california permanent disability rating · 2018-01-01 · 11 section 3-two parts: occupations and...

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California Permanent Disability Rating

Presented by Marlene Phillips

Bradford & Barthel’sRating and File Consultation Services

“When You Need More Than Just A Rating”

Email- [email protected]

Marlene Phillips

Ontario Office – (909) 476-0552

Email – [email protected]

Tim Mussack

Sacramento Office – (916) 569-0790

Email - [email protected]

www.bradfordbarthel.com 2

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IntroductionPermanent Rating Schedule www.dir.ca.gov/dwc/pdr.pdf

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Today’s Topics

� Application dates for Permanent Disability Rating Schedules (PDRS)

� Impairment versus Disability

� Converting Impairment to Permanent Disability

� Converting AMA Scales

� Combining Impairments


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PDRS Application Dates

� 1988 PDRS

� All dates of injury on or before 3/31/1997

� 1997 PDRS

� All dates of injury on or after 4/1/1997 and on or before 12/31/2004

� 2005 PDRS

� All dates of injury before 1/1/2013

� With some exceptions

� ‘NEW’ PDRS

Use modified 2005 PDRS for dates of injury on or after 1/1/2013.


‘NEW’ PDRS Application DatesLC §4660.1, added effective January 1, 2013

� Applies to all dates of injury on or after 1/1/2013

� Use age and occupational modifiers from 2005 PDRS until Schedule is amended

� ‘Modified’ 2005 PDRS

� No separate ranges for future earnings capacity (FEC) adjustment.

� All WPI, is then multiplied by 1.4 (equal to FEC 8) before age and occupation modifiers

� No additional PD for psyche, sleep, or sexual dysfunction

� Some exceptions for psyche only


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Impairment v. Disability

Impairment

Loss of use, or derangement of any body part, organ system, or organ function. Measured against impact on activities of daily living (ADL).

Measured using AMA GuidesWhole Person Impairment (WPI).

Does not consider WORK.

Disability

Effect of impairment on ability to meet occupational demands.

Measured as a Permanent Disability percentage.

Labor Code 4660 applies to injuries occurring before January 1, 2013.

Labor Code 4660.1. applies to injuries occurring on or after January 1, 2013.


Calculating Permanent DisabilityPermanent Rating Schedule www.dir.ca.gov/dwc/pdr.pdf

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What is PD based on?

� Nature of the physical injury or disfigurement (Impairment Standard or WPI)

� Diminished Future Earning Capacity (DFEC or FEC)

� After 1/1/2013, no DFEC or FEC

� Multiply WPI by 1.4

� Occupation

� Age


Section 1Introduction and Instructions

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The Rating Formula

� Impairment number (Section 2)

� Impairment standard (WPI from medical report)

� FEC rank (Section 2)

� After 1/1/2013, no FEC, multiply WPI by 1.4

� Occupation

� Age


The Rating Formula – 2005 PDRS

15.01.02.02 – 8 – [5]10 – 470H – 13 – 11% PD

① 15.01.02.02 – Cervical spine, Range of Motion Method, Soft Tissue Lesion

② 8 – Impairment standard (WPI, must be WPI not UE or LE! )

③ [5] – FEC Rank (not used after 1/1/2013, multiply WPI by 1.4)

④ 10 – Rating after FEC adjustment (or multiplication)

⑤ 470 – Occupational group number (Furniture Assembler, Heavy)

⑥ H – Occupational Variant

⑦ 13 – Rating after occupational adjustment

⑧ 11 – Rating after age adjustment (30 years old)


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The Rating Formula –Modified 2005 PDRS

15.01.02.02 –8 [1.4] – 11 – 470H – 14 – 12% PD

① 15.01.02.02 – Cervical spine, Range of Motion Method, Soft Tissue Lesion

② 8 – Impairment standard (WPI, must be WPI)

③ 11 – Rating after multiplication by 1.4

④ 470 – Occupational group number (Furniture Assembler, Heavy)

⑤ H – Occupational Variant

⑥ 14 – Rating after occupational adjustment

⑦ 12 – Rating after age adjustment (30 years old)


Section 2Impairment Number and Future Earnings Capacity (FEC) AdjustmentPart 1, 3, and 4 of rating formula in this section

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Almaraz/Guzman Impairment

� Allows doctor to use any chapter, table, or method within the ‘four corners’ of the AMA Guides to determine impairment.

