Life occasionally deals us hard times, such as a work-related accident that leaves one temporarily or permanently impaired and/or disabled. The worker files a claim and, if accepted, receives compensation, based on a physician’s evaluation rating of injury, using the American Medical Association Guides (AMA Guides 6th edition, 2007).
With the AMA Guide 6th edition, the International Classification of Function, Disability, and Health (ICF) Model was integrated into the evaluation process, which acts much like when the public is evaluated for disability claims. The evaluation can figure out if the injury is recoverable or whether it will be permanent, including the injury’s effect on mobility in future work and life moving forward.
The evaluation reviews what parts of the body have been injured, such as the visual system, upper body, lower body, and spine/hips. If there is an upper body injury, for example, then that AMA Guide related to the upper body, is used and includes in subdivisions, the arms, elbows, wrists, hands, and fingers (by parts of). More in-depth evaluation is applied for traumatic brain injury, along with internal organ functions, or lack thereof.
There is also a conversion rate, such as when eight percent of a finger converts to three percent of the hand, which then converts to three percent of upper body impairment. Finally, the results of the evaluation are classed between 1 and 4, with 4 as the most serious.
The physician generally works with the AMA Guides, although he or she has other options that may be more precise in awarding a financial rating to injuries. State statutes may override what the AMA Guide show for compensation, such as whether it is two eyes (AMA Guide) or one eye (A.R.S. §23-1044(B)(17)), so long as it is uncorrected. The AMA Guide does not support one eye oversight, only two.
On partial impairments whereby, the worker could return to work after recuperation and medical supervision, then the evaluation suggests a lower percentage of award at 50 to 55 percent. Total or permanent impairment without chance of returning to the job is set at 75 percent. Both percentages relate the cost of award, based on the salary of the worker at the time of injury.
We would use an example of a worker that we used elsewhere on this website. The worker had a foot injury that makes him permanently impaired and he could not return to work. His monthly salary was $4,250.00 and when multiplied by 75 percent, his monthly benefit was now $3,187.50. The percentage can range from 55 percent to 75 percent, dependent on the situation.
After treatment, the doctor closed the case because nothing else could be done for improvement. The patient received the full 40 months allowed for loss of foot availability, times the .08 percent which came out to 32 months for further calculation. Now the calculation is 32 months times $3,187.50 which comes out to $102,000.00 for the total impairment award, not counting the monthly benefit. The Permanent Partial Disability (PPD) is the only level at which there may be an award given, and calculations are not always the same.
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