I have a Psychiatric Workers’ Compensation Claim and have been provided a GAF (Global Assessment of Function) Score, What Does It Mean?: What You Need to Know

California Workers’ Compensation Law has special rules to assign Permanent Disability to Injured Workers who have sustained Psychiatric Injuries.

In order to obtain a Psychiatric Permanent Disability Percentage, an Injured Worker must obtain a permanent disability rating. A rating is obtained via an evaluation of the injured worker by a mental health practitioner. Generally, in California Workers’ Compensation Law, Psychiatrists or Psychologists are the medical providers who evaluate Injured Workers for Psychiatric Injuries. Treating Psychiatrists and Psychologists are also allowed to make this evaluation.

With respect to a Psychiatric Permanent Disability, the evaluators will make the assessment as to whether (a) there is a permanent disability; and (b) the amount of it.

The State of California has a publication on how to rate injuries. It is called the SCHEDULE FOR RATING PERMANENT DISABILITIES (2005.) It notes that “[r]ating Psychiatric Impairment .. shall be evaluated by the physician using the Global Assessment of Function (GAF) scale…”

The Schedule notes that “[t]he resultant GAF Score shall then be converted to a whole person impairment rating using the GAF conversion table…” A whole person impairment rating is then placed into a formula to generate a permanent disability percentage.

What is a GAF Score?

A GAF Score refers to a numeric scale that is used by mental health practitioners. It is called the Global Assessment of Functioning. The evaluator rates subjectively the social, occupational, and psychological functioning of the individual. The scores range from 100 to 1. A score of 100 would be that of someone who is normal or high functioning. A score of 1 would be for someone who is not healthy and is severely impaired. In making an assessment, the practitioner is asked to not include impairment of functioning due to physical or environmental limitations.

Further, there are two scores that are made. One is made for symptom severity. The other one is for functioning severity.

In sum, for an Injured Worker, the lower the GAF Score, the higher the permanent disability. The higher the GAF Score, the lower the permanent disability. GAF Scores of 70 or higher results in 0 percent whole person impairment. This in turn results in a percent disability percentage.

What are the Items that are looked at to evaluate Functioning Severity?

 

The following is a list of the items that can be used to evaluated functioning. I have taken the liberty to organize them in a way to offer a better understanding. This list is not intended to be a complete and comprehensive list as to what is evaluated.

  • Participation/Interest in Activities: This includes not leaving home and staying in bed all day, no job, and no friends. It may include hygiene issues and communication issues
  • Being Socially Effective: This includes the quality and amount of friendships
  • Relationship with Family Members: This includes neglecting family, arguments with family members, disputes with family members, and domestic violence
  • Performance in School: This includes truancy issues, school work issues, conflicts with peers, violence at school, failing at school, and not attending school
  • Performance at Work: This includes conflicts with co-workers, inability to keep a job, and lack of the job
  • Relationships with Friends: This includes having few friends to having no friends

What are the items that are looked at to evaluate Symptom Severity?

  • Anxiety: This includes Anxiety when taking examinations or in reaction to psycho-social stressors, and Anxiety in general
  • Depression: This includes depressed mood, and suicidal thought, ideation, and attempt
  • Insomnia: This includes an inability to sleep
  • Panic Attacks: This includes occasional panic attacks to more frequent attacks
  • Abnormal Behavior: This includes theft, frequent shoplifting. Further, it can include flat effect and in general acting inappropriately. Further, this includes suicide attempts
  • Abnormal Beliefs: This includes delusions and hallucinations
  • Suicidal Beliefs: This includes suicidal ideation and suicide attempts
  • Speech: This includes circumstantial speech, speech is at time illogical, obscure or irrelevant. Further, it can include incoherent speech and being mute
  • Obsessive Activity: This includes severe obsessive rituals
  • Thought Process: This includes trouble concentrating

How is the Evaluator Instructed to Assign a Score?

Per the SCHEDULE, the evaluator is to follow four steps:

“STEP 1: Starting at the top level of the GAF scale, evaluate each range by asking “is either the individual’s symptom severity OR level of functioning worse than what is indicated in the range description?”

STEP 2: Keep moving down the scale until the range that best matches the individual’s symptom severity OR the level of functioning is reached, whichever is worse.

STEP 3: Look at the next lower range as a double-check against having stopped prematurely. This range should be too severe on both symptom severity and level of functioning. If it is, the appropriate range has been reached (continue with step 4). If not, go back to step 2 and continue moving down the scale.

STEP 4: To determine the specific GAF rating within the selected 10 point range, consider whether the individual is functioning at the higher or lower end of the 10 point range. For example, consider an individual who hears voices that do not influence his behavior (e.g., someone with long-standing Schizophrenia who accepts his hallucinations as part of his illness). If the voices occur relatively infrequently (once a week or less) a rating of 39 or 40 might be most appropriate. In contrast, if the individual hears voices almost continuously, a rating of 31 or 32 would be more appropriate. (b) Global Assessment of Functioning (GAF) Scale Considers psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. Do not include impairment in functioning due to physical (or environmental) limitations.”

What does the GAF Score Scale look like?

The following is the GAF Score outline scale. This is the actual scale which the evaluators will reference when assigning the Score.

  • 91 – 100 Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.”
  • 81 – 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).
  • 71 – 80 If symptoms are present, they are transient and expected reactions to psycho-social stress (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).
  • 61 – 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
  • 51 – 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g.. few friends, conflicts with peers or co-workers). 41 – 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).
  • 31 – 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment thinking, or mood (e.g.. depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home and is failing at school).
  • 21 – 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home or friends).
  • 11 – 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).
  • 1 – 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.
  • 0 Inadequate information.”

How is the Score translated into a Whole Person Disability percentage?

First, prior to viewing this, it should be understood that the rating manual provides for a DFEC adjustment to the score. In other words, the number provided below is a raw score which will then be adjusted higher. Note: Scores of 70 or above amount of no Whole Person Impairment.

The following is the conversion chart in the Rating Manual.

GAF

     WPI

1


90


2


89


3


89


4


88


5


87


6


87


7


86


8


85


9


84


10


84


11


83


12


82


13


82


14


81


15


80


16


80


17


79


18


78


19


78


20


77


21


76


22


76


23


75


24


74


25


73


26


73


27


72


28


71


29


71


30


70


31


69


32


67


33


65


34


63


35


61


36


53


37


57


38


55


39


53


40


51


41


48


42

46


43

44


44

42


45

40


46

38


47

36


48

34


49

32


50

30


51

29


52

27


53

26


54

24


55

23


56

21


57

20


58

18


59

17


60

15


61

14


62

12


63

11


64

9


65

8


66

6


67

5


68

3


69

2


70

0


71

0


72

0


73


0


74


0


75


0


76


0


77


0


78


0


79


0


80

0


81

0


82

0


83


0


84


0


85


0


86


0


87


0


88


0


89


0


90


0


91


0


92


0


93


0


94


0


95


0


96


0


97


0


98


0


99


0


100


0


Where Can I Get Legal Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.