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Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities DWC Statewide Training – 2005 Session 1 Topics Impairment v. Disability Activities of daily living Role of doctor and rater Application dates of new PDRS Converting AMA scales

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permanent disability rating under sb 899

Permanent Disability Rating Under SB 899

The 2005 Schedule for Rating Permanent Disabilities

DWC Statewide Training – 2005

Session 1

topics
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

amendment of lc 4660
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

impairment v disability
Impairment v. Disability

Loss, loss of use, or derangement of any body part, organ system or organ function.

Impairment

Measured against impact on activities of daily living (ADL).

Disability

Effect of impairment on ability to meet occupational demands.

Measured against earning capacity loss.

DWC Statewide Training - 2005

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

Activities of Daily Living (ADL)

DWC Statewide Training - 2005

unscheduled impairment
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

DWC Statewide Training - 2005

exception to lc 4660
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

overview of rating process
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

doctor s responsibilities
Doctor’s Responsibilities
  • Perform physical exam
  • Determine all impairments
  • Calculate impairment rating using AMA rating criteria

DWC Statewide Training - 2005

key medical report components
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

documentation requirements
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

role of deu
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

application of new pdrs
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

translating impairment into disability
Translating Impairment into Disability

Impairment

Rating (UE)

Conv

Disability

Rating

Impairment

Rating (WP)

FEC

Occ

Age

DWC Statewide Training - 2005

ama scales
UE

100

0

40

60

LE

0

100

AMA Scales

WP

100

0

DWC Statewide Training - 2005

converting ama scales
Converting AMA Scales

Thumb

x .4

x .2

Index

Middle

Hand

x .1

Ring

Little

DWC Statewide Training - 2005

converting ama scales17
Converting AMA Scales

x .9

x .6

Hand

UE

WP

x .7

x .4

Foot

LE

WP

DWC Statewide Training - 2005

fec adjustment
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

DWC Statewide Training - 2005

fec adjustment examples
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%

DWC Statewide Training - 2005

fec adjustment20
FEC Adjustment
  • All impairments fit into one of eight ranks
  • Rank 1 = 10% increase = min. adj.
  • Rank 8 = 40% increase = max adj.

DWC Statewide Training - 2005

occupation and age
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

pain add on
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

rating a single impairment
Rating a Single Impairment
  • Occupation – Maintenance electrician
  • Group 380
  • Age 29

Knee: 19° ext. loss 20% LE

Pain factor 2% WP

DWC Statewide Training - 2005

convert to whole person scale
Convert to Whole Person Scale

20% LE x .4 = 8% WP

+ 2% WP for pain

10% WP

DWC Statewide Training - 2005

find impairment number
XX.XX.XX.XX

Chapter# Body part/ Subcategory Subcategory

Organ sys.

Find Impairment Number

DWC Statewide Training - 2005

start of rating formula
Start of Rating Formula

Always WP

17.05.04.00

– 10

Chap. 17 Knee ROM Unused

DWC Statewide Training - 2005

apply fec adjustment
Apply FEC Adjustment

17.05.04.00 – 10

– [2]11

Knee = Rank 2

DWC Statewide Training - 2005

adjust for occupation age
– 380I

– 16

– 14

Occup

Age

Adjust for occupation/age

17.05.04.00 – 10 – [2]11

FEC

DWC Statewide Training - 2005

example ankle rom loss
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

calculate ankle rating
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

DWC Statewide Training - 2005

example thumb amputation
Example – Thumb Amputation
  • Group 380/Age 29

Amputation of the thumb

at the MP joint = 100 Dt

DWC Statewide Training - 2005

thumb convert to wp
Thumb – Convert to WP

100 Dt Convert digit (Dt)

x .4scale to hand (Hd)

Hd

x .9Convert Hd to

UE upper ext. (UE)

x .6Convert UE to

WP whole person (WP)

