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Answers to workers' compensation practitioners' questions about applying the permanent disability rating schedule (PDRS)

new image The FAQs below apply to claims filed on or before Jan. 1, 2013. Updated information based upon the implementation of SB 863 and its changes to California’s workers’ compensation system will be available soon.

The Disability Evaluation Unit of the Division of Workers' Compensation (DWC) has received many questions regarding which permanent disability rating schedule applies to certain cases and how to apply the schedule correctly. DWC has prepared the following questions and answers to assist workers' compensation practitioners.

These FAQs are not exhaustive and the answers are subject to change if the Workers' Compensation Appeals Board and/or the courts issue a decision interpreting the provisions of Labor Code section 4660(d). Many other scenarios will also need to be decided on a case-by-case basis by the Workers' Compensation Appeals Board and/or courts.

Q: How do I select the appropriate permanent disability rating schedule (schedule)? What criteria are used?

A: In order to answer this question, you must first be familiar with Labor Code section 4660(d), which states:

The schedule shall promote consistency, uniformity, and objectivity. The schedule and any amendment thereto or revision thereof shall apply prospectively and shall apply to and govern only those permanent disabilities that result from compensable injuries received or occurring on and after the effective date of the adoption of the schedule, amendment or revision, as the fact may be. For compensable claims arising before January 1, 2005, the schedule as revised pursuant to changes made in legislation enacted during the 2003-04 Regular and Extraordinary Sessions shall apply to the determination of permanent disabilities when there has been either no comprehensive medical-legal report or no report by a treating physician indicating the existence of permanent disability, or when the employer is not required to provide the notice required by section 4061 to the injured worker.

The disability evaluator must be provided with as much information as possible to determine the appropriate schedule to use. Three criteria are important to make this determination:

1. The date a comprehensive medical-legal report issued indicating the existence of permanent disability
2. The date a treating physician report issued indicating the existence of permanent disability
3. Whether the employer was required to provide a notice under Labor Code section 4061 to the injured worker.

The following examples illustrate cases that would fall under the old schedule because a report issued prior to Jan. 1, 2005 that indicates the existence of permanent disability:

  • Comprehensive medical-legal report issued on or before Dec. 31, 2004 declaring the employee's condition permanent and stationary and indicating the existence of permanent disability
  • Treating physician report issued on or before Dec. 31, 2004 declaring the employee's condition permanent and stationary and indicating the existence of permanent disability. A panel qualified medical examiner (QME) examines the employee in 2005 and issues a comprehensive medical-legal report finding permanent disability. The old schedule applies regardless of the 2005 date of the comprehensive medical-legal report because there is a treating physician report issued on or before Dec. 31, 2004 declaring the employee's condition permanent and stationary and indicating the existence of permanent disability
  • Disability to multiple parts of the body (for example, injury to wrist and neck) where there is a report on or before Dec. 31, 2004 (either a primary treating physician report or a comprehensive medical-legal report) finding that one part of the body is permanent and stationary with existing disability, but the other injured part of the body does not become permanent and stationary until 2005.

The following example illustrates a case that falls under the old schedule based on the notice requirement under Labor Code section 4061:

  • Temporary disability indemnity benefits stop for any reason in 2004 and the employer is required to provide notice under Labor Code section 4061. The old schedule still applies regardless of whether or not the employee's condition becomes permanent and stationary in 2005 because the employer was required to provide the notice prior to Jan. 1, 2005.
The following examples illustrate cases that fall under the new schedule because a report issued or will issue after Jan. 1, 2005 that indicates the existence of permanent disability:
  • Date of the work-related injury is on or after Jan. 1, 2005

  • Treating physician examination performed on or before Dec. 31, 2004, but the treating physician report indicating existence of permanent disability is dated on or after Jan. 1, 2005
  • QME medical evaluation performed on or before Dec. 31, 2004, but the comprehensive medical-legal report indicating the existence of permanent disability is dated on or after Jan. 1, 2005
  • Date of the work-related injury is on or before Jan. 1, 2005 but temporary disability indemnity payments continue after Jan. 1, 2005 and the first treating physician report or comprehensive medical-legal report indicating the existence of permanent disability is issued on or after Jan. 1, 2005.

Q: Which combining chart do I utilize for a rating under the new schedule?

A: Use the combined values chart found in section eight of the new schedule. This is the chart that has been adopted by regulation and applies to all ratings under the new schedule. Do not use the combined chart contained in the AMA Guides.

For ratings under the old schedule, use the procedures for combining multiple disabilities on pages 81 and 82 of the old schedule.

Q: As a primary treating physician, how do I evaluate subjective impairment under the new schedule? For example, I am evaluating a lower extremity impairment and have found no objective impairment under chapter 17. Can I give a 3% whole person impairment to this case due to the limitation of some activities of daily living?

A: No. The new schedule states that an impairment rating based on the body or organ rating system of the AMA Guides may be increased up to 3% for pain that is above and beyond the pain associated with the underlying impairment rating. Under the new schedule, a subjective impairment (pain) can only be used as a potential add-on to an existing impairment. (See illustration in question below)

Q: The evaluating physician finds both objective and subjective impairment under chapter 16 of the AMA Guides. The limitation of the elbow motion results in 10% upper extremity impairment with 1% for pain. Do I add or combine the impairments?

A: Add the subjective and objective impairment at the whole person scale. The 10% upper extremity impairment would convert to 6% whole person impairment using table 16-3 (page 439 of the AMA Guides), or by multiplying by .6, then adding the 6% to the 1% for pain, for a total of 7% whole person impairment.

Q: What tools are available to facilitate report writing for treating doctors under the AMA Guides impairment system?

A: Chapters 15, 16 and 17 of the AMA Guides have impairment evaluation charts that can be used by the evaluating physician. For example, the AMA Guides have a spine evaluation charts on pages 404, 410, 416 and 429; an upper extremities chart on pages 436-437 and a lower extremities chart on page 561. Also, the permanent disability regulations include a new PR-4 form that may be a useful tool. This form is downloadable from the DIR Web site @ http://www.dir.ca.gov/dwc/PR-4.pdf.

November 2012