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Thread: WPI Ratings

  1. #1
    Join Date
    Aug 2010
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    3

    Default WPI Ratings

    On 04-2007 I was involved in a bad Big Rig accident. On 01-2010 my doctors issued a Permanent & Stationary report. I am completely confused as to what all these inpairment numbers mean, how much I will receive & how long this is going to take? As of now I have not received a dime because the insurance company is saying the employer did not have the proper coverage. The coverage was for secretaries & not for truck drivers. Below are the impairment ratings. I do have an attorney, but getting a chance to talk to him is next to impossible. Thanks for any help.

    Based on the Residual Functional Capacity Assessment performed in this case, impairment exists. As described in the adopted FCA this patient has the following WPI:
    -For Cervical Spine Impairment using the ROM method, the FCA findings result in 17% WPI for the cervical spine. -For Thoracic Spine Impairment using the ROM method, the FCA findings result in 1 % WPI for the thoracic spine.
    -For Lumbar Spine Impairment using the ROM method, the FCA findings result in 5% WPI for the Lumbar spine.
    -For Upper Extremity Impairment using the ROM method, the FCA findings result in a contribution of 8% WPI.
    -For Upper Extremity Impairment using the Grip Strength Loss method, the FCA findings result in a combined 18% WPI for the right upper extremity.
    -For Lower Extremity Impairment using the ROM method, the FCA findings result in a contribution of 4 % WPI.
    .
    As per Internal Medicine Management and Evaluation, an impairment summary was obtained and adopted: According to the Combined Value Chart of The AMA Guides, the patient is rated as having a Clinical Dementia Rating of mild (1.0). This is manifested by an overall moderate degree of cognitive impairment on current testing. Short-term or recent memory is at least moderately impaired overall, which in this case is 18% WPI. As discussed in the adopted report, the following impairments also apply.
    -For the examinees mastication impairment, the examinee finds that mastication of harder foods causes him to have facial and TMJ area pain, and due to his facial muscular spasms finds their bite to be off, resulting in dietary restrictions where his diet is geared towards semi-solid or soft foods, therefore, 10% WPI.
    -For the examinees speech impairment,
    the examinee is Class 1, 0,14% Voice/Speech Impairment due to the fact he finds his speech has abnormal qualities such as hoarseness and a "cotton mouth " effect caused by dryness because of the qualitative changes of saliva due to the side effect of medications, he is taking on an industrial basis, as well as an indistinct articulation, and finds he cannot speak continuously for prolonged periods of time due to facial/TMJ area pain; the examinee has 15% Voice/Speech Impairment that equates to 5% WPI.
    To this, a supplemental award for pain-related impairment is appropriate; the examinee appears to have pain-related impairment that has increased the burden of their condition slightly, Section 18.3dC, Page 573, therefore a 2% WPI for pain is appropriate.
    For the examinees hearing impairment, the examinee has 13.0% right and 16.9% left monaural hearing impairment, which translates into 15.3% binaural hearing impairment, this translates to 5% WPI.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: Wpi Ratings

    Based on the Residual Functional Capacity Assessment performed in this case, impairment exists.
    Where did that report come from ?
    Unfortunately, those numbers are not a final PD/WPI rating. Calif mandates use of the AMA 5th edition for rating disability, that number is then converted to a PD/WPI using the PDRS/Permanent Disability Rating Schedule.
    Your PTP/Primary Treating Physician decides when you are P&S/MMI, not the person evaluating under the FCA. Those are just tools used in determining functional capacity. That report will be sent to your PTP. If you or your atty dispute the final rating, you'll be evaluated by an AME/Agreed Medical Examiner. That report would contain the final PD/WPI rating.
    As of now I have not received a dime because the insurance company is saying the employer did not have the proper coverage. The coverage was for secretaries & not for truck drivers.
    Apparently you have a 3rd party claim/action combined with your WC claim.
    Difficult for the carrier to claim your employer didn't have the appropriate coverage...since THEY are the ones who sell the coverage, and audit the account generally every 6 months or so. Sometimes quarterly. ALL "employees" are included in that audit.
    Regardless of the WC insurance coverage, if you are a legitimate "employee" your ER is liable for the injuries. You may have to sue the ER in civil court.