� Impairment number is selected based on the diagnosis, not the chapter, table, or method used.

� Impairment number corresponds with AMA Guides Chapter number

� When using Almaraz/Guzman you must change the the last group of two digits to 99

� 15.01.02.99, not 15.01.02.02


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Impairment Number

15.01.02.02� 15 – Spine (Spine chapter in AMA 5th Edition)

� 01 – Cervical (neck)

� 02 – Range of Motion Method

� 02 – Soft Tissue Lesion


Future Earning Capacity

� Attempts to adjust impairment rating using RAND study information, to reflect the average percentage of long-term loss of income resulting from each type of injury for similarly situated employees LC §4660(b)(2)

� FEC never decreases impairment values!

� Do not use Table B (page 1-7), ALWAYS use FEC to the right of impairment number on pages 2-2 thru 2-5

� Not used for dates of injury on or after 1/1/2013 (multiply by 1.4 – same as FEC 8)


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Spine = 5 FEC?Yes, for 27 out of 31 impairment

numbers – but others are different.


www.bradfordbarthel.com

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Section 3- two parts:Occupations andGroup Numbers

15.01.02.02 – 8 – [5]10 – 470H – 13 – 11% PDPart 5 of the rating formula in this section

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General Information

� Each occupation group number has three digits.

� First digit (1 to 5) identifies the physical requirements of the job

� A bigger number indicates greater physical demand

� 3 is average


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Section 4Occupational Variant15.01.02.02 – 8 – [5]10 – 470H – 13 – 11% PD

Part 6 of the rating formula in this section

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Section 5Occupational Adjustment15.01.02.02 – 8 – [5]10 – 470H – 13 – 11% PD

Part 7 of the rating formula is from this section

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Section 6Age Adjustment15.01.02.02 – 8 – [5]10 – 470H – 13 – 11% PD

Part 8 (the final part) of the rating formula in this section

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Section 7Examples

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Error! 39% PD should be 32% PD(see page 7-2)

Error! 61% PD should be 50% PD(see page 7-3)



Example B Page 7-3

1. Convert individual impairments to the whole person scale.

Left leg amputation: 80% LE × .4 = 32% WPI

Left knee motion: 35% LE × .4 = 14% WPI

2. Apply 3% add-on for pain.

32% WPI + 3% WPI = 35% WPI

3. Apply earning capacity, occupation and age adjustments to

each whole person impairment.

L leg amp.: 17.01.02.02 – 35 – [5]45 – 351G – 48 – 44 PD

L knee motion: 17.05.04.00 – 14 – [2]16 – 351G–18 – 16 PD

4. Combine the adjusted impairments for the left leg.

44% PD C 16% PD = 53% PD

5. Calculate the maximum value for a single leg adjusted for

earning capacity, age and occupation. The maximum rating

for a leg before adjustments is 40%.

17.01.02.01 – 40 – [5]51 – 351G – 54 – 50 PD

Reminder - Page 1-11

The composite rating for an extremity (after

adjustments) may not exceed the amputation value of the

extremity adjusted for earning capacity, occupation and age.

The occupational variant used to rate an entire extremity shall

be the highest variant of the involved individual impairments.

Page 7-3 footnote:

See AMA Guides, 5th edition, page 527, for lower extremity conversion

factors. Rating adjustments and formulas are explained in Section 1 of this

Schedule..

