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  1. #1
    Join Date
    Jul 2009
    Location
    Lincoln, CA
    Posts
    21

    Default I Have Been Rated at 7%. What Does This Mean

    My wife (MW) wanted me to ask some questions that you someone may be able to answer:

    Can you explain what this means: QME Under Impairment Rating Says:
    Lumbar Spine: Chapter #15, Table 15-3, Page 384, 7% whole person impairment.

    Is there a value for this statement?
    Future Medical: MW will require future medical care for her lumbar spine. Future medical care will consist of physician visits for flare-ups, physical therapy as determined by ACOEM Guidelines, durable medical equipment, prescriptive medication, and diagnostic testing. Provision should also be given for lumbar epidural steroid injections as determined by a consultant's evaluation and there should also be provisions for possible surgery, if indicated.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: I Have Been Rated at 7%. What Does This Mean

    it refers the AMA rating guides.
    the WPI is the Whole Person Impairment rating given by the doctor as referenced by the material and directions in the AMA guides.
    yes. the future medical considerations will help the carrier/employer estimate the potential costs of the claim.

    from fact sheet D link previously given

    [/i]"Q: Who determines if I should get permanent disability benefits? How is that done?
    A: A doctor determines if your injury or illness caused permanent disability (PD). The doctor’s report is then turned into a PD rating. The process used to turn the doctor’s report into a rating can vary depending on your date of injury and other factors. The PD rating determines the benefits you’ll receive.
    After your doctor decides your injury or illness has stabilized and no change is likely, permanent disability is evaluated. At that time, your condition has become permanent and stationary (P&S). Your doctor might use the term maximal medical improvement (MMI) instead of P&S.
    Once you are P&S or have reached MMI, your doctor will send a report to the claims administrator telling them whether you have any PD. The doctor also determines if any of your disability was caused by something other than your work injury. For example, a previous injury or other condition. This is called apportionment.
    The insurance company may ask you to fill out a form describing your disability."[/i]
    Last edited by .SH; 10-02-2009 at 08:32 AM.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: I Have Been Rated at 7%. What Does This Mean

    The statutes provide for a pre-determined number of weeks indemnity for each 1% of the rating. In MW case, that is 3...so the indemnity value here is 21 weeks... if that is the max rate, around $260/wk, she is due about $5460 +/- depending on the factors surrounding her status.

    She could be subject to a 15% increase/decrease in the PD/WPI indemnity.

    That statute is here http://www.leginfo.ca.gov/cgi-bin/di...file=4650-4664

    Info on the AMA guides here http://www.impairment.com/tips/, once the AMA rating is done, that number is converted by using the PDRS/Permenant Disability Rating Schedule...here...http://www.dir.ca.gov/dwc/PDR.pdf
    PD/WPI ratings are complex calculations. When there is a dispute by one of the parties, you should be offered the opportunity to select a Panel QME or AME if you have an atty.
    Once the PQME issues a report, and rating, that is sent to the DEU/Disability Evaluation Unit. The DEU provides a rating, that rating too is the only one a ALJ will accept.

  4. #4
    Join Date
    Feb 2008
    Posts
    50

    Default Re: I Have Been Rated at 7%. What Does This Mean

    I don't understand any of the % stuff..I know it's something we all would like to know and understand better.
    I'm rated at a 1% total disabled and no gainfull employment...I don't understand any of this...
    Good luck on understanding..I need to go to college to learn all this.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: I Have Been Rated at 7%. What Does This Mean

    It would be very difficult for any one to try to explain the rating process.
    The law says the doctor must use the AMA 5th edition to rating disability... if you can grasp that, you are WAY ahead of anyone here... its' all medical to be used by medical professionals...read though this http://www.impairment.com/tips/, as you can see, the guides address all body parts.

    Once that AMA rating is done, the doctors use the state PDRS/Permenant Disability Rating Schedule. That converts the AMA number using age, job classification, wage etc to a ratable PD/WPI %, which in turn provides the number of weeks payments due. Indemnity is money paid to compensate you for the reduced ability to compete in the open labor market. The PDRS are here http://www.dir.ca.gov/dwc/PDR.pdf if you want to peruse them. They are no more informational than the AMA guide.

    I'm rated at a 1% total disabled and no gainfull employment...
    1% would be 'permenant partial disability'...100% would be Total Disability. Your rating of 1% provides for 3 weeks payments/indemnity.
    If you disagree with that, you should request a PQME evaluation. At the very least that rating could be increased by up to an additional 3% for 'pain'.

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