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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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DWC Statewide Training - 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
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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
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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. DWC Statewide Training
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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 DWC Statewide Training
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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 ADL’s DWC Statewide Training
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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
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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 DWC Statewide Training
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Doctor’s Responsibilities
Perform physical exam Determine all impairments Calculate impairment rating using AMA rating criteria DWC Statewide Training
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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 DWC Statewide Training
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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 DWC Statewide Training
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DWC Statewide Training - 2005
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
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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 DWC Statewide Training
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Translating Impairment into Disability
Rating (UE) Conv Disability Rating Impairment Rating (WP) FEC Occ Age DWC Statewide Training
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DWC Statewide Training - 2005
AMA Scales UE 100 WP 40 60 100 100 LE DWC Statewide Training
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DWC Statewide Training - 2005
Converting AMA Scales Thumb x .4 x .2 Index Middle Hand Ring Little x .1 DWC Statewide Training
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DWC Statewide Training - 2005
Converting AMA Scales x .9 x .6 Hand UE WP x .7 x .4 Foot LE WP DWC Statewide Training
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DWC Statewide Training - 2005
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
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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% DWC Statewide Training
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DWC Statewide Training - 2005
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
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DWC Statewide Training - 2005
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
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DWC Statewide Training - 2005
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
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Rating a Single Impairment
Occupation – Maintenance electrician Group 380 Age 29 Knee: 19° ext. loss % LE Pain factor 2% WP DWC Statewide Training
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Convert to Whole Person Scale
20% LE x .4 = 8% WP + 2% WP for pain 10% WP DWC Statewide Training
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Find Impairment Number
XX.XX.XX.XX Chapter# Body part/ Subcategory Subcategory Organ sys. DWC Statewide Training
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Start of Rating Formula
Always WP – 10 Chap Knee ROM Unused DWC Statewide Training
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DWC Statewide Training - 2005
Apply FEC Adjustment – 10 – [2]11 Knee = Rank 2 DWC Statewide Training
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Adjust for occupation/age
– 10 – [2]11 – 16 – 380I Occup – 14 Age FEC DWC Statewide Training
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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 DWC Statewide Training
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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 – 7 – [2]8 – 380I – 12 – 10% PD DWC Statewide Training
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Example – Thumb Amputation
Group 380/Age 29 Amputation of the thumb at the MP joint = 100 Dt DWC Statewide Training
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DWC Statewide Training - 2005
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) DWC Statewide Training
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DWC Statewide Training - 2005
Thumb - Adjustments – 22 – [1]24 – 380H – 29 – 26 PD DWC Statewide Training
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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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DWC Statewide Training - 2005
Agenda Spinal impairment – DRE v. ROM Psychiatric impairment – GAF scores Combining multiple impairments DWC Statewide Training
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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
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DWC Statewide Training - 2005
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 WP DWC Statewide Training
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Formula – Spine Impairment
__ WP (for DRE) + __ WP (for pain) = __ WP – ________________________ Impairment Number/standard FEC Occupation Age DWC Statewide Training
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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
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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
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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% DWC Statewide Training
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DWC Statewide Training - 2005
Psychiatric Example Name the proper GAF range: Mild insomnia Occasional panic attacks Some difficulty following multi-step instructions at work DWC Statewide Training
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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 DWC Statewide Training
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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
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Multiple Impairments of Single Body Part
Thumb Amp Dt Hand PD Hand Hd x.9 Hand UE x.6 Hand WP Index ROM Dt = Adjustment for earning capacity, occupation, age DWC Statewide Training
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Unilateral Upper Extremity Combining Process
Hand PD Wrist PD Arm PD Wrist UE x.6 Wrist WP G Arm PD G Arm UE x.6 G Arm WP = Adjustment for earning capacity, occupation, age DWC Statewide Training
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Unilateral Lower Extremity Combining Process
Foot PD Foot LE x.4 Foot WP Knee DJD LE Knee PD Leg PD Knee LE x.4 Knee WP Knee fx. LE G Leg PD G Leg LE x.4 G Leg WP = Adjustment for earning capacity, occupation, age DWC Statewide Training
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Combining Remaining Impairments
C-Spine PD R Arm PD Final PD L-Spine PD L Arm PD DWC Statewide Training
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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 DWC Statewide Training
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DWC Statewide Training - 2005
Combining example 16 C 12 C 14 = ? 36 or 37? Always work from large to small DWC Statewide Training
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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 DWC Statewide Training
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Convert Impairment to Whole Person Scale
Amputation: 80 LE x __ = __ WP Knee ROM: 35 LE x __ = __ WP DWC Statewide Training
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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
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Combine Values and Compare to Max for Extremity
Combined value for leg: __ C __ = __ PD Amputation value for leg: ______________________ DWC Statewide Training
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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
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Combine Largest to Smallest
__ C __ = __ Final PD DWC Statewide Training
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