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PERMANENT DISABILITY RATING

For injuries on or after 1/1/2005, and for some injuries before that date, the starting point is the AMA Guides. The Primary Treating Physician and a Qualified Medical Evaluator or Agreed Medical Evaluator prepare reports that discuss the factors of disability and assigns a WPI, or whole person impairment. SB 863 added subsection (i) to Labor Code §4061:

No issue relating to the existence or extent of permanent impairment and limitations resulting from the injury may be the subject of a declaration of readiness to proceed unless there has first been a medical evaluation by a treating physician and by either an agreed or qualified medical evaluator.

The report can be rated by the Disability Evaluation Unit (DEU), which "determines permanent disability ratings by evaluating medical descriptions of physical and mental impairment. The determinations are used by workers' compensation administrative law judges, injured workers and insurance claims administrators to determine permanent disability benefits." The DEU prepares three types of ratings: 1)  Formal, done at the request of a workers' compensation judge; 2)  Consultative, done on litigated cases at the request of an attorney or DWC information and assistance officer; and 3)  Summary, done on non-litigated cases at the request of a claims administrator or injured worker.

In the en banc decision, Blackledge v. Bank of America, the Workers' Compensation Appeals Board delineated the respective roles of the evaluating physician, the workers' compensation judge, and the DEU rater when determining ratings under the AMA Guides.

The permanent disability rating schedules are available here.

The 2005 Schedule For Rating Permanent Disabilities is currently in use for injuries on or after 1/1/05 and for some injuries preceding that date (see Labor Code §4660(d) for exceptions. The 1997 schedule covered injuries from 4/1/1997 until 2005, with some exceptions listed in Labor Code &4660(d). Until a new schedule issues for injuries on or after 1/1/2013, the 2005 schedule will be used but the adjustment factor will be 1.4 for all listed body parts/systems, and the FEC was eliminated (see Labor Code §4660.1).

Psychiatric ratings for injuries under the 2004 schedule use GAF, the Global Assessment of Function, to assess psychiatric permanent disability: see 2005 rating schedule (p. 1-12). For injuries on or after 1/1/13 where there is psychiatric disability resulting from a physical injury (a compensable consequence), there will be no additional psychiatric rating. (See Labor Code §4660.1).

Despite valiant efforts to restrict rating to the tables and charts of the AMA Guides, case law has extended to the four corners of the Guides and allowed the use of analogy and some other methods when the values in the tables for a particular condition are not an accurate way to arrive at WPI, or the condition is not mentioned in the Guides. See in particular Milpitas Unified School District v. WCAB (Guzman) (2010) 187 Cal.App.4th 808. This case was mentioned twice in SB 863: in Section 1, (c): “That in enacting this act, it is not the intent of the Legislature to overrule the holding in [Guzman]” and in new Labor Code §4660.1(h) the words are repeated.

See the DWC chart for permanent disability rates. Note that SB 863 eliminated the 15% bump for dates of injury beginning 1/1/13.

See, too, Permanent Disability, Apportionment, and Work Restrictions

Label Item Links Comments
Labor Code Labor Code §4061: No issue relating to the existence or extent of permanent impairment and limitations resulting from the injury may be the subject of a declaration of readiness to proceed unless...

Labor Code §4660: For determining permanent disability for injuries occurring before 1/1/13.

Labor Code §4660: For determining permanent disability for injuries occurring on or after 1/1/13.

LC §4061



LC §4660

LC §4660.1

 
  Need to note “each party’s proposed permanent disability rating” on Pre-trial statement
Labor Code §5502(d)(3)  
Regulations/Rules Permanent Disability Rating Determination

PD Rating  
Cases  The 2010 en banc Blacklege decision delineated the roles of the evaluating physician, the workers' compensation judge, and the DEU rater when determining ratings under the AMA Guides. Blackledge v. Bank of America  
Forms Forms used to rate permanent disability DEU Forms  
Websites Disability Evaluation Unit (with rating schedules)

Dr. Brautbar's Workers' Compensation Impairment Rating

DEU

Brautbar

 
Practice Tips    
Publications
 
Articles SB 863 and PD, PDRS: handout from DWC 20th annual educational conference 2/13

Rating Spine Impairments: handout from DWC 20th annual educational conference 2/13

Rating Strategies: handout from DWC 20th annual educational conference 2/14

Ten Common Issues and Errors in Ratings

Rating Impairments That Are Missing From the AMA Guides

SB 863 & PD, PDRS


Rating spine

 

Rating strategies

10 Common Issues


Rating Impairments Missing From AMAG

Magazine Articles  
Roundtable  
Miscellaneous    

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