The symbol used to represent the operation of combining is “C”. Use the

Combined Values Chart on page 8-2 of the Schedule to combine ratings.

Compare the results of step 4 and 5 above. Choose the lower

as the final value. The correct disability rating for the left

leg is 50% PD.

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Section 8Combined Values Chart

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Combined Values Chart

� Use the chart in the PDRS (Section 8)

� The Combined Values Chart in the AMA Guides has 5 errors (pages 604 – 606)

� The Chart uses greatest value on the left and smaller value at the

bottom of the chart. Intersection of that row and column provides the combined value.

� Ensures that summary value will not exceed 100%


AMA Guides Corrections

� 54 c 12 = 60

� 58 c 25 = 69

� 94 c 78 = 99

� 95 c 30= 97

� 95 c 34 = 97


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AMA Scales

UE

WPI

LE

0 100

0 100

0 40 60 100


Example

� 25 year old attorney with amputation above the knee (mid-thigh)

� 90% LE impairment.


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Example (continued)

� Impairment #?� page 2-4

� 17.01.02.01

� Impairment Standard = 90%� 17.01.02.01-90 ?

NO!


90% L.E. Impairment

� (not WPI)

� Must “convert” LE to WPI

� AMA Guides page 527

� 90% LE = 36% WPI

� 17.01.02.01 - 36


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Example – The Rest

� FEC Rank� 5 (page 2-4)� 17.01.02.01-36-[5]46

� Occupation = 110 (page 3-14)� 110=D (page 4-8)� 17.01.02.01-36-[5]46-110D-40

� Age?� 25 year old (see 6-3)� 17.01.02.01-36-[5]46-110D-40-35% PD


Summary

� 2005 PDRS used for all injuries� Exceptions may apply for DOI before 1/1/2005

� Always use WPI in PD ‘string’

� If doctor gives single WPI for multiple injuries –Do Not Use; Use correct combining rules

� When multiple injuries, always verify doctor’s combining/adding of impairment

� Pain add-on is 3% WPI maximum per DOI� Add to WPI, not PD


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Combining Impairments

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General Rule for Combining

� All impairments are:

� Converted to WPI

� Adjusted for FEC, occupation and age

� Combined


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Multiple Impairments in Single Part of Extremity (2005 PDRS page 1-11)

� Combine at the extremity level

� Convert to WPI

� Adjust for FEC, occupation, age

� Combine result with other parts of same extremity

Example:

UE shoulder instability and limited ROM


Multiple Impairments in Single Part of Extremity

Shoulder Instability

(UE impairment)

Shoulder ROM(UE impairment)

Total ShoulderUE impairment

ShoulderWPI

Shoulder PDAdjust

Convert

Combine


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Selecting an Impairment Number

Select “other” when combining 2 or more impairments for same body part

� Shoulder-other 16.02.02.00

Select “other” if the impairment is not listed


ExampleMultiple Impairments in Same Part of an Extremity

Stevedore (Group 351) – 30 years old

Right shoulder limited motion = 20% UE

Right shoulder instability = 12% UE

Step 1 – Combine at extremity level

Use Combined Values Chart

20% c 12% = 30% UE


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Step 2 – Convert to WPI:

Use Table 16-3 (AMA Guides, page 439)

30% UE = 18% WPI

OR Calculate – UE x 60% = WPI

30% x 60% = 18% WPI



Step 3 – Adjust

What impairment number? (PDRS, page 2-4)

Shoulder - ROM = 16.02.01.00

Shoulder - Other = 16.02.02.00

“Other”……16.02.02.00

16.02.02.00 – 18 – [7]24 – 351G – 27 – 24% PD


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Multiple Impairments in the Same Extremity, different parts

� Use general combining rules� Convert each part (elbow, shoulder, etc) to WPI

� Adjust for FEC, Occupation, Age

� Combine at PD level


ExampleMultiple Impairments in Different Parts of the Same Extremity


Right shoulder from previous example:

