Permanent Disability Rating Under SB 899

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Permanent Disability Rating Under SB 899

• The 2005 Schedule for Rating Permanent
  Disabilities
• DWC Statewide Training 2005
• Session 1

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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

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Amendment of LC 4660

• Nature of physical injury to incorporate
  descriptions, measurements and percentages of AMA
  Guides, 5th ed.
• Consideration to be given to employees
  diminished future earning capacity based on
  empirical data
• Adopt new PDRS by 1/1/05

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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.
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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

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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 ADLs

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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

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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

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Doctors Responsibilities

• Perform physical exam
• Determine all impairments
• Calculate impairment rating using AMA rating
  criteria

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Key Medical Report Components

• Physical exam
• Medical record review
• Diagnostic studies
• Diagnoses/impairments
• Impairment rating/rationale
• Apportionment
• Need for future medical treatment

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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

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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

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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
• PS date as general criterion

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Translating Impairment into Disability
Impairment Rating (UE)
Conv
Disability Rating
Impairment Rating (WP)
FEC
Occ
Age
15
AMA Scales
WP
100
0
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Converting AMA Scales
Thumb
x .4
x .2
Hand
Index Middle
x .1
Ring Little
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Converting AMA Scales
x .9
x .6
Hand
UE
WP
x .7
x .4
Foot
LE
WP
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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

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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

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Rating a Single Impairment

• Occupation Maintenance electrician
• Group 380
• Age 29

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
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Start of Rating Formula
Always WP
17.05.04.00
10
Chap. 17 Knee ROM Unused
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Apply FEC Adjustment
17.05.04.00 10
211
Knee Rank 2
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Adjust for occupation/age
17.05.04.00 10 211
FEC
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Example Ankle ROM Loss

• Occupation Maintenance electrician
• Group 380
• Age 29

Plantar flexion limited to 5 Pain factor
15 LE
1 WP
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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
28
380I 12
10 PD
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Example Thumb Amputation

• Group 380/Age 29

Amputation of the thumb at the MP joint 100 Dt
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Thumb Convert to WP
100 Dt Convert digit (Dt) x .4 scale
to hand (Hd) Hd
x .9 Convert Hd to UE upper ext. (UE)
x .6 Convert UE to WP whole person (WP)
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Thumb - Adjustments
16.06.01.02 22 124 380H 29 26 PD
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Permanent Disability Rating Under SB 899

• The 2005 Schedule for Rating Permanent
  Disabilities
• DWC Statewide Training 2005
• Session 2

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Agenda

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

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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
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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
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Formula Spine Impairment
__ WP (for DRE) __ WP (for pain) __ WP
FEC
Occupation
Age
15.03.01.00 ________________________ Impairment
Number/standard
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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

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Psychiatric Impairment
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Psychiatric Impairment
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Psychiatric Example

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

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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

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Multiple Impairment Procedures (cont)

• 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

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Multiple Impairments of Single Body Part
Thumb Amp Dt
Hand PD
x.9
Hand Hd
Hand UE
Hand WP
x.6
Index ROM Dt
Adjustment for earning capacity, occupation, age
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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
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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
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Combining Remaining Impairments
C-Spine PD
R Arm PD
Final PD
L-Spine PD
L Arm PD
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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
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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
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Convert Impairment to Whole Person Scale
Amputation 80 LE x __ __ WP Knee ROM 35 LE
x __ __ WP
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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
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Combine Values and Compare to Max for Extremity
Combined value for leg __ C __ __ PD
Amputation value for leg 17.01.02.01 - 40 -
______________________
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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
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Combine Largest to Smallest
__ C __ __
__ C __ __
__ C __ __ Final PD