists (RANZCP), individuals with serious mental health disorders commonly experience a diminished ability to initiate and maintain daily routines, often requiring structured support or external prompting to complete even simple tasks (RANZCP, 2016).

Understanding ADL Assessments

An Activities of Daily Living (ADL) assessment is a structured evaluation conducted by an occupational therapist. It systematically reviews a person’s ability to perform daily self-care and instrumental tasks, including:

  • Personal hygiene and grooming
  • Toileting and continence
  • Dressing and undressing
  • Meal preparation and eating
  • Housework and home maintenance
  • Mobility and transport
  • Medication management
  • Managing finances
  • Child care or the care of others in the household

The assessment captures both the client’s current capacity and the level of support they require (either formal or informal), providing a comprehensive functional profile. For individuals with mental health injuries, ADL assessments often reveal subtle but profound difficulties that standard psychiatric evaluations or impairment ratings may not highlight.

Legal Relevance: Gratuitous Care and Domestic Assistance in NSW

Under Australian common law, particularly in states following Griffiths v Kerkemeyer (1977) 139 CLR 161, plaintiffs can claim damages for care and assistance provided voluntarily by family or friends, provided that:

  1. The care is necessary due to the injury
  2. It is provided for at least six hours per week
  3. It is likely to continue for six months or more

In NSW, this has been further developed through legislative updates. Under Section 60AA of the Workers Compensation Act 1987, an injured worker can claim compensation for domestic assistance if:

  • A medical practitioner certifies, based on a functional assessment, that the assistance is reasonably necessary due to the injury
  • The assistance would not have been required but for the injury
  • The injury has resulted in a permanent impairment of at least 15%, or the assistance is to be provided on a temporary basis as specified

This provision underscores the importance of medical assessments, such as ADL evaluations, in substantiating the necessity for domestic assistance. In Williams v Wollongong City Council (NSWDC 2020), the NSW District Court recognized that hospital admissions linked to the injury did not break the continuity of gratuitous care, reinforcing the need for evidence-based care claims even amidst interruptions.

SIRA guidelines also emphasize the role of functional assessments in determining the necessity of domestic assistance, making ADL reports a valuable and admissible piece of evidence for these claims.

Justifying Structured Occupational Therapy

Beyond litigation, ADL assessments can be used to support structured rehabilitation interventions. For mental health clients, the goal isn’t just symptom reduction but functional recovery—returning to meaningful routines, roles, and responsibilities.

Occupational therapy plays a vital role here.

When an occupational therapist identifies deficits in areas like hygiene, cooking, budgeting, or public transport use, they can develop structured, graded interventions aimed at helping the client re-learn or re-engage with those tasks. The ADL assessment thus acts as a clinical roadmap for treatment, which can be particularly effective when paired with psychological therapy.

Evidence shows that occupation-focused therapy can lead to substantial gains in function and quality of life for people living with depression, anxiety, and trauma-related conditions (American Journal of Occupational Therapy, 2018; Meta-analysis by Brown et al., 2016). The key is targeted, client-centered intervention grounded in a clear functional baseline—exactly what an ADL assessment provides.

Case Snapshot: The Client Who Couldn’t Cook

Consider a hypothetical but common scenario. A 43-year-old woman develops a severe anxiety disorder and depression following a workplace bullying incident. She receives a WPI rating of 17% under the Psychiatric Impairment Rating Scale (PIRS). Her psychiatrist recommends ongoing treatment, but her daily life deteriorates. She lives alone and often skips meals, struggles to maintain hygiene, and becomes socially withdrawn.

An ADL assessment reveals that she no longer shops or cooks due to panic attacks in public spaces and fear of injury when using the stove. A neighbor checks in daily and delivers cooked meals. Her lawyer, armed with the ADL report, includes a claim for gratuitous care in the damages brief and successfully argues for ongoing occupational therapy input as part of a rehabilitation program.

The occupational therapist, using the ADL data, introduces graded exposure therapy in partnership with her psychologist and teaches her safe meal preparation techniques using a slow cooker. Over time, she regains confidence and independence.

This functional recovery—and its legal and therapeutic foundation—started with a simple ADL assessment.

Final Thoughts for Plaintiff Lawyers

For clients with a 15%+ WPI related to psychological injury, ADL assessments are a critical tool for bridging the gap between diagnosis and functional reality. They provide:

  • Clear documentation of how mental health injuries impair daily life
  • Objective evidence to support gratuitous care and domestic assistance claims under NSW law
  • A foundation for structured occupational therapy that promotes real recovery

In a legal landscape where insurers often question the severity or functional relevance of psychological injuries, these assessments offer credible, clinician-led insight that can significantly improve claim outcomes and client well-being.

If your clients aren’t yet being referred for ADL assessments—especially where WPI is 15% or more—it’s time to make this a routine part of your case strategy.

References:

  • Royal Australian and New Zealand College of Psychiatrists (RANZCP). (2016). The Economic Cost of Serious Mental Illness and Comorbidities in Australia and New Zealand
  • Brown, M., Stoffel, V.C., & Muñoz, J.P. (2016). Occupational Therapy in Mental Health: A Vision for Participation. AOTA Press
  • American Journal of Occupational Therapy. (2018). Occupational Therapy Interventions for Adults With Serious Mental Illness: A Systematic Review.
  • Workers Compensation Act 1987 (NSW), Section 60AA
  • Williams v Wollongong City Council [2020] NSWDC 264
  • State Insurance Regulatory Authority (SIRA) Guidelines (2018)