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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 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

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  1. Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities DWC Statewide Training – 2005 Session 1

  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 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

  5. 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

  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 DWC Statewide Training - 2005

  7. 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 Impairment Rating (UE) Conv Disability Rating Impairment Rating (WP) FEC Occ Age DWC Statewide Training - 2005

  15. UE 100 0 40 60 LE 0 100 AMA Scales WP 100 0 DWC Statewide Training - 2005

  16. Converting AMA Scales Thumb x .4 x .2 Index Middle Hand x .1 Ring Little DWC Statewide Training - 2005

  17. Converting AMA Scales x .9 x .6 Hand UE WP x .7 x .4 Foot LE WP 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 DWC Statewide Training - 2005

  19. 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

  20. 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

  21. 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. 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

  24. Convert to Whole Person Scale 20% LE x .4 = 8% WP + 2% WP for pain 10% WP DWC Statewide Training - 2005

  25. XX.XX.XX.XX Chapter# Body part/ Subcategory Subcategory Organ sys. Find Impairment Number DWC Statewide Training - 2005

  26. Start of Rating Formula Always WP 17.05.04.00 – 10 Chap. 17 Knee ROM Unused DWC Statewide Training - 2005

  27. Apply FEC Adjustment 17.05.04.00 – 10 – [2]11 Knee = Rank 2 DWC Statewide Training - 2005

  28. – 380I – 16 – 14 Occup Age Adjust for occupation/age 17.05.04.00 – 10 – [2]11 FEC 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 DWC Statewide Training - 2005

  31. Example – Thumb Amputation • Group 380/Age 29 Amputation of the thumb at the MP joint = 100 Dt DWC Statewide Training - 2005

  32. 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

  33. Thumb - Adjustments 16.06.01.02 – 22 – [1]24 – 380H – 29 – 26 PD DWC Statewide Training - 2005

  34. Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities DWC Statewide Training – 2005 Session 2

  35. Agenda • Spinal impairment – DRE v. ROM • Psychiatric impairment – GAF scores • Combining multiple impairments DWC Statewide Training - 2005

  36. 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

  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 region Diagnosis Related Estimate (DRE) Category II 8 WP DWC Statewide Training - 2005

  38. Formula – Spine Impairment __ WP (for DRE) + __ WP (for pain) = __ WP 15.03.01.00 – ________________________ Impairment Number/standard FEC Occupation Age 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 DWC Statewide Training - 2005

  41. Psychiatric Impairment DWC Statewide Training - 2005

  42. 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 • 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) • 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

  45. 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

  46. 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

  47. 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

  48. Combining Remaining Impairments C-Spine PD R Arm PD Final PD L-Spine PD L Arm PD 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 DWC Statewide Training - 2005

  50. Combining example 16 C 12 C 14 = ? 36 or 37? Always work from large to small DWC Statewide Training - 2005

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