Permanent Disability Rating Under SB 899
The 2005 Schedule for Rating Permanent Disabilities
DWC Statewide Training – 2005Session 1
DWC Statewide Training - 2005 2
Topics Impairment v. Disability Activities of daily living Role of doctor and rater Application dates of new PDRS Converting AMA scales Calculating PD for single
impairments
DWC Statewide Training - 2005 3
Amendment of LC §4660
“Nature of physical injury” to incorporate descriptions, measurements and percentages of AMA Guides, 5th ed.
Consideration to be given to employee’s “diminished future earning capacity” based on empirical data
Adopt new PDRS by 1/1/05
DWC Statewide Training - 2005 4
Impairment v. Disability
Impairment
Disability
Loss, loss of use, or derangement of any body part, organ system or organ function.
Effect of impairment on ability to meet occupational demands.
Measured against impact on activities of daily living (ADL).
Measured against earning capacity loss.
DWC Statewide Training - 2005 5
Activities of Daily Living (ADL) Self-care,
personal hygiene Communication Physical activity –
stand, walk, sit Sensory function –
hearing, seeing
Non-specialized hand activities – lifting, grasping, tactile discrimination
Travel Sexual function Sleep
DWC Statewide Training - 2005 6
Unscheduled Impairment If impairment based on an
objective medical condition is not addressed by the AMA Guides, physician may rate by analogy (p. 1-4)
Compare to medical condition with similar limitation of ADL’s
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Exception to LC 4660 Presumption of total disability (LC
4662) Loss of both eyes or sight thereof Loss of both hands or use thereof Total paralysis Incurable insanity
DWC Statewide Training - 2005 8
Overview of Rating Process
Doctor evaluates worker and provides impairment rating
Rater verifies accuracy of impairment rating and translates it into a permanent disability rating
DWC Statewide Training - 2005 9
Doctor’s Responsibilities
Perform physical exam
Determine all impairments
Calculate impairment rating using AMA rating criteria
DWC Statewide Training - 2005 10
Key Medical Report Components Physical exam
Medical record review
Diagnostic studies
Diagnoses/impairments
Impairment rating/rationale
Apportionment
Need for future medical treatment
DWC Statewide Training - 2005 11
Documentation Requirements Full explanation of the basis of rating
List all charts, tables, page numbers Provide rationale for all opinions
Use of Guides’ forms recommended Upper extremity – p. 436 Lower extremity – p. 561 Cervical range of motion (ROM) – p. 422 Thoracic ROM – p. 416 Lumbar ROM – p. 410
DWC Statewide Training - 2005 12
Role of DEU Insure that impairments receive
the proper disability rating Return incomplete medical reports Seek clarification of AMA rating issues Correct impairment rating errors Calculate and issue PD ratings
Act as resource on AMA Guides and PD
DWC Statewide Training - 2005 13
Application of New PDRS New PDRS applies to injury dates
before 1/1/05 per LC 4660(d) if: No med-legal or treating doctor report
indicating existence of PD
No notice required under LC 4061, i.e. TD is still being paid
P&S date as general criterion
DWC Statewide Training - 2005 14
Translating Impairment into Disability
ImpairmentRating (WP)
DisabilityRatingFEC Occ Age
ImpairmentRating (UE)
Con
v
DWC Statewide Training - 2005 15
AMA Scales
100
0
UE0 10
0
0 100
LE
WP6040
DWC Statewide Training - 2005 16
Converting AMA Scales
Thumb
Hand
x .4
x .2IndexMiddle
RingLittle
x .1
DWC Statewide Training - 2005 17
Converting AMA Scales
Hand UE WPx .9 x .6
Foot LE WPx .7 x .4
DWC Statewide Training - 2005 18
FEC Adjustment Goal of proportionality between
disability rating and future earnings loss
Under 1997 PDRS, hands were compensated more generously (relative to earnings loss) than shoulders
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FEC Adjustment Examples Hand/fingers Rank 1 – 10%
Knee Rank 2 – 14.2%
Lumbar spine Rank 5 – 27.1%
Shoulder Rank 7 – 35.7%
Psych Rank 8 – 40%
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FEC Adjustment
All impairments fit into one of eight ranks
Rank 1 = 10% increase = min. adj.
