2012 IMPAIRMENT GUIDELINES
Presented by
Susan R. Duffy, Esq.
Hamberger & Weiss
Impairment from Conditions Other than Spinal
} Asthma (Chapter 12.2)
} Traumatic Brain Injury (Chapter 15)
} Psychiatric (Chapter 17)
} Pain (Chapter 16)
} Impairment Due to Asthma
} Diagnostic work up must confirm diagnosis of asthma
} Compatible history of episodic symptoms
} Airflow obstruction that is at least partially reversible
} Alternative diagnoses are excluded
Medical Impairment Class—Asthma (Table 12.2)
} Severity rankings include A, B, D, F, L, R, Z
} If claimant does not meet all the necessary requirements for any one medical impairment class, objective tests should be given greater weight than other criteria in determining the appropriate class
} Asthma Class 1(a): Severity Ranking “A”
} Intermittent Asthma Symptoms: not more than two times per weekor nighttime awakening not more than two times per month.
} And all of the following:
} No interference with normal activity
} Rescue medication for symptom control not more than two times per week
} Lung function normal FEV1 and FEV1/FVC between exacerbations
} FEV1 more than 80% predicted
} Exacerbations up to one time per year requiring systemic oral corticosteroids
} Asthma Class 1(b):Severity Rank “B”
} All of the above but exacerbations more than two times per year requiring steroids
} Asthma Class 3:Severity Ranking “L”
} Daily symptoms or nighttime awakening more than one time per week but not nightly
} And all of the following:
} Some limitation of normal activity due to symptoms
} Rescue medication needed not more than one time per day
} Lung function FEV1 between exacerbations of more than 60% but less than 80% predictedor FEV1/FVC reduced by less than 5% of predicted
} Exacerbations more than one time per year requiring steroids
} Asthma Class 5:Severity Ranking “Z”
} Persistent severe symptoms throughout the dayor nightly awakening due to symptoms
} And all of the following:
} Extremely limited in normal activities
} Rescue medication required several times per day
} Lung function: FEV1 between exacerbations less than 35% predicted
} Exacerbations more than one time per year
} Traumatic Brain Injury (Chapter 15)
} Intended for residuals resulting from organic injury to the brain.
} Distinction among classes reflects impact on activities of daily living and ability to function in the workplace.
} Episodic neurological disorders includes:
◦ Seizure disorder
◦ Vestibular disorder
◦ Neuro-ophthalmologic disorder or oculomotor
◦ Headaches
} Medical Impairment Brain Class 2: Severity Ranking “A” to “C”
} “Nuisance” level residuals with only minor impact on ADL
} Cognition – minimal cognitive or memory deficits do not materially impair ADL or work capability
} Language deficit no more than minimal
} Emotional disturbances, fatigue, lethargy minimal and and transient
} Episodic sleep disturbances are minimal
} Episodic neurological disorders must be completely controlled and not interfere with ADL
} Brain Class 4:Severity Rank “Q” to “S”
} Not completely independent in ADL, requires some type of supervision, assistance or guidance at times
} Cognition (Rancho Los Amigos Scale—Revised Level 7)
} Mild to moderate language deficit
} Emotional/behavioral disturbances or personality changes moderate, disproportionate to situation and consistently present
} Episodic sleep disturbances are moderate and interfere with ADL
} Episodic neurologic disorder that is not completely controlled and markedly interferes with ADL
Psychiatric Impairment (Default Guidelines – Table 17.3)
} Post-traumatic neurosis, post-traumatic stress disorder and other causally related psychiatric conditions
} Should have psychiatric and psychological evaluations and opinions as well as psychological and/or neuropsychological testing
} Impairment evaluation should include impact of the psychiatric impairment on functional ability, including ADL
} Document impact on ability to function in the workplace, including activities relevant to obtaining, performing and maintaining employment
} No “A” to “Z” ranking
} Pain (Chapter 16)
} Designed for individuals with extraordinary, severe, persistent painful conditions
} Extent to which pain symptoms can reasonably be accepted as consistent with objective medical evidence
} Examples include headache following severe head trauma or skull fracture, Chronic Regional Pain Syndrome (CRPS – Table S 16.2)
} Pain Impairment Rating: Yes or No
} Extraordinary, severe, persistent pain with all of the following:
◦ Reasonable medical basis for pain
◦ Consistency of pain over time and situation
◦ Consistency with anatomy and physiology
◦ A pain disability questionnaire score of at least 101
◦ No behavior that is inconsistent with pain symptoms
} Impairment of More Than One Body Part or System
} Not a mathematical combination of severity rankings
} Consider impact of each impairment on function and LWEC to determine cumulative effect
} Impact of impairments on ability to perform specific job functions of particular occupation
For further information, please contact:
Ronald Weiss, 585-262-6390,rweiss@hwcomp.com
Mark Hamberger, 716-852-5200, mhamberger@hwcomp.com