Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities
Download ReportTranscript Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities
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 Calculating PD for single impairments DWC Statewide Training - 2005 2 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 Disability 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 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 5 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 6 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 7 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 8 Doctor’s Responsibilities Perform physical exam Determine all impairments Calculate impairment rating using AMA rating criteria DWC Statewide Training - 2005 9 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 10 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 11 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 12 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 13 Translating Impairment into Disability Impairment Rating (UE) Impairment Rating (WP) FEC Occ Age DWC Statewide Training - 2005 Disability Rating 14 AMA Scales UE WP LE 100 0 0 40 0 100 60 DWC Statewide Training - 2005 100 15 Converting AMA Scales Thumb x .4 Index Middle x .2 Ring Little x .1 Hand DWC Statewide Training - 2005 16 Converting AMA Scales Hand Foot x .9 x .7 UE LE x .6 x .4 DWC Statewide Training - 2005 WP WP 17 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 18 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 19 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 20 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 21 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 22 Rating a Single Impairment Occupation – Maintenance electrician Group 380 Age 29 Knee: 19° ext. loss Pain factor DWC Statewide Training - 2005 20% LE 2% WP 23 Convert to Whole Person Scale 20% LE x .4 = 8% WP + 2% WP for pain 10% WP DWC Statewide Training - 2005 24 Find Impairment Number XX.XX.XX.XX Chapter# Body part/ Organ sys. Subcategory DWC Statewide Training - 2005 Subcategory 25 Start of Rating Formula 17.05.04.00 – 10 Chap. 17 Knee ROM DWC Statewide Training - 2005 Always WP Unused 26 Apply FEC Adjustment 17.05.04.00 – 10 – [2]11 Knee = Rank 2 DWC Statewide Training - 2005 27 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 Occupation – Maintenance electrician Group 380 Age 29 Plantar flexion limited to 5° 15% LE Pain factor 1% WP DWC Statewide Training - 2005 29 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 30 Example – Thumb Amputation Group 380/Age 29 Amputation of the thumb at the MP joint = 100 Dt DWC Statewide Training - 2005 31 Thumb – Convert to WP 100 Dt x .4 Hd x .9 UE x .6 WP Convert digit (Dt) scale to hand (Hd) Convert Hd to upper ext. (UE) Convert UE to whole person (WP) DWC Statewide Training - 2005 32 Thumb - Adjustments 16.06.01.02 – 22 – [1]24 – 380H – 29 – 26 PD DWC Statewide Training - 2005 33 Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities DWC Statewide Training – 2005 Session 2 Agenda Spinal impairment – DRE v. ROM Psychiatric impairment – GAF scores Combining multiple impairments DWC Statewide Training - 2005 35 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 DWC Statewide Training - 2005 37 Formula – Spine Impairment __ WP (for DRE) + __ WP (for pain) = __ WP 15.03.01.00 – ________________________ Impairment Number/standard FEC Occupation DWC Statewide Training - 2005 Age 38 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 39 Psychiatric Impairment GAF score GAF findings AMA findings AMA FEC rating adjust 61-70 Some diffi- Mild 0 to culty in occ. limitation of 14% functioning ADL’s 51-60 Moderate symptoms/ difficulty 0 to 20% Moderate 15 to 21 to limitation of 29% 41% some ADL’s DWC Statewide Training - 2005 40 Psychiatric Impairment GAF score GAF findings AMA findings AMA FEC rating adjust 31-50 Serious to Severe 30 to 42 to major work limitation of 69% 97% impairment most ADL’s 1-30 Inability to function in most areas Severe 70 to 98 to limitation of 90% 100% all ADL’s DWC Statewide Training - 2005 41 Psychiatric Example Name the proper GAF range: •Mild insomnia •Occasional panic attacks •Some difficulty following multi-step instructions at work DWC Statewide Training - 2005 42 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 43 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 44 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 G Arm x.6 UE Wrist WP Wrist PD G Arm WP G Arm PD Arm PD = Adjustment for earning capacity, occupation, age DWC Statewide Training - 2005 46 Unilateral Lower Extremity Combining Process Knee DJD LE Knee fx. LE Foot LE x.4 Foot WP Foot PD Knee LE x.4 Knee WP Knee PD G Leg x.4 LE G Leg WP G Leg PD Leg PD = Adjustment for earning capacity, occupation, age DWC Statewide Training - 2005 47 Combining Remaining Impairments C-Spine PD R Arm PD Final PD L-Spine PD L Arm PD DWC Statewide Training - 2005 48 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 49 Combining example 16 C 12 C 14 = ? 36 or 37? Always work from large to small DWC Statewide Training - 2005 50 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 51 Convert Impairment to Whole Person Scale Amputation: 80 LE x __ = __ WP Knee ROM: 35 LE x __ = __ WP DWC Statewide Training - 2005 52 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 53 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 54 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 55 Combine Largest to Smallest __ C __ = __ __ C __ = __ __ C __ = __ Final PD DWC Statewide Training - 2005 56