Rank 8 = 40% increase = max adj.
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Occupation and Age Applied to FEC-adjusted rating One new occupational group – 493
Applies to less arduous athletic occupations
Examples: professional bowler, instructor/aerobics
Group descriptions added to assist with unscheduled occupations
DWC Statewide Training - 2005 22
Pain Add-on Max is 3% WP
3% can be subdivided between different impairments
Add impairment to WP value for affected body part(s) before adjustments
DWC Statewide Training - 2005 23
Occupation – Maintenance electrician
Group 380 Age 29
Rating a Single Impairment
Knee: 19° ext. loss 20% LE
Pain factor 2% WP
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Convert to Whole Person Scale
20% LE x .4 = 8% WP
+ 2% WP for pain
10% WP
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Find Impairment Number
XX.XX.XX.XX
Chapter# Body part/ Subcategory Subcategory
Organ sys.
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Start of Rating Formula
17.05.04.00
Chap. 17 Knee ROM Unused
– 10Always WP
DWC Statewide Training - 2005 27
Apply FEC Adjustment
17.05.04.00 – 10
Knee = Rank 2
– [2]11
DWC Statewide Training - 2005 28
Adjust for occupation/age
17.05.04.00 – 10 – [2]11
FEC
– 16– 380I
Occup
– 14
Age
DWC Statewide Training - 2005 29
Example – Ankle ROM Loss Occupation – Maintenance
electrician Group 380 Age 29
Plantar flexion limited to 5°
Pain factor
15% LE
1% WP
DWC Statewide Training - 2005 30
Calculate Ankle Rating Convert to whole person Add pain factor Adjust for FEC, occupation and age
15%
LE
x .4 = 6% WP+ 1% (pain) = 7% WP
17.07.04.00 – 7– [2]8 – 380I – 12– 10% PD
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Example – Thumb Amputation
Amputation of the thumb
at the MP joint = 100 Dt
Group 380/Age 29
DWC Statewide Training - 2005 32
Thumb – Convert to WP
100 Dt Convert digit (Dt) x .4 scale to hand (Hd)
Hdx .9 Convert Hd to
UE upper ext. (UE)
x .6 Convert UE toWP whole person
(WP)
DWC Statewide Training - 2005 33
Thumb - Adjustments
16.06.01.02 – 22 – [1]24 – 380H – 29 – 26 PD
Permanent Disability Rating Under SB 899
The 2005 Schedule for Rating Permanent Disabilities
DWC Statewide Training – 2005Session 2
DWC Statewide Training - 2005 35
Agenda Spinal impairment – DRE v. ROM Psychiatric impairment – GAF
scores Combining multiple impairments
DWC Statewide Training - 2005 36
Example – Spine Impairment
Injured lifting heavy motor; no prior injury
Lumbar spine, 4mm herniation at L4-5
Left-sided radiculopathy resolved
Significant pain on heavy lifting = 1 WP
Occupation – Maintenance electrician
Group 380/Age 29
DWC Statewide Training - 2005 37
DRE v. ROM method
DRE method applies because: New injury, not recurrent Herniation on one side – not
bilateral Herniation at single, not multiple,
levels within lumbar regionDiagnosis Related Estimate (DRE) Category II 8 WP
DWC Statewide Training - 2005 38
Formula – Spine Impairment
__ WP (for DRE) + __ WP (for pain) = __ WP
FEC Occupation Age
15.03.01.00 – ________________________
ImpairmentNumber/standard
DWC Statewide Training - 2005 39
Psychiatric Impairment Psychiatric ratings not provided by
AMA
PDRS approach
Doctor assesses impairment using global assessment of function (GAF) scale
GAF scores mapped to WP impairment by comparison of definitions
DWC Statewide Training - 2005 40
Psychiatric Impairment
GAF score
GAF findings
AMA findings
AMA rating
FEC adjust
