I am often asked how I know when a case is ready to settle. There are many factors that go into this judgment call, one of the most important being the disability rating assigned to my client.
What is a "disability rating" and how does it impact the settlement value of a Georgia workers compensation case?
The Georgia workers’ compensation statute looks to the American Medical Association (AMA) Guidelines as the required framework for a physician to assign a disability rating to a claimant. The AMA Guidelines are designed to assist physicians in objectively evaluating a claimant’s injuries and limitations. AMA Guidelines currently exist for a wide variety of body systems – including, for example, the muskuloskeletal system, the cardiovascular system, the immune system, etc. The AMA Guidelines are used in Georgia workers’ compensation cases, but they can also be used in personal injury matters. Click on the link to read how a Virginia accident lawyer discusses how he uses the Guidelines when evaluating a vehicle accident caes.
Here is a summary of the current AMA Guideline for the cervical spine (thanks to Spinal-Logic.com):
Category I (0%)
- No significant clinical findings
- No muscle spasm or guarding
- No documentable neurological impairment
- No alteration in structural integrity
- No fractures
Category II (5-8%)
- History and exam relevant to a specific injury
May include:
- Muscle spasm
- Asymmetrical loss of range of motion
- Complaints of radiculopathy without objective findings
- No alteration of structural integrity
Or:
- Significant radiculopathy
- Disc herniation at expected site verified by imaging study
- Patient improved after nonoperative treatment
Or one of the following Fractures:
- Less than 25% compression of one vertebral body
- Healed posterior element fracture without loss of structural integrity or radiculopathy
- Spinous or transverse process fracture with displacement
Category III (15-18%)
Significant signs of radiculopathy:
- Dermatomal pain and/or sensory loss
- Loss of reflexes
- Loss of strength
- Muscular atrophy
- Neurologic impairment verified by electrodiagnosis
Or:
- Significant radiculopathy with disc herniation verified by imaging study
- Improvement of radiculopathy following surgery
Or one of the following Fractures:
- 25-50% compression of one vertebral body (healed without loss of structural integrity)
- Posterior element fracture with displacement into the spinal canal (healed without loss of structural integrity)
Category IV (25-28%)
- Bilateral or multilevel radiculopathy.
- Alteration in motion segment integrity determined from flexion extension radiographs as 3.5mm or greater of translation or angular motion 11 degrees greater than each adjacent level (radiculopathy need not be present).
Or:
- More than 50% compression of one vertebral body without residual neurological compromise.
Category V (35-38%)
- Significant impairment of the upper extremity requiring adaptive functional devices.
- Single level total neurologic loss.
- Multilevel neurological dysfunction.
As you can see, this particular Guideline requires the examining physician to look at numerous factors and requires conclusions that fall within a proscribed range. In other words, a claimant with a Category IV cervical spine injury can qualify a disability rating of between 25 and 28%. The doctor has some leeway but the goal would be for similarly limited claimants to receive similar disability ratings regardless of who conducts the exam.
Not all physicians will issue an AMA Guideline rating and I have found that sometimes, treating doctors will refer a claimant out for a functional capacity evaluation (FCE) to determine the patient’s specific capacity for various physical activities like lifting, pushing, pulling, etc. In my experience, FCE evaluations often introduce a level of subjectivity into the disability rating process as clinicians performing the FCE tests are called upon to evaluate effort and motivation. This is especially true when the facility conducting the FCE receives most or all of its business from insurance companies.
In some instances, I will challenge the validity of a disability rating if I feel that the evaluating physician introduced too much subjectivity into the process.
Once a disability rating has been assigned, the Code provides for a calculation whereby the rating percentage is multipled by the claimant’s average weekly wage number and by a multiplier. The resulting product is called the Permanent Partial Disability amount and that figure becomes part of my settlement negotiation.
Obviously the higher the disability rating, the more serious the injury and the more uncertainty there will be for the claimant’s future.
Disability ratings are almost always issued when the claimant is approaching "maximum medical improvement" or that point where the claimant’s condition is beginning to stabalize. If you have been receiving weekly wage benefits and your doctor is beginning to talk about issuing a disaiblity rating, you need legal representation to help you understand what is happening and to mazimize your recovery.
Pro Se says
MAXIMUM MEDICAL IMPROVEMENT !!
Once again it’s a rather ubiquitous term . It’s in common use, but it’s ubiquitous nonetheless. That is most difficult if you don’t have abeginning and an end. I am marveled at the ability of any doctor to say this!
Where is the beginning and where is the end ? What is the maximum and what is the minimum ? If you don’t have two measurings points, I don’t know how to measure !
I gotta go ! But , I have much more to say about this section of your Blog !
Pro Se
LOUIS GRANT says
I’m wondering how this affects my injuries.
I injured my lower back and left knee almost a year ago can you give me more details
on how to go about filing or learning how the process works.
Jodi Ginsberg says
Louis, without knowing the details of your case I cannot comment. Let me also point out that legal advice about AMA Guidelines is what an experienced lawyer can offer.
Ronald lackage says
I had l5-S1 surgery July 2009. A cage,plate and screws. Three out of four have broken. Two are broke off in the spinal canal and cannot be removed. I have seen four surgeons and all agree that it’s too risky to try and remove them. I had a nerve test done and its positive for L5-S1 damage. I saw the Chicago Transit Authority pension doctor and he signed off on giving me my pension and the board approved it. I went thru the same with Social Security and I am receiving ssi also. My
lawyer tells me I have to stop receiving the pension (resign) stop ssi and go back to work doing sedatary work before the fce test is even completed. Question – will a fce test say I can do a light duty job even if I have broken hardware that can’t be fixed ?
Jodi Ginsberg says
Ron, you need to pose this question to a workers’ compensation lawyer in your state (I presume from your comment that you live in Illinois). It would appear that your medical condition would result in significant activity limitations but you need legal advice specific to your situation as opposed to general information from a blog dealing with a different state’s laws. Good luck to you.
sarah parker says
i live in the state of ga. while working i fell and had to have a complete hip replacement still in physical therpy also my left leg is one half inch shorter than my right leg now. the dr at my next visit said he would have my disibility rating .what do you think it could be.