SGI attaches this form to the PI-Scarring Information Request letter it sends an injury claimant whose accident left cuts, lacerations or surgical scars. The customer's practitioner describes each scar so SGI's medical consultant can rate it for the permanent impairment benefit, a lump sum for permanent impairment, scarring or disfigurement. SGI does not publish the form; it arrives with the request.
The customer's own practitioner completes the whole form, recording each scar's location, description, type, length and width. The customer supplies the labelled photographs of the scars that go with it.
Download the current version from the source each time; forms change without notice.
Permanent Impairment Description form
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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About 10 months after the accident for the interim permanent impairment assessment and payment, and about 10 months after the last accident-related surgery for the final assessment. SGI's Injury Manual says scars need at least ten months to heal fully and mature, and it treats photos and measurements sent earlier than 10 months after the accident as premature.
From the injured customer. SGI does not publish the form: it is attached to the PI-Scarring Information Request letter that SGI sends the customer, with instructions for the photographs. The practitioner completes it from that letter, and it returns to SGI with the labelled scar photos.
SGI's medical consultant rates the extent of the impairment from the scar description, measurements and photos, and the Personal Injury Representative decides entitlement. SGI makes an interim payment on or about the first anniversary of the accident and a final payment once the customer reaches maximum medical improvement.