16.02.02.00 – 18 – [7]24 – 351G – 27 – 24% PD

Plus – Right hand impairment (loss of motion) = 16% UE

Step 1 – Convert all impairments to WPI:

16% UE = 10% WPI


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ExampleMultiple Impairments in Different Parts of the Same Extremity

Step 2 – Adjust:

16.05.01.00 – 10 – [1]11 – 351G – 13 – 11% PD

Step 3 – Combine at PD level:

24% c 11% = 32% PD (for right arm)


Multiple Impairments in Single Part of Extremity

Shoulder(UE impairment)

Hand(UE impairment)

Hand WPIShoulder WPI

Shoulder PD

Adjust

Convert

Combine

Convert

Hand PD

Adjust

Extremity PD


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Multiple Impairments in Multiple Extremities/Systems

“ Impairments of an individual extremity are adjusted and combined at the whole person [permanent disability] level with other impairments of the same extremity before combining with impairments of other body parts.” (2005 PDRS, page 1-11)



� Use general combining rules for each extremity� Convert each part (elbow, shoulder, etc) to WPI

� Adjust for FEC, Occupation, Age

� Combine at PD level to determine PD for each involved extremity, then

� Combine Extremities and Systems, largest to smallest PD%


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ExampleMultiple Impairments in Multiple Extremities/Systems


Right upper extremity from previous examples:

16.02.02.00 – 18 – [7]24 – 351G – 27 – 24% PD

16.05.01.00 – 10 – [1]11 – 351G – 13 – 11% PD

Combine: 24 c 11 = 32% PD

Plus – Left leg amputation – 100% LE

Lumbar spine (DRE) – 10% WPI

Right knee loss of motion – 8% LE



Step 1 – Determine PD for each extremity

Right arm – 32% PD

Left leg – Convert to WPI – 100% LE = 40% WPI

Adjust: 17.01.02.01 – 40 – [5]51 – 351G – 54 – 50% PD

Right leg (knee) – Convert to WPI – 8% LE = 3% WPI

Adjust: 17.05.04.00 – 3 – [2]4 – 351G – 5 – 4% PD


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Step 2 – Determine PD for other systems

Lumbar Spine – 10% WPI

Adjust: 15.03.01.00 – 10 – [5]13 – 351G – 15 – 13% PD

Step 3 – Combine PD – bigger to smaller

50% (left leg) c 32% (right arm) = 66% PD

66% c 13% (back) = 70% PD

70% c 4% (right leg) = 71% total PD



Spine WPI Spine PD

Right Arm PD

Right Leg WPI

Left Leg WPI

AdjustCombine

Left Leg PD

Adjust

TotalPD

Right Leg PD

Adjust


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ExampleSimulated DEU Rating

Right shoulder – 16.02.02.00 – 18 – [7]24 – 351G – 27 – 24% PD (A)

Right hand – 16.05.01.00 – 10 – [1]11 – 351 G – 13 – 11% PD (A)

Left leg – 17.01.02.01 – 40 – [5]51 – 351G – 54 – 50% PD

Lumbar spine – 15.03.01.00 – 10 – [5]13 – 351G – 15 – 13% PD

Right knee – 17.05.04.00 – 3 – [2]4 – 351G – 5 – 4% PD

A = 24 c 11 = 32% PD (A)

50 c 32 (A) =66; 66 c 13=70; 70 c 4 = 71% final PD


Practice 2

� Carpenter – 28 years old

� Right shoulder – Loss of Motion – 10% UE

� Right shoulder – Arthroplasty – 10% UE

� Right wrist – Loss of Motion – 5% UE

� Left elbow – Loss of Motion – 9% UE

� Lumbar spine – DRE, 7% WPI


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Practice 2

1. Combine impairments that are in the same part of the same extremity, convert to WPI, adjust.

2. Any other parts in the above extremity? Convert to WPI, adjust.

3. Combine all disability in the same extremity.

4. Repeat 1, 2, 3 for each extremity.

5. Combine all extremity impairments with other systems and body parts – biggest to smallest.


Practice 2

� Combine right shoulder loss of motion with arthroplasty at extremity level.

