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  1. #11
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    Default Re: 2 Much Pain to Work/ What to Do

    I don't think there is any question to whether or not chronic pain is to be provided treatment... I have a diagnosis of "Chronic Pain", and receiving treatment under a FMC award. RSD/CRPS as well as Fibromyalgia is ''pain'' and fully treatable under a FMC award if accepted by the ER/IC in the stipulations, or Finding by a judge.

    These conditions are not a 'work related injury' however. And the max add on to a PD/WPI rating is 3%.

    "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."
    There is additional information for Calif here http://www.dir.ca.gov/CHSWC/Reports/...book-3rdEd.pdf
    Thus, read literally, if the AMA impairment is a zero, then there is no pain related impairment that can be added on..."
    Calif uses the AMA 5th edition for rating disability, but that rating is then converted using the current PDRS/Permenant Disability Rating Schedule. Ratings are complex issues, many 'pros' are not well versed in ratings.
    The 2005/current PDRS can be found here http://www.dir.ca.gov/dwc/PDR.pdf

    As I said in a prior post...For WC purposes, pain is not a ''disability'' that would qualify for TTD/TPD wage loss benefits.
    ...That remains true. That said though, there would be PPD/Permenant Partial Disability benefits paid, UP TO the 9 weeks max for a 3% add on to a final PD/WPI rating.

    Even though your reference to TX audit is valid, and I agree with the outcome. That does not IMHO, have anything to do with the issue we are discussing here. Nor to Calif regs.

    There are a number of injuries/illness that are not initially compensable claims. RSD/CRPS, Fibro as mentioned above, and "Chronic Pain" would be included in that definition as not being reason to file a First Report of Injury. Just like cervical dystonia, these are not 'work related injury'. They can and often are "compensable consequence" after the claim has been filed and accepted.

  2. #12
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    Oct 1971
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    3,428

    Default Re: 2 Much Pain to Work/ What to Do

    OK, I got a headache, case closed.
    Tony
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  3. #13
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    Jun 2007
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    339

    Default Re: 2 Much Pain to Work/ What to Do

    I think both BvIA and Tony are right but you are just misunderstanding each other. What is being misunderstood is that pain is an indicator of a problem. Often it is the pain that will lead a person to seek treatment to find the underlying cause. So pain by itself is not the injury.

    In California a rating is given for the injury itself and there is an add on of 3%allowed for pain. It is possible that the injury for the body part itself could result in a 0% rating and have just the 3% added for pain. In such a case the final rating would be 3%.

    Pain can be dibilitating and may well be cause for a person to not be able to retrun to work. That however will not be the diagnosis that a doctor would give. The doctor would give a diagnosis as to the cause and state that the pain renders the patient unable to perform certain duties or that it limits certain life functions. If that were the case it could very well be that the IW is considered TTD. At some point though it will be determined that they are MMI. Unfortunately in California that may result in the IW being unable to return to work and left with a very small PD rating.

  4. #14
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    Oct 1971
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    3,428

    Default Re: 2 Much Pain to Work/ What to Do

    frustratediw
    I think both BvIA and Tony are right but you are just misunderstanding each other.
    Depends on what statement you listen to.
    I understood his statements just fine, he's posted them repeatedly without clarification.

    BvIA said "For WC purposes, pain is not a ''disability'' that would qualify for TTD/TPD wage loss benefits."
    And
    "Pain" in itself is not a disability. Lots of people go to work every day with some level of pain."

    Both of these statements are 100% false.
    I will not allow this type of rhetoric to go unchallenged.

    Pain is a disability that qualifies for TTD/TPD if it was causally connected to an original compensable injury.
    Also
    In some cases the injured employee can return to work with the pain and 'live with it.'
    However, often the pain can be severe enough to be debilitating, preventing the injured employee from returning to work.
    In these cases the employee is entitled to wage loss and medical.

