Oftentimes as physicians we are asked to calculate permanent partial impairment ratings. Impairment is defined as a significant deviation, loss or loss of use of any body structure or function in individual with a health condition, disorder or disease. Impairments are determined as a percentage of the body part involved and then converted to a percentage of the whole person. An injury may result in an impairment from 0 to 100% of the whole person depending on the severity of the condition. Impairment ratings are defined by anatomic, structural, functional and diagnostic criteria. An accurate exam is also important in determining impairment as is the specific diagnosis. Ultimately the system for determining impairment should be reliable so that different raters arrived at consistent impairment ratings when assessing the same individual.
To achieve consistency the American Medical Association has been publishing The Guides to Evaluation of Permanent Impairment since the 1950s. Every seven years a new edition is printed. The most recent edition is the Sixth Edition published in 2008. This addition continues to emphasize diagnosis as a key contributor to determining the impairment rating. There are also adjustments for the significance of the patient symptoms and functional abilities. The physical findings and diagnostic studies can also influence the impairment. In my opinion The 6th Edition provides a better template for determining impairment. However it is a more complicated process and physicians have been slow to accept and utilize this edition. Many physicians still rely on the Fifth Edition. Some jurisdictions require the use of specific references for determining impairment.
Generally impairment should not be determined until the patient has reached a point of maximum medical improvement (MMI). Until the patient reaches a point of maximum improvement their impairment may change. For instance if a patient needs surgery for an unstable joint their impairment prior to the surgery would be much higher as they would likely lack motion and stability of the joint. After the surgery they would potentially improve functionally and symptomatically. Furthermore their joint would become more stable and have greater range of motion. Their impairment would be much less after the surgery if the outcome was as described above. Similarly when determining impairment for brain or nerve injuries we need to wait until the patient has made maximum medical improvement. After they have fully benefited from therapy and time we can then accurately measure their neurologic findings which will help to determine the significance of their loss and resultant impairment.
When determining impairment the physician should cite the reference and include the page or tables that were used in calculating the percentage. Furthermore if a body part is converted to a larger part or whole person the methodology needs to be described. A properly calculated impairment rating should be easily understood by those reading the report. It should also be easily supported by the reference utilized to determine the PPI.
Related terms include “Physical Capacities Evaluation” (PCE), “Functional Capacity Assessment” (FCA) or “Work Capacity Evaluation.”
A Functional Capacity Evaluation/Exam (FCE) is a series of tests designed to measure physical strength, ”range of motion”, stamina, and tolerance to functional activities, including lifting and carrying and will begin with an in-depth questionnaire.
In a workers’ compensation claim, the results of Functional Capacity Evaluation are typically used to develop return-to-work plans, as the basis of an offer of alternative employment, or as the foundation for a feasibility development plan (work-focused rehabilitation). An evaluator SHOULD ONLY use tests that have to do with the specific individual’s diagnosis and return-to-work goals or job demands.
These tests can be used to evaluate work tolerance and work restrictions, if necessary. The exam is used to determine the extent of the employee’s residual or permanent disability. Do your best, be honest, and remember there’s no right or wrong answer.
P.S. I can safely guess that you WILL NOT be jumping rope.
If you have a condition that significantly reduces or limits your ability to work, you may be considered disabled according to the Americans with Disabilities Act (ADA) and therefore protected by this federal law.
The ADA applies to any employer with 15 or more employees. The Act says that an employer cannot discriminate against workers with disabilities. This includes those who may be a candidate for a position as well as those who already hold a position, such as an injured worker who is left with a disability due to a work accident, but who wants to return to his or her place of employment.
An injured worker whose work abilities have been limited by a work accident will probably be evaluated by a doctor to find out how well he or she can perform the necessary duties of the job. If the worker’s condition limits him or her from performing job tasks that are not critical to the job, then the ADA would require these tasks be reassigned. In a similar manner, if the task that the worker is unable to do are critical to the job, then the ADA requires the employer to consider a reasonable accommodation that would help the worker to still complete this task. This might include special equipment or a device that relieves some of the physical nature of the worker’s job; however, the law does not clearly define this term.
Your first pay check should arrive about 14 days after the first day you were unable to work.
Around the same time, you will likely receive a form called an Agreement to Compensation of Employee and Employer (Form 1043) from the worker’s compensation insurance carrier showing the amount you are entitled in disability pay. This should be carefully reviewed, signed, and then returned to the insurance carrier for filing with the Worker’s Compensation Board of Indiana.
After you have been ordered off work for more than 21 days, you will receive pay for the first 7 days you were off before your disability pay kicked in.
You should receive your disability pay each week; the Board would have to order your paychecks to be sent in any other installment (for example, bi-weekly or monthly).
If you do not receive your check on time, make sure the doctor has still ordered you off work or on restrictions that your employer is unable to meet, and then contact the insurance adjuster assigned to your case or consult with your attorney.