  3. #3
    Join Date
    Aug 2010
    Posts
    3

    Default Re: Wpi Ratings

    Thank You for the response. The P&S report came from my treating Doctors office. As I understand, I have to see the insurance co's Doctor? What is a 3rd party claim? How will the insurance issue be resolved? Will it go to trial? Why is this taking so long to resolve? Is it the system or my Attorney that is so slow? I am asking these questions because I am permanently unable to work because of so many injuries and problems.

    Thank You
    I really appriciate this forum and the people replying! You guys rock!

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: Wpi Ratings

    YOu said you were involved in a "big rig accident", to me, big rig is a semi tractor/trailer. If that's the case, there is apparently another ins carrier involved, depending on who's fault the accident was.
    Either way, it's a valid WC claim, if you were in the course of your job, and job duties.

    Your ''treating doctors office"... is that a WC Dr/PTP...? Or a doctor you chose to treat you at the time of the accident...?

    Regardless... that report is not finished...those are not final PD/WPI ratings. ALL of those should/must be brought down to ONE number...ie 45% PD/WPI.
    Permanent disability is first calculated using the AMA guides, by evaluation of the body parts injured. Just like in the report. THEN, all of those are converted using the PDRS/schedule....as I described before. You cannot calculate the potential value of your claim, the indemnity, until you have that final rating.
    How will the insurance issue be resolved? Will it go to trial? Why is this taking so long to resolve? Is it the system or my Attorney that is so slow?
    Eventually the WC coverage will be resolved... I don't know exactly cuz there isn't enough info here.
    Everything 'legal' takes an inordinate amount of time. The courts are heavily blocked up with claims issues to be resolved, YOu are just in line with all the other 100's of thousands of claims.
    There isn't any reason for your atty to slow things down... why would that be of any benefit to the atty... he doesn't get paid for repping you until the claim settles. You haven't paid the atty any money... have you.?
    I am asking these questions because I am permanently unable to work because of so many injuries and problems.
    If I translated that... it would be "when am I going to get my money?".... Not until all the issues are resolved. You said the WC carrier is denying coverage of the ER... there is probably a 3rd party personal injury claim here.
    You may be permanently unable to work, by your estimation, maybe by your Dr. That doesn't mean you are 100% disabled under the comp definition. I'm not reading that in the report you posted.

    The coverage was for secretaries & not for truck drivers.
    Actually, that doesn't matter. The coverage is for the employer, not the employees. The job classification is only to calculate the amount of the premiums due on the policy.
    If you are listed as an ''employee'', it's the carriers responsibility to get the correct info, job classification for all employees, wages etc. The insurance is to ensure or guarantee there is financial responsibility of the employer for industrial injury/illness.

    In the 3rd party action, your ER/carrier is entitled to subrogation...that means any money they have paid in benefits/treatment for your injury, they get reimbursed.
    Up to the dollar amount paid.
    IF or when the 3rd party claim settles, you would be eligible to pain and suffering, past/future lost wages, possibly punitive damages, and money for future medical reimbursement. But, the future medical would be a credit to the WC carrier or cash payment.

    Really need to get this stuff cleared up with your atty...

  5. #5
    Join Date
    Aug 2010
    Posts
    3

    Default Re: Wpi Ratings

    It seems to be a waiting game while people suffer. In my opinion the system is very broken. I left a bunch of information out of the posting. I have a traumatic brain injury. My body is held together with wires and rods. I was involved in a tractor trailer accident. No one else was involved I had a stroke and lost control. I smacked into a mountain @ 60MPH with 20 tons of apple juice in the trailer. In a coma for 6 months, died several times. I am very lucky to be here today. Had to learn everything all over again. Please forgive me if my stuff sounds a bit out of wack. It's the best i can do at this time.
    I thank You for your time.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Wpi Ratings

    Additional info always seem to change the responses on a message board.
    Obviously there is no 3rd party here... but, as I said, if you were an ''employee'' of this company, they are liable for injury that meets the AOE/COE standard.
    Even a stroke while you are employed by this company, and in the course of performing your job duties can be a compensable injury.

    AOE/COE means Arose Out of Employment, and in the Course Of Employment...or performing your job duties.

    If you have an AA/Applicant Atty, which you do, you really should be addressing the insurance coverage issue with him/her. And expect to be seeing the AME again for a final PD/WPI rating. As I said, this report is not a final under the rating rules of Calif.

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