2018 Workers’ Compensation Guidelines for Determining Impairment

The Workers’ Comp Board was directed to consult with those who represent labor, business, medical providers, insurance carriers, as well as self-insured employers surrounding the revisions to permanency impairment guidelines. This direction was taken in order to adopt revised guidelines for the evaluation of medical impairment and determination of permanency. As mandated by law, these guidelines need to reflect the advancements of modern medicine which enhances, and encourages, healing which results in a better outcome. These revised permanency guidelines supersede the Board’s 2012 Impairment Guidelines which concern medical evaluation of injuries amenable to a schedule loss of use, as well as any other provision of the 2012 Impairment Guidelines that do not show consistencies with the 2018 Guidelines.

The 2018 Workers’ Compensation Guidelines for Determining Impairment includes, but is not limited to, guidelines pertaining to injuries surrounding Upper Extremities, Knee and Tibia, Lower Extremities, Central Nervous System, Visual System.

Types of Disabilities Under Workers’ Compensation

The Workers’ Compensation Law has established the following forms of workers’ comp cases:

  1. Temporary Total Disability
  2. Permanent Total Disability
  3. Temporary Partial Disability
  4. Permanent Partial Disability

Evaluation determining permanent disability occurs when there is a permanent impairment remaining after the claimant reaches the maximum medical improvement (MMI). The guidelines were created to determine impairment for permanent disabilities.

Maximum Medical Improvement

The finding of MMI is based on a medical judgment where (a) the claimant recovered from the work injury or illness to the greatest expected extent and (b) further improvement is not reasonably expected. Palliative or symptomatic treatment does not preclude a finding of MMI. Cases where surgery or fractures are not involved, MMI cannot be determined prior to 6 months from the date of injury or disablement – unless stated and agreed to by both parties involved.

Examining Medical Providers Role in Workers’ Compensation Cases

Under obligation to the Board, medical providers are required to provide the Board, and the parties involved, their best professional opinion with regards to the claimant’s medical condition, degree of impairment, as well as functional abilities. The Guidelines provide detailed criteria to determine the severity of medical impairment, with a greater weight given to objective findings. It is the responsibility of the medical provider to submit any medical evidence to the Board that will be taken into consideration when making a legal determination surrounding disability.

Medical providers are not to infer findings or manifestations which were not drawn from the physical examination or test reports. They are to look at the objective findings of the physical examination and data contained within the patient’s medical records. This process fosters consistency, predictability, and inter-rater reliability to determine impairment.

Schedule Awards

A schedule award is not given for an injury sustained but rather for the residual permanent physical and functional impairments. The final adjustment of a claim by a schedule award is required to comply with medical requirements are described by the 2018 Workers’ Compensation Guidelines for Determining Impairment.

Non-Scheduled Awards

Included in non-schedule awards are permanent impairments that are not covered by a schedule, such as conditions of the spine, pelvis, lungs, heart, as well as impairments of the extremities that are not amenable to a schedule award as described by the 2018 Workers’ Compensation Guidelines for Determining Impairment.