    Tony
    Last edited by tony; 05-25-2010 at 12:44 PM.
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  5. #15
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    Calif
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    Default Re: 2 Much Pain to Work/ What to Do

    TTD/TPD would be granted for the underlying injury. Pain is not an injury in and of itself.
    You would never get a claim accepted or ordered by a WCAB judge by reporting "I have lots of pain", there must be a specific onset injury, or a CT/Cumulative Trauma injury, ie carpal tunnel syndrom, Pain is a symptom, not the injury.

    The AMA guides, and PDRS already include pain in calcualting a PD/WPI rating, so only if there is additional pain the PTP can support would the 3% add on be considered. You would not have a zero rating plus the add on for pain.
    Both of these statements are 100% false.
    I will not allow this type of rhetoric to go unchallenged.
    That's ok to challenge, please just provide the link to support the opinion.
    Pain may be a qualifier for being awarded SSDI, or other STD/LTD benefits. WC is not the same, nor does pain qualify as an "on the job injury".
    I'd like to see something that says "pain" is an injury qualifying for WC temporary total/partial disability.

    I can provide one such authority...
    Initial Evaluation for Chronic Pain

    History

    Determine the chief complaint
    Determine if there was a specific incident that caused or triggered the onset of pain or if pain was insidious in onset
    Determine the severity and specific anatomic location of the pain (including radiation patterns)
    Determine if the pain has remained localized, or if it become more multifocal/generalized
    Determine the character of pain including the following:
    Quality of pain (by descriptions such as aching, dull, sharp, allodynia, burning, electric, dysesthesia, paresthesias, and/or neuralgia)
    Continuous or intermittent
    Associated neurological factors (weakness, numbness, balance problems)
    Factors that exacerbate or relieve
    Effect of activity, body position
    Effect of stress
    Determine previous tests and results
    Determine the effect of previous treatment including medications
    Assess the ability of the patient to perform functions such as walking, lifting, sitting, and standing including job-related limitations
    Assess for evidence of substance abuse in the patient in the past or currently (including alcohol, smoking, or illicit drugs). A family history should also be ascertained
    Examine for evidence of concordant depression, anxiety, other mood disturbance, sleep disturbance, or eating disturbance
    Assess the effect that pain has had on quality of life in regards to social and family interactions and sexual function
    Assess for involvement of litigation or evidence of secondary gain
    Assess the patient's goals of treatment
    This info is from This guideline updates a previous version: Work Loss Data Institute. Pain (chronic). Corpus Christi (TX): Work Loss Data Institute; 2007 Jul 5. 372 p.

    The Official Disability Guidelines product line, including ODG Treatment in Workers Comp, is updated annually, as it has been since the first release in 1996.
    http://www.guideline.gov/summary/sum...6&nbr=6564#s23 A federal gov't guideline to treatment/diagnosis for "Chronic Pain". Bold emplysis added byme. The point being, that pain is the underlying condition/symptom. Not the root cause for disability.

    The Chronic Pain Treatment Guidelines, or MTUS/Medical Treatment Utilization Schedule as adopted by the state of Calif, will provide the treatment protocols for pain, post the acute stage of the injury. Generally 90 days post injury where symptoms of pain continue, the IW is considered "chronic". http://www.guideline.gov/summary/sum...6&nbr=6564#s23

    This from ICIS/Inst for Clinical Systems Improvement, also provides for treatment guides to 'Chronic Pain"... and are often used to rebut the ACOEM/MTUS guides. http://www.icsi.org/pain__chronic__a...uideline_.html

    WC benefits for pain would include PPD, PD indemnity, but not Temporary Total Disability/Temporary Partial Disability by it self. There must be an underlying injury/illness that would be the cause of a Dr/PTP declaring the IW TTD.

  6. #16
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    Jun 2007
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    339

    Default Re: 2 Much Pain to Work/ What to Do

    Quote Quoting BvIA View Post
    The AMA guides, and PDRS already include pain in calcualting a PD/WPI rating, so only if there is additional pain the PTP can support would the 3% add on be considered. You would not have a zero rating plus the add on for pain.
    You are right and I stand corrected. There would have to be at least a 1% rating under the AMA guidelines. Likewise the ratings including the add on are for the whole person rating and may not reflect directly the same in the final rating for PPD purposes.

