Why is it Important to my Workers’ Compensation Case?
In California Workers’ Compensation Law, Applicants are assigned percentages for their disabilities. These percentages eventually translate into monetary compensation.
An Applicant’s percentage of disability is first established by determining the Applicant’s Whole Person Impairment or “WPI.” Medical evaluators are the individuals who make the determination as to what the WPI is for an individual. The evaluator could be a Treating Doctor, a Qualified Medical Examiner, or an Agreed Medical Examiner. In rare circumstances, a Judge can appoint a Regular Physician to make the assessment.
The Labor Code establishes the way of calculating and definition of Whole Person Impairment. California Labor Code Section 4660(b)(1) provides that the “nature of the physical injury or disfigurement” shall incorporate the descriptions and measurements of physical impairments and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition). In other words, the AMA Guide to Evaluation of Permanent Impairment (5th Edition) is the tool that physicians are required to employ to assess an individual’s impairment.
The AMA Guides to the Evaluation of Permanent Impairment 5th Edition defines impairment as “a loss, loss of use, or derangement of any body part, organ system, or organ function.”
The AMA Guides 5th Edition indicates that
“[a]n impairment can be manifested objectively, for example, by a fracture, and/or subjectively, through fatigue and pain. Although the Guides emphasizes objective assessment, subjective symptoms are included within the diagnostic criteria. According to the Guides, determining whether an injury or illness results in a permanent impairment requires a medical assessment performed by a physician. An impairment may lead to functional limitations or the inability to perform activities of daily living.”
The AMA Guides indicate that impairment percentages or ratings developed by medical specialists are consensus-derived estimates that reflect the severity of the medical condition and the degree to which the impairment decreases an individual’s ability to perform common activities of daily living (ADL), excluding work. Impairment ratings were designed to reflect functional limitations and not disability. The Whole Person Impairment (WPI) percentages listed in the Guides estimate the impact of the impairment on the individual’s overall ability to perform Activities of Daily Living, excluding work, as listed in Table 1-2.
Activities of Daily Living
Table 1-2 defines Activities of Daily Living. This term is frequently abbreviated in reporting as ADLs. The ADLs are:
- Self-care: urinating, defecating, brushing teeth, personal hygiene combing hair, bathing, dressing oneself, eating.
- Communication: writing, typing, seeing, hearing, speaking.
- Physical Activity: standing, sitting, reclining, walking, climbing stairs.
- Sensory function: hearing, seeing, tactile feeling, tasting, smelling.
- Nonspecialized Grasping: lifting, tactile, hand activities discrimination.
- Travel: riding, driving, flying.
- Sexual function: orgasm, ejaculation, lubrication, erection.
- Sleep: restful, nocturnal.
Why are ADLs, Activities of Daily Living, important?
The physician evaluating an Injured Worker will take an inventory of their ADLs. Usually, a physician will present the Injured Worker with a pre-printed form which contains questions about ADLs. The physician may assign a greater impairment if the medical disability has a significant impact to their Activities of Daily Living. In the AMA Guides, there are certain tables for which ADL impact allows the doctor to increase or decrease an impairment.
Are there any other impairments besides Whole Person Impairments? Why is this important?
In the AMA Guides, besides Whole Person Impairment, there are a number of other impairments. These other impairments can create confusion when a layperson looks at a medical report. Most times, the other impairments have a lesser value than the Whole Person Impairment compensation. Because of this, an Injured Worker might believe their rating is higher if the doctor does not convert the impairment to WPI.
Doctors, in generating their reports, have to use these other impairments in order to calculate the Whole Person Impairment. The other impairments include an Upper Extremity Impairment and a Lower Extremity Impairment. For the Upper Extremities, impairments are further broken down to Hand Impairment, Index/Middle Finger Impairment, Right/Little Finger Impairment and Thumb Impairment. For Vision, there is a Visual System Impairment Rating which is used in part to generate a Whole Person Impairment Rating for injuries to the Eye.
For the Upper and Lower Extremity Impairments, they are of a lesser value than a Whole Person Impairment. An Upper Extremity Impairment is only 60 percent of the value of a Whole Person Impairment. Therefore, a 10 percent Upper Extremity Impairment translates into a 6 percent Whole Person Impairment. Also, a Lower Extremity Impairment is only a 40 percent value of a Whole Person Impairment. Therefore, a 10 percent Lower Extremity Impairment translates into a 4 percent Whole Person Impairment.
Therefore, when you are analyzing medical reports, you must pay attention to what type of impairment has been assigned. Also, evaluators sometimes make mistakes in assessing the impairments. Sometimes, they can assign the wrong type of impairment. The Impairments listed in any doctor’s report should be double-checked for accuracy.
Is a Psychiatric Injury assigned Whole Person Impairment differently?
In California, Psychiatric Injuries are to be assessed upon a Global Assessment of Function Score (GAF.) A GAF score is a number which is generally assigned Psychiatrist or Psychologist. It measures both Symptom Severity and Level of Functioning. This GAF score is then translated into a Whole Person Impairment. The conversion page is located on page 1-16 of the Scedule for Rating Permanent Disabilities. http://www.dir.ca.gov/dwc/PDR.pdf
How Do Physicians in California Use the Guides in Determining Whole Person Impairment?
In California, physicians writing impairment reports have an obligation to follow a strict interpretation of the Guides in assigning a Whole Person Impairment. Caselaw, however, allows them to deviate from this strict interpretation. There is a series of cases called Almaraz/Guzman cases which essentially indicate that “ based upon the physician’s judgment, experience, training, and skill each reporting physician (treater or medical-legal evaluator) should give an expert opinion on the injured employee’s WPI using the chapter, table, or method of assessing impairment of the AMA Guides that most accurately reflects the injured employee’s impairment.” In summary, Almaraz Guzman allows the physician to use the “four corners” of the Guides when making an assessment of whole person impairment.
Also, there are some circumstances in which the AMA Guides does not contain a table or a chart for which to assess a particular medical condition. Again, the physician, in those circumstances, is to employ the four corners of the Guides to make the most accurate assessment of one’s whole person impairment.
After a WPI is assigned, How is Permanent Disability Calculated?
After a WPI is accessed, the WPI is adjusted for a diminished future earning capacity multiplier (currently for injuries after 1/1/13, the multiplier is 1.4, i.e. if the WPI is 10, then it would be adjusted to 14) and for age and occupation.
In order to perform the calculation, the Schedule for Rating Permanent Disabilities is used. The following is a link to the publication. http://www.dir.ca.gov/dwc/PDR.pdf. In Workers’ Compensation, all of the numbers and adjustments are written out to show how the formula derived the rating. The industry term for it is the “rating string.”
With more than 23 years of expertise in defending workers’ rights, the Law Offices of Edward J. Singer, A Professional Law Corporation, is here to assist. If you have any questions concerning your rights, please do not hesitate to contact our offices. Please contact us today if you have questions or are in need of a workers’ compensation attorney.