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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
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
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
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
Exception to LC 4660
Loss of both eyes or sight thereof Loss of both hands or use thereof Total paralysis Incurable insanity
Doctor evaluates worker and provides impairment rating Rater verifies accuracy of impairment rating and translates it into a permanent disability rating
Doctor s Responsibilities
Perform physical exam Determine all impairments Calculate impairment rating using AMA rating criteria
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
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
p. 422
11
Role of DEU
Return incomplete medical reports Seek clarification of AMA rating issues Correct impairment rating errors Calculate and issue PD ratings
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
FEC
Occ
Age
Disability Rating
14
AMA Scales
UE WP LE 0 0 0 40 100
DWC Statewide Training - 2005 15
100 100
60
Hand
UE
x .6
WP
Foot
x .7
LE
x .4
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
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19
FEC Adjustment
All impairments fit into one of eight ranks Rank 1 = 10% increase = min. adj. Rank 8 = 40% increase = max adj.
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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
22
Maintenance electrician
20% LE 2% WP
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24
Chapter#
Subcategory
Subcategory
25
17.05.04.00
10
Chap. 17
Knee
ROM
Unused
26
Knee = Rank 2
27
17.05.04.00
10
[2]11
380I
16
14
FEC
DWC Statewide Training - 2005
Occup
Age
28
Example
15% LE 1% WP
29
Convert to whole person Add pain factor Adjust for FEC, occupation and age
Example
Thumb Amputation
Group 380/Age 29
31
Thumb
Convert to WP
Convert digit (Dt) scale to hand (Hd) Convert Hd to upper ext. (UE) Convert UE to whole person (WP)
32
100 Dt x .4 Hd x .9 UE x .6 WP
Thumb - Adjustments
16.06.01.02
22
[1]24
380H
29
26 PD
33
Agenda
Spinal impairment DRE v. ROM Psychiatric impairment GAF scores Combining multiple impairments
35
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
DWC Statewide Training - 2005 36
Formula
Spine Impairment
Impairment Number/standard
38
Psychiatric Impairment
Doctor assesses impairment using global assessment of function (GAF) scale GAF scores mapped to WP impairment by comparison of definitions
39
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
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
41
1-30
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
Hand Hd
x.9
Hand UE
x.6
Hand WP
Hand PD
Wrist WP
Wrist PD
Arm PD
G Arm x.6 UE
G Arm WP
G Arm PD
Foot WP Knee WP
x.4
G Leg x.4 LE
G Leg WP
G Leg PD
Final PD
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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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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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:
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54
55
56