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Permanent Disability Rating Under SB 899

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

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


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 3

Impairment v. Disability
Impairment Loss, loss of use, or derangement of any body part, organ system or organ function. Measured against impact on activities of daily living (ADL). Effect of impairment on ability to meet occupational demands. Measured against earning capacity loss.
DWC Statewide Training - 2005 4

Disability

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

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


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




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
  

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

DWC Statewide Training - 2005

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 Upper extremity p. 436 Lower extremity p. 561 Cervical range of motion (ROM) Thoracic ROM p. 416 Lumbar ROM p. 410
DWC Statewide Training - 2005

Use of Guides forms recommended


    

p. 422

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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

P&S date as general criterion


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Translating Impairment into Disability


Impairment Rating (UE)

Impairment Rating (WP)

FEC

Occ

Age

Disability Rating
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DWC Statewide Training - 2005

AMA Scales
UE WP LE 0 0 0 40 100
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100 100

60

Converting AMA Scales


Thumb Index Middle Ring Little x .4 x .2 x .1
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Hand

Converting AMA Scales


Hand
x .9

UE

x .6

WP

Foot

x .7

LE

x .4

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

DWC Statewide Training - 2005

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FEC Adjustment Examples


    

Hand/fingers Knee Lumbar spine Shoulder Psych

Rank 1 Rank 2 Rank 5 Rank 7 Rank 8

10% 14.2% 27.1% 35.7% 40%

DWC Statewide Training - 2005

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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.

DWC Statewide Training - 2005

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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

DWC Statewide Training - 2005

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Rating a Single Impairment


  

Occupation Group 380 Age 29 Knee:

Maintenance electrician

19 ext. loss Pain factor

20% LE 2% WP

DWC Statewide Training - 2005

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Convert to Whole Person Scale


20% LE x .4 = 8% WP + 2% WP for pain 10% WP

DWC Statewide Training - 2005

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Find Impairment Number


XX.XX.XX.XX

Chapter#

Body part/ Organ sys.

Subcategory

Subcategory

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Start of Rating Formula


Always WP

17.05.04.00

10

Chap. 17

Knee

ROM

Unused

DWC Statewide Training - 2005

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Apply FEC Adjustment


17.05.04.00 10 [2]11

Knee = Rank 2

DWC Statewide Training - 2005

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Adjust for occupation/age

17.05.04.00

10

[2]11

380I

16

14

FEC
DWC Statewide Training - 2005

Occup

Age
28

Example
  

Ankle ROM Loss


Maintenance electrician

Occupation Group 380 Age 29

Plantar flexion limited to 5 Pain factor

15% LE 1% WP

DWC Statewide Training - 2005

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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 [2]8 380I 12 10% PD


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DWC Statewide Training - 2005

Example


Thumb Amputation

Group 380/Age 29

Amputation of the thumb at the MP joint = 100 Dt

DWC Statewide Training - 2005

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Thumb

Convert to WP
Convert digit (Dt) scale to hand (Hd) Convert Hd to upper ext. (UE) Convert UE to whole person (WP)
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100 Dt x .4 Hd x .9 UE x .6 WP

DWC Statewide Training - 2005

Thumb - Adjustments

16.06.01.02

22

[1]24

380H

29

26 PD

DWC Statewide Training - 2005

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Permanent Disability Rating Under SB 899


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

Agenda
  

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

DWC Statewide Training - 2005

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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
DWC Statewide Training - 2005 36

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 15.03.01.00 ________________________


FEC Occupation Age

Impairment Number/standard

DWC Statewide Training - 2005

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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

DWC Statewide Training - 2005

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Psychiatric Impairment
GAF score 61-70 GAF findings AMA findings AMA FEC rating adjust 0 to 20%

Some diffi- Mild 0 to culty in occ. limitation of 14% functioning ADL s Moderate symptoms/ difficulty

51-60

Moderate 15 to 21 to limitation of 29% 41% some ADL s


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DWC Statewide Training - 2005

Psychiatric Impairment
GAF score 31-50 GAF findings AMA findings AMA FEC rating adjust

Serious to Severe 30 to 42 to major work limitation of 69% 97% impairment most ADL s Inability to function in most areas Severe 70 to 98 to limitation of 90% 100% all ADL s
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1-30

DWC Statewide Training - 2005

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


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
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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
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Multiple Impairments of Single Body Part


Thumb Amp Dt Index ROM Dt

Hand Hd

x.9

Hand UE

x.6

Hand WP

Hand PD

= Adjustment for earning capacity, occupation, age


DWC Statewide Training - 2005 45

Unilateral Upper Extremity Combining Process


Hand PD Wrist UE
x.6

Wrist WP

Wrist PD

Arm PD

G Arm x.6 UE

G Arm WP

G Arm PD

= Adjustment for earning capacity, occupation, age


DWC Statewide Training - 2005 46

Unilateral Lower Extremity Combining Process


Foot LE Knee DJD LE Knee fx. LE Knee LE
x.4

Foot WP Knee WP

Foot PD Knee PD Leg PD

x.4

G Leg x.4 LE

G Leg WP

G Leg PD

= Adjustment for earning capacity, occupation, age


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Combining Remaining Impairments


C-Spine PD R Arm PD L-Spine PD L Arm PD
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Final PD

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 Group 351 Age 29

Tractor operator

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:

DWC Statewide Training - 2005

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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 - ______________________

DWC Statewide Training - 2005

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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

DWC Statewide Training - 2005

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Combine Largest to Smallest


__ C __ = __ __ C __ = __ __ C __ = __ Final PD

DWC Statewide Training - 2005

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