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The enactment of SB 899, and the promulgation of the new
Permanent Disability Rating Schedule (PDRS) effective
January 1, 2005, dramatically impacted the evolution of
permanent disability in California Workers’ Compensation
claims.
While the AMA Guides 5th edition, and the assessment of the
“whole person impairment” (WPI) thereunder now serve as the
primary basis for establishing permanent disability ratings,
this approach is not followed in the assessment of
psychiatric injury.
Under the prior PDRS, the measuring of disability utilized
the right work function impairments scale with a somewhat
complex weighting formula to arrive at the standard rating
before adjustment for age and occupation.
The new system incorporates the Global Assessment of
Functioning (GAF) scale, which has been used in the clinical
setting since the 1970’s.
Generally, this is a reverse-order scale, i.e., the higher
scale number equates to a higher level of functioning, and
conversely a lower level of disability. Under the PDRS there
is a conversion index in which the assigned GAF score is
converted to the whole person impairment (WPI) rating, which
is then subject to adjustment for age (at time of injury),
occupation (at time of injury), and the newly added modifier
future earning capacity (FEC). Note that for a GAF of 70 or
more, the WPI drops to 0%.
Under the GAF scale, there are basically 10 categories (or
ranges) which then break into a total 100 point scale, based
on (1) symptom severity, and (2) social and occupational
functioning. It specifically does not include impairment in
functioning due to physical or environmental limitations.
The reporting physician is to select a single value that
best reflects the patient’s overall level of functioning,
and more specifically will consider the following factors:
• Impact of patient’s
psychiatric symptoms:
| o |
Danger to
Self |
| o |
Violence and
Aggression |
| o |
Judgment |
| o |
Communication
|
| o |
Reality
Testing |
| o |
Non-Psychotic
and Non-Dangerous Symptoms |
• Level of functional
impairment:
| • |
Inability to
Maintain Basic Hygiene |
| • |
Occasionally
Fail to Maintain Basic Hygiene |
| • |
Inability to
Function in Almost All Areas |
| • |
Major
Impairment in Several Areas |
| • |
Serious
Impairment |
| • |
Moderate
Impairment |
| • |
Mild
Impairment |
| • |
Sight
Impairment |
| • |
Good
Functioning |
| • |
Superior
Functioning |
Within the above framework,
the reporting physician is then asked to consider the
following:
o Starting at the top
level of the scale (100), is either the individual’s
symptom severity or the level of functioning worse then
what is indicated in the range description.
o Moving down the scale until the range that best
matches the individual’s symptoms severity or the level
of functioning is reached, which ever is worse.
o Consider whether the next lower range more accurately
reflects either the symptom severity or level of
functioning, if not then the appropriate range has been
reached.
o With the selection of the appropriate range, then
determine the appropriate GAF rating within the 10 point
range.
From a rating standpoint, an example might include a 50
year old elementary school teacher with an
industrially-induced schizophrenia (which in reality is
remotely possible but far-fetched). The reporting
physician assigns a GAF rating of 40; the corresponding
WPI is 50%, which then results in the following rating
under the new PDRS:
100% (14.01.00.00 – 50 – [8] – 70% – (214 – I) – 77 –
80) 80
There is no set standardized testing to evaluate under
GAF, with the reporting physician looking to clinical
correlation and a detailed examination to reach the
final conclusion.
While the implementation of the new PDRS greatly
imparted the assessment of psychiatric permanent
disability, SB 899 did not impact the basic
compensability requirements to include:
o The actual events of employment as the predominant
cause (51%) of disability [Labor Code §208.3(a)]
o A minimum of 6 months (not necessarily contiguous)
employment with the employer [Labor Code §3208.39(d)],
unless the result of a “sudden or extraordinary
employment condition”.
o Not substantially caused (35 – 40%) by a lawful,
non-discriminatory good faith personnel action [(Labor
Code §3208.3(a)].
o With limitations on claims of injury to the psyche
filed after the employee is terminated (fired or laid
off) [Labor Code §3208.39(e)].
o Or the result of being the victim of direct exposure
to a violent act which is the substantial cause (35 –
40%) of the injury.
Further, the application of Labor Code §§4663 and 4664,
as they pertain to the apportionment of permanent
disability, and the rapidly emerging case law on this
issue are not directly effected by the GAF assessment,
although the reporting physician may be a dual GAF
assessment (based on pre-injury and past injury GAF
assessment) to formulate the opinion on permanent
disability.
Disclaimer: The
information contained in this publication is intended
for informational purposes only and should not be
construed as legal advice. You should seek competent
legal counsel for advice on any legal matter.
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