61-70 Some diffi-culty in occ. functioning
Mild limitation of ADL’s
0 to 14%
0 to 20%
51-60 Moderate symptoms/difficulty
Moderate limitation of some ADL’s
15 to 29%
21 to 41%
DWC Statewide Training - 2005 41
Psychiatric Impairment
GAF score
GAF findings
AMA findings
AMA rating
FEC adjust
31-50 Serious to major work impairment
Severe limitation of most ADL’s
30 to 69%
42 to 97%
1-30 Inability to function in most areas
Severe limitation of all ADL’s
70 to 90%
98 to 100%
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Psychiatric Example
Name the proper GAF range:
•Mild insomnia
•Occasional panic attacks
•Some difficulty following multi-step instructions at work
DWC Statewide Training - 2005 43
Multiple Impairment Procedures
1. Consolidate impairment ratings for upper and lower extremities by body part
AMA dictates method of consolidation, e.g. adding v. combining
Hands & feet considered one body part Global arm/leg impairments (16.01/17.01
series) considered one body part
DWC Statewide Training - 2005 44
Multiple Impairment Procedures (con’t)
2. Convert each impairment to WP scale
3. Adjust each WP rating for FEC, occupation, age
4. Combine within each extremity subject to maximum for that extremity
5. Combine all remaining values
DWC Statewide Training - 2005 45
Multiple Impairments of Single Body Part
= Adjustment for earning capacity, occupation, age
Thumb AmpDt
Index ROMDt
HandHd
HandUE
HandPD
x.9 HandWP
x.6
DWC Statewide Training - 2005 46
Unilateral Upper Extremity Combining Process
WristUE
WristWP
WristPD
ArmPD
= Adjustment for earning capacity, occupation, age
HandPD
x.6
G ArmUE
G ArmWP
G ArmPD
x.6
DWC Statewide Training - 2005 47
Unilateral Lower Extremity Combining Process
FootLE
Knee DJDLE
Knee fx.LE
G LegLE
KneeLE
FootWP
G LegWP
KneeWP
FootPD
KneePD
G LegPD
LegPD
x.4
x.4
x.4
= Adjustment for earning capacity, occupation, age
DWC Statewide Training - 2005 48
Combining Remaining Impairments
C-SpinePD
R ArmPD
L ArmPD
FinalPD
L-SpinePD
DWC Statewide Training - 2005 49
Rules for Combining Values For any group of combinable
numbers: Combine the two largest values first Round the result to whole percentage Combine result with next larger value
Use same formula (or chart) for impairments and disabilities
Do not combine impairments with disabilities
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Combining example
16 C 12 C 14 = ?
36 or 37?
Always work from large to small
DWC Statewide Training - 2005 51
Multiple Impairment Example Occupation – Tractor operator Group 351 Age 29
Left leg amputation below knee = 80 LE
Substantial stump pain = 3 WP
Left knee flexion of 55 degrees = 35 LE
DWC Statewide Training - 2005 52
Convert Impairment to Whole Person Scale
Amputation: 80 LE x __ = __ WP
Knee ROM: 35 LE x __ = __ WP
DWC Statewide Training - 2005 53
Add for Pain and Adjust for FEC, Occupation and Age
32 WP (Knee amp) + 3 WP (pain) = 35 WPL. Leg amp:
L. Knee ROM:
DWC Statewide Training - 2005 54
Combine Values and Compare to Max for Extremity
Combined value for leg:__ C __ = __ PD
Amputation value for leg:17.01.02.01 - 40 - ______________________
DWC Statewide Training - 2005 55
Combining Additional Impairments
Left leg amputation and ROM = 50 PD
Right hip arthritis = 14 PD
Lumbar spine fusion = 25 PD
Moderate psychiatric symptoms = 41 PD
DWC Statewide Training - 2005 56
Combine Largest to Smallest
__ C __ = __
__ C __ = __
__ C __ = __ Final PD
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