Permanent Disability Rating Under SB 899 The 2005 Schedule for Rating Permanent Disabilities DWC Statewide Training – 2005 Session 1

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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 - 20052 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
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  • DWC Statewide Training - 20053 Amendment of LC 4660 Nature of physical injury to incorporate descriptions, measurements and percentages of AMA Guides, 5 th ed. Consideration to be given to employees diminished future earning capacity based on empirical data Adopt new PDRS by 1/1/05
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  • DWC Statewide Training - 20054 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.
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  • DWC Statewide Training - 20055 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
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  • DWC Statewide Training - 20056 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 ADLs
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  • DWC Statewide Training - 20057 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
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  • DWC Statewide Training - 20058 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
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  • DWC Statewide Training - 20059 Doctors Responsibilities Perform physical exam Determine all impairments Calculate impairment rating using AMA rating criteria
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  • DWC Statewide Training - 200510 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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  • DWC Statewide Training - 200511 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
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  • DWC Statewide Training - 200512 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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  • DWC Statewide Training - 200513 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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  • DWC Statewide Training - 200514 Translating Impairment into Disability Impairment Rating (WP) Disability Rating FECOccAge Impairment Rating (UE) Conv
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  • DWC Statewide Training - 200515 AMA Scales 100 0 UE 0 100 0 LE WP 6040
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  • DWC Statewide Training - 200516 Converting AMA Scales Thumb Hand x.4 x.2 Index Middle Ring Little x.1
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  • DWC Statewide Training - 200517 Converting AMA Scales HandUEWP x.9 x.6 FootLEWP x.7 x.4
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  • DWC Statewide Training - 200518 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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  • DWC Statewide Training - 200519 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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  • DWC Statewide Training - 200520 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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  • DWC Statewide Training - 200521 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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  • DWC Statewide Training - 200522 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
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  • DWC Statewide Training - 200523 Occupation Maintenance electrician Group 380 Age 29 Rating a Single Impairment Knee: 19 ext. loss 20% LE Pain factor2% WP
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  • DWC Statewide Training - 200524 Convert to Whole Person Scale 20% LE x.4 = 8% WP + 2% WP for pain 10% WP
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  • DWC Statewide Training - 200525 Find Impairment Number XX.XX.XX.XX Chapter#Body part/Subcategory Subcategory Organ sys.
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  • DWC Statewide Training - 200526 Start of Rating Formula 17.05.04.00 Chap. 17 Knee ROM Unused 10 Always WP
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  • DWC Statewide Training - 200527 Apply FEC Adjustment 17.05.04.00 10 Knee = Rank 2 [2]11
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  • DWC Statewide Training - 200528 Adjust for occupation/age 17.05.04.00 10 [2]11 FEC 16 380I Occup 14 Age
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  • DWC Statewide Training - 200529 Example Ankle ROM Loss Occupation Maintenance electrician Group 380 Age 29 Plantar flexion limited to 5 Pain factor 15% LE 1% WP
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  • DWC Statewide Training - 200530 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 - 200531 Example Thumb Amputation Amputation of the thumb at the MP joint = 100 Dt Group 380/Age 29
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  • DWC Statewide Training - 200532 Thumb Convert to WP 100DtConvert digit (Dt) x.4scale to hand (Hd) Hd x.9Convert Hd to UEupper ext. (UE) x.6Convert UE to WPwhole person (WP)
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  • DWC Statewide Training - 200533 Thumb - Adjustments 16.06.01.02 22 [1]24 380H 29 26 PD
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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 - 200535 Agenda Spinal impairment DRE v. ROM Psychiatric impairment GAF scores Combining multiple impairments
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  • DWC Statewide Training - 200536 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
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  • DWC Statewide Training - 200537 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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  • DWC Statewide Training - 200538 Formula Spine Impairment __ WP (for DRE) + __ WP (for pain) = __ WP FEC Occupation Age 15.03.01.00 ________________________ Impairment Number/standard
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  • DWC Statewide Training - 200539 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
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  • DWC Statewide Training - 200540 Psychiatric Impairment GAF score GAF findings AMA findings AMA rating FEC adjust 61-70Some diffi- culty in occ. functioning Mild limitation of ADLs 0 to 14% 0 to 20% 51-60Moderate symptoms/ difficulty Moderate limitation of some ADLs 15 to 29% 21 to 41%
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  • DWC Statewide Training - 200541 Psychiatric Impairment GAF score GAF findings AMA findings AMA rating FEC adjust 31-50Serious to major work impairment Severe limitation of most ADLs 30 to 69% 42 to 97% 1-30Inability to function in most areas Severe limitation of all ADLs 70 to 90% 98 to 100%
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  • DWC Statewide Training - 200542 Psychiatric Example Name the proper GAF range: Mild insomnia Occasional panic attacks Some difficulty following multi-step instructions at work
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  • DWC Statewide Training - 200543 Multiple Impairment Procedures 1.Consolidate impairment ratings for upper and lower extremities by body p

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