Pain rating (California) (California)

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Pain rating (California) (California)

Postby zacko1 on Mon May 17, 2010 8:50 am

I am sure this has been gone over in years past on these forums, but let's try again. Can someone show/tell me where it says in the Guides that a 1-3% pain add-on can only be done if there is at least a 1% underlying WPI? As I read pages 573-574, If a pain-related impairment increases the burden of an individual's condition slightly, 1-3% can be added on to the underlying WPI, without a formal assessment of pain-related impairment. So, even if the underlying WPI is 0%, can't a physician determine that there is still pain-related impairment and add 1-3% to the 0%?
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Re: Pain rating (California) (California)

Postby davidd on Mon May 17, 2010 9:13 am

I think the restriction come from the PDRS instructions rather than the AMA Guides.

Page 1-12 of the PDRS, "Pursuant to Chapter 18 of the AMA Guides, a whole person impairment rating based on the body or organ rating system of the AMA Guides (Chapters 3 through 17) may be increased by up to 3% WPI if the burden of the worker's condition has been increased by pain related impairment in excess of the pain component already incorporated in the WPI rating in Chapters 3-17."

Thus, read literally, if the AMA impairment is a zero, then there is no pain related impairment that can be added on...

Of course I've been wrong before (just see my response and the beating I took in "Order to Terminate TTD (California)".
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Re: Pain rating (California) (California)

Postby gaiassoul1@yahoo.com on Mon May 17, 2010 10:28 am

not even worth fighting, any A/A with half a brain is going to cross ex the doc and increase the rating. Chapter 2 permits the physician to give a 3% impairment for a successful recovery...you can add a pain rating to this, so the cost of the cross ex alone equals the pain rating....boils down to penny wise and pound foolishness.

Again, an advisement don't get lost in the litigation all you do is increase the employer's ex-mod and the insurance company costs. Since you are going to end up at a pain rating anyway plus additional WPI per chapter 2, does it not make more sense to get it done the least expensive way possible and expeditiously to close a file?
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Re: Pain rating (California) (California)

Postby vampireinthenight on Mon Dec 03, 2012 9:39 am

Some judges have told me that there must be underlying WPI for there to be a pain add-on. The Blackledge case seems to indicate as much. However, I just got a DEU rating where they are of the opinion a pure pain rating through Chapter 18 is perfectly ratable. Is there anything new in this area???
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Re: Pain rating (California) (California)

Postby denyse on Wed Dec 12, 2012 4:11 pm

Doctor cannot add pain related impairment to zero percent conventional related impairment (page 1-12, 2005 PDRS and DWC website: http://www.dir.ca.gov/dwc/faq/deu%5Ffaq.html)

The DEU routinely rates what the doctors say and stay out of it. I have seen ratings that say "an alternative rating may rate higher", even though the doctor never referenced AG2. There is no such thing as an erroneous rating, just an alternative. That all being said, the only rating that matters is the one from the judge's instructions. I do agree with the other poster that discusses x-mods. Pick your battles wisely.
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Re: Pain rating (California) (California)

Postby vampireinthenight on Thu Dec 13, 2012 1:37 pm

OK, that seems consistent. Thanks for the DWC reference! :)
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Re: Pain rating (California) (California) (California)

Postby bknight on Thu Dec 20, 2012 3:18 pm

denyse wrote:Doctor cannot add pain related impairment to zero percent conventional related impairment (page 1-12, 2005 PDRS and DWC website: http://www.dir.ca.gov/dwc/faq/deu%5Ffaq.html)

The DEU routinely rates what the doctors say and stay out of it. I have seen ratings that say "an alternative rating may rate higher", even though the doctor never referenced AG2. There is no such thing as an erroneous rating, just an alternative. That all being said, the only rating that matters is the one from the judge's instructions. I do agree with the other poster that discusses x-mods. Pick your battles wisely.


I would disaree with the statement that the DEU routinely rates what the doctor says and stays out of it. What the DEU will do is check the tables the doctor used in the impairment rating. if there is a mathematical error or an incorrect impairment value assigned for a particular measurement, the DEU will correct. The DEU will also employ Table 17-2 in a standard AMA Guides rating as well as other rules of duplication as expressly indicated in the Guides. The DEU will also employ the rules of the PDRS to the impairments given by the doctor. The DEU will annotate any corrections in ratings.

The DEU will not re-classify an impairment into a different class based on table criteria. However the DEU will annotate any issues on ratings such as possible use of incorrect spine rating method or table class.

I also disagree with the statement that there is no such thing as an erroneous rating. Errors are made in impairment ratings and parties should follow up.
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Re: Pain rating (California) (California)

Postby denyse on Thu Dec 27, 2012 10:21 am

I was attempting to say check your rating yourself and make sure you are in agreement. If not, get clarification (or resolve). Don't wait for a DEU rating. My issue is more about the controversies and lack of discussion (on many issues).

Gait (w/o pathologic findings), grip (with tendonitis), DRE II (no clinical evidence or table 15-3 criteria), max DRE + pain (no explanation), etc. This is what I referenced as routine. They seem to get rated with no identification of an issue.

e.g. If there is no release/rupture of the epicondyle (16.7d), nor rare case rationale under 16.8b (unrelated etiologic or pathomechanical causes) OR even a rationale for rating grip in general, why should this not be identified as possibly being invalid under the Guides? What about the 20% variance under 16.8c. I am not trying to be argumentative, but I am not sure how this differs from identifying an ROM/DRE issue (that you reference). I get the easy 17-2 stuff, but it seems the controversy discussions are inconsistent, and usually bias the employer.

BTW, I have seen an "alternative rating may rate higher" from a PTP with no discussion of AG, deviation, alternative, accuracy, etc. It was just an error that the doctor corrected. Once these ratings are out there, it is in the IW's psyche and the employer has an exposure to deal with. Many unfortunately lead to an AA and new issues (AG, new body parts, etc.). And the costs to defend.

I am hopeful you can explain the grip versus ROM/DRE difference. Your last line seems equivocal. It would be helpful in the exposure analysis. Thanks.

p.s. I feel all the Kenneth Kingdon material should be mandatory reading.
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