Permanent Disability Rating Under SB 899

The 2005 Schedule for Rating Permanent Disabilities

DWC Statewide Training – 2005Session 1

DWC Statewide Training - 2005 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

Impairment

Disability

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

Effect of impairment on ability to meet occupational demands.

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

Measured against earning capacity loss.

DWC Statewide Training - 2005 5

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 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

ImpairmentRating (WP)

DisabilityRatingFEC Occ Age

ImpairmentRating (UE)

Con

v

DWC Statewide Training - 2005 15

AMA Scales

100

0

UE0 10

0

0 100

LE

WP6040

DWC Statewide Training - 2005 16

Converting AMA Scales

Thumb

Hand

x .4

x .2IndexMiddle

RingLittle

x .1

DWC Statewide Training - 2005 17

Converting AMA Scales

Hand UE WPx .9 x .6

Foot LE WPx .7 x .4

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

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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.

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

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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 23

Occupation – Maintenance electrician

Group 380 Age 29

Rating a Single Impairment

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

Find Impairment Number

XX.XX.XX.XX

Chapter# Body part/ Subcategory Subcategory

Organ sys.

DWC Statewide Training - 2005 26

Start of Rating Formula

17.05.04.00

Chap. 17 Knee ROM Unused

– 10Always WP

DWC Statewide Training - 2005 27

Apply FEC Adjustment

17.05.04.00 – 10

Knee = Rank 2

– [2]11

DWC Statewide Training - 2005 28

Adjust for occupation/age

17.05.04.00 – 10 – [2]11

FEC

– 16– 380I

Occup

– 14

Age

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

Amputation of the thumb

at the MP joint = 100 Dt

Group 380/Age 29

DWC Statewide Training - 2005 32

Thumb – Convert to WP

100 Dt Convert digit (Dt) x .4 scale to hand (Hd)

Hdx .9 Convert Hd to

UE upper ext. (UE)

x .6 Convert UE toWP whole person

(WP)

DWC Statewide Training - 2005 33

Thumb - Adjustments

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

Permanent Disability Rating Under SB 899

The 2005 Schedule for Rating Permanent Disabilities

DWC Statewide Training – 2005Session 2

DWC Statewide Training - 2005 35

Agenda Spinal impairment – DRE v. ROM Psychiatric impairment – GAF

scores Combining multiple impairments

DWC Statewide Training - 2005 36

Example – Spine Impairment

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

Occupation – Maintenance electrician

Group 380/Age 29

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 regionDiagnosis Related Estimate (DRE) Category II 8 WP

DWC Statewide Training - 2005 38

Formula – Spine Impairment

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

FEC Occupation Age

15.03.01.00 – ________________________

ImpairmentNumber/standard

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

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 - 2005 41

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 - 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

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

DWC Statewide Training - 2005 44

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

DWC Statewide Training - 2005 45

Multiple Impairments of Single Body Part

= Adjustment for earning capacity, occupation, age

Thumb AmpDt

Index ROMDt

HandHd

HandUE

HandPD

x.9 HandWP

x.6

DWC Statewide Training - 2005 46

Unilateral Upper Extremity Combining Process

WristUE

WristWP

WristPD

ArmPD

= Adjustment for earning capacity, occupation, age

HandPD

x.6

G ArmUE

G ArmWP

G ArmPD

x.6

DWC Statewide Training - 2005 47

Unilateral Lower Extremity Combining Process

FootLE

Knee DJDLE

Knee fx.LE

G LegLE

KneeLE

FootWP

G LegWP

KneeWP

FootPD

KneePD

G LegPD

LegPD

x.4

x.4

x.4

= Adjustment for earning capacity, occupation, age

DWC Statewide Training - 2005 48

Combining Remaining Impairments

C-SpinePD

R ArmPD

L ArmPD

FinalPD

L-SpinePD

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 51

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 52

Convert Impairment to Whole Person Scale

Amputation: 80 LE x __ = __ WP

Knee ROM: 35 LE x __ = __ WP

DWC Statewide Training - 2005 53

Add for Pain and Adjust for FEC, Occupation and Age

32 WP (Knee amp) + 3 WP (pain) = 35 WPL. Leg amp:

L. Knee ROM:

DWC Statewide Training - 2005 54

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 55

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 56

Combine Largest to Smallest

__ C __ = __

__ C __ = __

__ C __ = __ Final PD