� 10 c 10 = 19% UE

� Convert to 11% WPI

� Adjust


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Practice 2 Answer

Rt. Shoulder

16.02.02.00 – 11 – [7]15 – 380H – 19 – 17% PD (B)

Rt Wrist

16.04.01.00 – 3 – [4]4 – 380J – 8 – 7% PD (B)

Left elbow

16.03.01.00 – 5 – [2]6 – 380I – 9 – 8% PD

Lumbar spine

15.03.01.00 – 7 – [5]9 – 380H – 12 – 10% PD


Practice 2 Answer

Combine right arm first (B):

17 c 7 = 23% PD for right arm

23 c 10 = 31

31 c 8 = 37% total PD


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Interesting Facts - 1

“Impairments with disability numbers in the 16.01 and 17.01 series are converted to whole person impairment and adjusted before being combined with any other impairment of the same extremity.”(2005 PDRS, page 1-11)

Example:

Injured worker with carpal tunnel and cubitaltunnel injures.

Use 16.01.02.02 and 16.01.02.03



“Multiple impairments involving the hand or foot are combined using standard AMA Guides protocols. The resulting impairment is converted to whole person impairment and adjusted before being combined with other impairments of the same extremity.”(2005 PDRS, page 1-11)


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“The composite rating for an extremity (after adjustments) may not exceed the amputation value of the extremity adjusted for earning capacity, occupation and age.” (2005 PDRS, page 1-11)


Pain

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Pain Add-On

“Pursuant to Chapter 18 of the AMA Guides, a whole person impairment rating based on the body or organ rating system of the AMA Guides (Chapters 3 through 17) may be increased by 0% up to 3% WPI if the burden of the worker’s condition has been increased by pain-related impairment in excess of the pain component already incorporated in the WPI rating in Chapters 3-17.” (2005 PDRS, page 1-12)


Chapter 18 – All About Pain

�The Errata Sheet changes significant portions of Chapter 18.

�According to the Guides

�Not automatic

�Maximum of 3% per injury

�Chapter 18 analysis required


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Pain – According to the DEU16th Annual DWC Educational Conference – Feb 2009


Pain Add-On

The DEU stated:

“Criterion assumes an underlying body system impairment rating greater than zero.” (DWC 15th Annual Educational Conference 2008)

The WCAB, in Blackledge en banc, states:

“Because this pain add-on can be assessed only to ‘increase’ other ratable impairment, there can be no pain add-on if there is no underlying WPI for a particular body part or system.”


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Exception for Pain!

�Pain without objective findings:

� In cases of direct head trauma without objective findings and complaints of headache pain.

� ‘Counts’ toward 3% WPI limit.� Use impairment – 13.01.00.99


Pain Add-On

� Max is 3% WPI per date of injury

� 3% can be subdivided between different impairments

� Add impairments to WPI value for affected body part(s) before adjustments


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Orthopedic AME

Internal AME


Neurologic AME


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Summary

� 2005 PDRS used for all injuries� Exceptions may apply for DOI before 1/1/2005

� Always use WPI in PD ‘string’

� If doctor gives single WPI for multiple injuries –Do Not Use; Use correct combining rules

� When multiple injuries, always verify doctor’s combining/adding of impairment

� Pain add-on is 3% WPI maximum per DOI� Add to WPI, not PD


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“When You Need More Than Just A Rating”

Marlene Phillips - Ontario Office – (909) 476-0552

Email – [email protected]

Tim Mussack - Sacramento Office – (916) 569-0790

Email - [email protected]

Web – [email protected]


california permanent disability rating · 2018-01-01 · 11 section 3-two parts: occupations and...

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