    Here are some answers from the DWC FAQ website that may help to clarify:

    http://www.dir.ca.gov/dwc/faq/deu_faq.html

    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.

    The reality is that many IW's in California get a rude awakening when they find they cannot return to work. The actual ratings typically will not cover their wage loss. The rating system supposedly does account for it but it generally falls short.

  7. #17
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    Oct 1971
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    Default Re: 2 Much Pain to Work/ What to Do

    BvIA
    That's ok to challenge, please just provide the link to support the opinion.
    I think we did that several times, if you can't click a link, that's your problem.
    I don't give "opinions" I give facts and sources to support them, go back and read.
    The statements you made are 100% wrong and you can't supply one source that says anything close to your quotes.

    I could care less about the games you're playing with ratings.
    Most injuries that result in chronic pain have a high enough rating to make the resulting pain rating irrelevant, it's all games.
    No you won't misrepresent the facts.
    California statutes and ratings are unique and don't represent the norm.

    Pain is a disability that qualifies for TTD/TPD.

    Pain can be severe enough to be debilitating, preventing the injured employee from returning to work.
    In these cases the employee is entitled to wage loss and medical.

    This isn't my "opinion" these are the facts.

    Now you can spin it anyway you want, I won't allow your bull to stand as fact.
    Please stop with the cutting and pasting those silly ratings and statutes, they don't change a dam thing and most of the members of this board have no clue as to what they mean.
    Tony
    Last edited by tony; 05-25-2010 at 03:27 PM.
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
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  8. #18
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    Jun 2007
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    339

    Default Re: 2 Much Pain to Work/ What to Do

    Quote Quoting tony View Post
    California statutes and ratings are unique and don't represent the norm.

    Please stop with the cutting and pasting those silly ratings and statutes, they don't change a dam thing and most of the members of this board have no clue as to what they mean.
    Tony
    I couldn't agree with you more in regards to California not being the norm...however...these posts are on the California section of this board and therefore they reflect the way it is in California.

    I do disagree about the posting of those silly ratings and statutes. There was a time I did not have a clue as to what they meant. I learned very quickly though that I had better get a clue. I don't think I am much different in that regards to many of the IW's I have seen here. They may be silly ratings and statutes but they are what we have to deal with here in California. I don't like it, it's not right but it is what it is and we are at least for the time being stuck with it!

  9. #19
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    Feb 2007
    Location
    Calif
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    Default Re: 2 Much Pain to Work/ What to Do

    Part of the problem IW's face in their claims is not understanding what the terms mean, and what benefits are paid for.

    In this thread, and board, we are talking about Calif, specifically.
    To date, regardless of what links you have posted, and I have indeed 'clicked' on them, you have not provided one, yet, that defines "pain" as a disability.

    Pain is always secondary to a specific onset, or CT injury/illness.
    "I have a headache" is not going to get anyone TTD.

    It's not fair to any IW, in any state, to continue to provide information that is opinion. That's the reason for the quotes and links I've provided. That people don't want to take the time to understand why/what/how of the system is the reason they come here to ask in the first place. And, for the most part, why most dislike the answers I have provided.

    There is no "spin" here. I've given you links to prove up my contention that "pain" is not a disability in and of itself. There is not way to contest that.

    I have not disagreed with you that PPD indemnity is due, nor that FMC is a benefit that should be provided.

    Whether it's WC, STD/LTD or SSDI no one will ever present to any Dr and say "I have pain", and expect to be placed on TTD, SDI, or granted SSDI. It's not going to happen. Pain is/can always be a contributing factor to disability, granted. But never a "disability" or compensable in and of itself, beyond what the rules provide ..and that is a max of 3% add on where there is already medical reasoning to support a rating. That is the law in Calif.
    Please stop with the cutting and pasting those silly ratings and statutes, they don't change a dam thing and most of the members of this board have no clue as to what they mean.
    Tony
    As this is the law in Calif, it means everything. There is no spin to that.

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