In Workers’ Compensation, Permanent Disability Ratings are a part of the compensation benefits received by Injured Workers. As an Injured Worker goes through their workers’ compensation claim, they receive medical reporting from Treating Doctors, Qualified Medical Evaluators, Agreed Medical Evaluators or Regular Physicians which provide for Permanent Disability Impairments.
The Permanent Disability Impairment Reports must be taken and placed into a Permanent Disability Rating Formula to determine the Permanent Disability Percentage. This formula provides for adjustments for age and occupation. The Department of Industrial Relations has a special unit which assists the parties in analyzing the medical reports and providing the permanent disability percentage. This article will discuss this special unit, the Disability Evaluation Unit.
What Is the Disability Evaluation Unit?
The Disability Evaluation Unit is a part of the Department of Industrial Relations. It is responsible for performing a number of functions on behalf of Injured Workers with respect to their claims. These functions include providing permanent disability ratings as well as making commutation calculations.
The determinations of the DEU are used by Workers’ Compensation Judges, Injured Workers and Insurance Claims Administrators to determine permanent disability benefits.
How Does The Disability Evaluation Unit Determine Permanent Disability Ratings?
The Disability Evaluation Unit evaluates medical descriptions of physical and mental impairment. These descriptions may be in the form of medical reporting from physicians or other practitioners. These descriptions can also be in the form of instructions from a Workers’ Compensation Judge.
What Types Of Ratings That Are Performed By The DEU?
There are three types of ratings performed by the DEU. They are Summary Ratings, Consultative Ratings, and Formal Ratings.
What Is A Summary Rating?
A Summary Rating is done when there is a non-litigated case. These requests are done at the request of the Claims Administrator or the Injured Worker.
What Is A Consultative Rating?
A Consultative Rating is done on litigated cases at the request of an Applicant’s Attorney, a Defendant’s Attorney, the Claims Administrator, or the DWC Information and Assistance Officer.
What Is A Formal Rating?
A Formal Rating is one that is requested by a Workers’ Compensation Judge. A Formal Rating is generally used when a matter has been tried and the Judge has made a determination as to which medical evidence describes the Applicant’s Permanent Disability. The Judge will make Formal Rating Instruction which will then be translated into a Permanent Disability Rating by the DEU.
As noted in Blackledge, “[f]ormal rating instructions are tentative findings of fact and must be based on substantial medical evidence. When a WCJ instructs a rater to utilize particular WPI [Whole Person Impairment] ratings, the WCJ has concluded that all of those WPI ratings are based on substantial medical evidence. Accordingly, when framing formal rating instructions, it is incumbent on the WCJ to carefully review the report(s) or portions of report(s) of the physician(s) upon whom the WCJ intends to rely and determine whether the WPI ratings comport with the AMA Guides, including as interpreted by appellate and en banc decisions.” .” Blackledge vs. Bank of America, (2010) 75 Cal. Comp. Cases 613, 2010 Cal. Wrk. Comp. LEXIS 74
What Is A Rater?
A Rater is an employee of the Disability Evaluation Unit. Raters are trained to analyze medical reports and accurately interpret them in accordance with the AMA Guides to the Evaluation of Permanent Impairment (5th Edition) and in accordance with California Workers’ Compensation Law. Besides the medical reporting, they are trained to determine the Injured Worker’s Occupational Group Number as well. The Occupational Group Number is part of the rating formula.
Sometimes, when the Raters are analyzing the medical reporting, they will find errors and inaccuracies by the doctors or evaluators. Raters will note these errors or inaccuracies within their ratings.
Are Raters Always Right?
The answer is “no.” Raters are not always right. Raters, for the most part, do an outstanding job. When an Injured Worker has a claim with multiple reports for different body parts, the Raters have to go through hundreds of pages of medical reports to complete a rating. At times, it can be a very daunting task. It is very difficult and they do excellent work putting together these varying opinions into a rating.
On a rare occasion, however, there can be a discrepancy in a rating. Many times, the discrepancies can be the result of a missing document or incomplete information provided to the rater. Raters are only as good as the documentation they are provided to analyze. It is recommended that the parties take the time and review DEU Ratings for accuracy.
For Formal Ratings, the parties are allowed to cross-examine the Disability Evaluation Rater. This cross-examination is done as part of the Trial before a Workers’ Compensation Judge.
I have had the opportunity to cross-examine DEU Raters. In some of those circumstances, I was able to get them to change their opinion. As noted above, however, DEU Raters are very knowledgeable and it is not easy to get them to change their mind.
Is There Any Important Caselaw Concerning The Disability Evaluation Unit?
Yes. There is an important case concerning DEU Formal Ratings. In Blackledge, the WCAB En Banc dealt with the Workers’ Compensation Judge’s communications with the DEU Rater with respect to Formal Rating Instructions.
The WCAB indicated that “[o]nce a case has reached the stage of a formal rating, there shall be no ex parte communication between the trial judge and the rater who will be preparing the formal rating.” Blackledge vs. Bank of America, (2010) 75 Cal. Comp. Cases 613, 2010 Cal. Wrk. Comp. LEXIS 74
Essentially, this means that if the Workers’ Compensation Judge had any questions for the DEU Rater concerning the formal rating or the formal rating instructions, the WCJ is obligated to communicate their concerns to all parties. Likewise, the DEU would issue its responses in writing as well. These DEU responses would be served upon the parties as well.
What If I Need Advice?
If you would like a free consultation regarding your workers’ compensation claim, 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 workers’ compensation cases for 26 years. Contact us today for more information.