DWC Statewide Training - 2005

thumb adjustments
Thumb - Adjustments

16.06.01.02 – 22 – [1]24 – 380H – 29 – 26 PD

DWC Statewide Training - 2005

permanent disability rating under sb 89934

Permanent Disability Rating Under SB 899

The 2005 Schedule for Rating Permanent Disabilities

DWC Statewide Training – 2005

Session 2

agenda
Agenda
  • Spinal impairment – DRE v. ROM
  • Psychiatric impairment – GAF scores
  • Combining multiple impairments

DWC Statewide Training - 2005

example spine impairment
Example – Spine Impairment
  • Occupation – Maintenance electrician
  • Group 380/Age 29

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

DWC Statewide Training - 2005

dre v rom method
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 region

Diagnosis Related Estimate (DRE)

Category II 8 WP

DWC Statewide Training - 2005

formula spine impairment
Formula – Spine Impairment

__ WP (for DRE) + __ WP (for pain) = __ WP

15.03.01.00 – ________________________

Impairment

Number/standard

FEC

Occupation

Age

DWC Statewide Training - 2005

psychiatric impairment
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

psychiatric impairment40
Psychiatric Impairment

DWC Statewide Training - 2005

psychiatric impairment41
Psychiatric Impairment

DWC Statewide Training - 2005

psychiatric example
Psychiatric Example
  • Name the proper GAF range:
  • Mild insomnia
  • Occasional panic attacks
  • Some difficulty following multi-step instructions at work

DWC Statewide Training - 2005

multiple impairment procedures
Multiple Impairment Procedures
  • 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

multiple impairment procedures con t
Multiple Impairment Procedures (con’t)
  • Convert each impairment to WP scale
  • Adjust each WP rating for FEC, occupation, age
  • Combine within each extremity subject to maximum for that extremity
  • Combine all remaining values

DWC Statewide Training - 2005

multiple impairments of single body part
Multiple Impairments of Single Body Part

Thumb Amp

Dt

Hand

PD

x.9

Hand

Hd

Hand

UE

x.6

Hand

WP

Index ROM

Dt

= Adjustment for earning capacity, occupation, age

DWC Statewide Training - 2005

unilateral upper extremity combining process
Unilateral Upper Extremity Combining Process

Hand

PD

Wrist

PD

Arm

PD

x.6

Wrist

UE

Wrist

WP

G Arm

PD

x.6

G Arm

UE

G Arm

WP

= Adjustment for earning capacity, occupation, age

DWC Statewide Training - 2005

unilateral lower extremity combining process
Unilateral Lower Extremity Combining Process

Foot

PD

x.4

Foot

LE

Foot

WP

Knee DJD

LE

Knee

PD

Leg

PD

x.4

Knee

LE

Knee

WP

Knee fx.

LE

G Leg

PD

x.4

G Leg

LE

G Leg

WP

= Adjustment for earning capacity, occupation, age

DWC Statewide Training - 2005

combining remaining impairments
Combining Remaining Impairments

C-Spine

PD

R Arm

PD

Final

PD

L-Spine

PD

L Arm

PD

DWC Statewide Training - 2005

rules for combining values
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

DWC Statewide Training - 2005

combining example
Combining example

16 C 12 C 14 = ?

36 or 37?

Always work from large to small

DWC Statewide Training - 2005

multiple impairment example
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

convert impairment to whole person scale
Convert Impairment to Whole Person Scale

Amputation: 80 LE x __ = __ WP

Knee ROM: 35 LE x __ = __ WP

DWC Statewide Training - 2005

add for pain and adjust for fec occupation and age
Add for Pain and Adjust for FEC, Occupation and Age

32 WP (Knee amp) + 3 WP (pain) = 35 WP

L. Leg amp:

L. Knee ROM:

DWC Statewide Training - 2005

combine values and compare to max for extremity
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

combining additional impairments
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

combine largest to smallest
Combine Largest to Smallest

__ C __ = __

__ C __ = __

__ C __ = __ Final PD

DWC Statewide Training - 2005