Workers' Compensation Guidelines for Determining Impairment

Workers¡¯ Compensation

Guidelines for

Determining Impairment

First Edition, November 22, 2017

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Forward

Legislation enacted in April 2017 [WCL¡ì15(3)(x)] directed the Board to consult with

¡°representatives of labor, business, medical providers, insurance carriers, and self-insured

employers regarding revisions to permanency impairment guidelines, including permitting

review and comment by such representatives¡¯ chosen medical advisors¡­¡±, to adopt revised

guidelines for the evaluation of medical impairment and determination of permanency with

respect to injuries which are amenable to a schedule loss of use award pursuant to

paragraphs (a) through (v) of subdivision 3 of section 15 of the WCL. As the law directs, these

Guidelines are to be ¡°¡­reflective of advances in modern medicine that enhance healing and

result in better outcomes.¡± [WCL¡ì15(3)(x)]

Therefore, these revised permanency guidelines supersede those sections of the Board¡¯s

2012 Impairment Guidelines concerning medical evaluation of injuries amenable to a

schedule loss of use (chapters 1 through 8 of the 2012 Guidelines), as well any other provision

of the 2012 Impairment Guidelines which are inconsistent with these Guidelines.

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Table of Contents

Chapter 1:

Introduction ......................................................................................................6

1.1

Types of Disability Under the Workers¡¯ Compensation Law .................................... 6

1.2

Maximum Medical Improvement (MMI) ................................................................... 6

1.3

Role of Examining Medical Providers ...................................................................... 6

1.4

Types of Final Evaluation Examinations.................................................................. 7

1.5

Schedule Awards ....................................................................................................8

1.6

Non-Schedule Awards (Classification) .................................................................... 8

1.7

Abbreviation Codes.................................................................................................9

Chapter 2:

Upper Extremities ¨C Thumb and Fingers ........................................................ 10

2.1

Objectives for Determining Impairment for Thumb and Fingers............................. 10

2.2

Methods Available to Assess Permanent Impairment ........................................... 10

2.3

Maximum Rating of Body Part............................................................................... 10

2.4

Thumb ..................................................................................................................11

2.4

(A) Thumb Range of Motion .................................................................................. 11

2.4

(B) Calculating Loss of Use of Thumb ................................................................... 13

2.4

(C) Thumb Special Considerations ....................................................................... 15

2.5

Fingers..................................................................................................................15

2.5

(A) Finger Range of Motion ................................................................................... 15

2.5

(B) Calculating Loss of Use of Finger .................................................................... 16

2.5

(C) Finger Special Considerations ........................................................................ 17

2.6

Loading .................................................................................................................18

2.7

Amputation ...........................................................................................................20

Chapter 3:

Upper Extremities ¨C Hand and Wrist .............................................................. 22

3.1

Objectives for Determining Impairment for Hand and Wrist ................................... 22

3.2

Methods Available to Assess Permanent Impairment ........................................... 22

3.3

Wrist Range of Motion .......................................................................................... 22

3.4

Calculating Loss of Use ........................................................................................ 24

3.5

Special Considerations ......................................................................................... 25

3.6

Amputation ...........................................................................................................25

Chapter 4:

Upper Extremities - Elbow.............................................................................. 26

4.1

Objectives for Determining Impairment for Elbow ................................................. 26

4.2

Methods Available to Assess Permanent Impairment ........................................... 26

4.3

Elbow Range of Motion ......................................................................................... 26

4.4

Calculating Loss of Use ........................................................................................ 27

4.5

Special Considerations ......................................................................................... 27

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4.6

Amputation ...........................................................................................................28

Chapter 5:

Upper Extremities - Shoulder ......................................................................... 29

5.1

Objectives for Determining Impairment for Shoulder ............................................. 29

5.2

Methods Available to Assess Permanent Impairment ........................................... 29

5.3

Shoulder Range of Motion .................................................................................... 29

5.4

Calculating Loss of Use ........................................................................................ 30

5.5

Special Considerations ......................................................................................... 32

5.6

Amputation ...........................................................................................................33

Chapter 6: Hip and Femur .................................................................................................. 34

6.1

Objectives for Determining Impairment for Hip and Femur .................................... 34

6.2

Methods Available to Assess Permanent Impairment ........................................... 34

6.3

Hip Range of Motion ............................................................................................. 35

6.4

Calculating Loss of Use ........................................................................................ 36

6.5

Special Considerations ......................................................................................... 38

6.6

Amputation ...........................................................................................................40

Chapter 7:

Knee and Tibia............................................................................................... 41

7.1

Objectives for Determining Impairment for Knee and Tibia ................................... 41

7.2

Methods Available to Assess Permanent Impairment ........................................... 41

7.3

Knee Range of Motion .......................................................................................... 41

7.4

Calculating Loss of Use ........................................................................................ 42

7.5

Special Considerations ......................................................................................... 43

7.6

Amputation ........................................................................................................... 45

Chapter 8:

Lower Extremities ¨C Ankle and Foot............................................................... 46

8.1

Objectives for Determining Impairment for Ankle and Foot ................................... 46

8.2

Methods Available to Assess Permanent Impairment ........................................... 46

8.3

Ankle Range of Motion .......................................................................................... 47

8.4

Calculating Loss of Use of the Foot ...................................................................... 48

8.5

Special Considerations ......................................................................................... 49

8.6

Amputation ...........................................................................................................49

Chapter 9:

Lower Extremity ¨C Great and Lesser Toes ..................................................... 50

9.1

Objectives for Determining Impairment for Toes ................................................... 50

9.2

Methods Available to Assess Permanent Impairment ........................................... 50

9.3

Maximum Rating of Body Part............................................................................... 50

9.4

Great Toe ............................................................................................................. 51

9.4

(A)Calculating Loss of Use of Great Toe ............................................................... 51

9.5

Smaller Toes (Second, Third, Fourth & Fifth) ........................................................ 52

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9.5

(A) Calculating Loss of Use of Smaller Toes ......................................................... 52

9.6

Amputations and Loading ..................................................................................... 53

Chapter 10:

Central Nervous System Conditions, Peripheral Nerve Injuries and

Entrapment / Compression Neuropathies............................................................................ 54

10.1

Central Nervous System - Cranial Nerves ............................................................ 54

10.2

Peripheral Nervous System .................................................................................. 55

10.3

Entrapment / Compression Neuropathies ............................................................. 56

Chapter 11:

11.1

Visual System/Auditory System/Facial Scars and Disfigurement ................ 59

Visual System Introduction.................................................................................... 59

11.1.1 Criteria and Methods for Evaluating Permanent Impairment ................................. 59

11.2

Loss of Hearing ..................................................................................................... 62

11.2.1 Occupational Loss of Hearing ............................................................................... 62

11.2.2 Traumatic Loss of Hearing .................................................................................... 62

11.3

Facial Scars and Disfigurement ............................................................................ 63

APPENDIX A ......................................................................................................................64

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