Scheduled Loss of Use

A workplace injury determines a patient’s legal disability and ability to work. The available medical evidence or other pertinent information will evaluate the disability level by a Workers’ Compensation Law Judge. In addition, the patient’s health professional, employer medical consultant, or an independent medical examiner may submit medical evidence to determine impairment or disability.

We evaluate if a patient has any anatomic or functional abnormality or loss through a complete medical examination and precise objective function assessment. The Guidelines outline the uniform evaluation process of a documented medical work-related injury or illness resulting in impairment.

Workers’ Compensation Law Types of Disability

The Workers’ Compensation Law establishes total and partial temporary and total and partial permanent disability compensation cases. A permanent disability case becomes evaluated after the patient reaches maximum medical improvement (MMI). Guidelines determine permanent disability impairment.

Maximum Medical Improvement (MMI)

Maximum Medical Improvement (MMI) is a medical judgment where the patient has either recovered from the work injury or illness to the expected extent and without reasonably expected further improvement.

However, MMI does not require palliative or symptomatic treatment. MMI is not determined six months before the injury or disablement date of nonsurgical or cases involving fractures unless both parties agree.

Examining Medical Professionals’ Roles

We must provide the Board and the parties with their best professional opinion regarding the patient’s medical condition, impairment degree, and functionality. The Guidelines structure determines the severity criteria of a medical impairment with greater significance to objective discoveries. In addition, we must submit medical evidence to the Board to conclude a legal disability determination. The findings can not draw outside the physical examination, test reports, or patient medical records to facilitate consistency, predictability, and inter-rater reliability of impairment determination.

We must adhere to the following process when preparing a permanent impairment report.

  • Review the Guidelines and recognize the affected body part or system, including the non-schedule disability chapter, table number, class, and severity level. We must utilize the Other Injuries and Occupational Diseases chapter guideline for additional body parts.
  • Evaluate pertinent medical records and history.
  • Complete a full physical examination.
  • Use a goniometer to measure the active range of motion (AROM) and perform three measurements to determine the maximum AROM.
  • Compare a baseline assessment with the contralateral body part unless previously injured or absent.
  • Document and report a patient’s work-related medical diagnosis(es) and examination assessment, including appropriate specific medical history references and test results.
  • Establish an impairment level based on recommendations.
  • Determine how the impairment impacts the patient’s functional and exertional abilities for non-schedule permanent disabilities.
  • Utilize the Medical Impairment and Functional Assessment Guidelines found within the 2012 New York State Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity during evaluation.
  • The total value of numerous range of motion deficit assessments must not exceed the full joint ankylosis value when determining the value of a schedule loss of use.
  • The summation of multiple ankylosed joints can not exceed the amputation value, although loading may surpass the amputation value when adding deficits of digits.

Final Evaluation Examination Types

We will determine a final evaluation examination with the following award categories.

A Schedule Award for:

  • Extremities impairment, including extremity influence due to nervous system impairment
  • Vision loss
  • Hearing loss
  • Facial disfigurement

 Non-Schedule Award for:

  • Permanent partial disability classification
  • Permanent total disability classification

The Workers’ Compensation Board must authorize patient evaluations in New York. Evaluations outside New York must comply with the Guidelines and any forms the Chair prescribes.

Schedule Awards

A patient is entitled to a schedule award for a residual permanent physical and functional impairment, not the sustained injury.

A schedule award final claim adjustment must meet the following medical requirements.

  • As defined by law, permanent extremity impairment, permanent vision or hearing loss, and permanent facial disfigurement.
  • Impairment requires anatomical or functional loss, for example, physical bone, muscle, cartilage, tendons, nerves, blood vessels, or tissue damage.
  • The patient must have acquired maximum medical improvement (MMI).
  • The patient must have an absence of residual area systemic impairments before the extremity schedule evaluation within the same accident. We must prescribe a percentage loss or body member loss according to Workers’ Compensations Law Section 15. Utilize Appendix A: Weeks by Percentage Loss of Use of Body Part to determine the entitled compensation weeks based on the loss percentage.

Non-Schedule Awards (Classification)

Impairments not covered by a schedule will receive non-schedule awards. Examples of non-schedule awards include permanent impairments, conditions of the spine and pelvis, lungs, heart, skin, brain, and extremities impairment.

Schedule Impairments Subject to Classification

Examples of non-schedule extremity impairment awards include:

  1. Progressive and severely painful conditions that affect major extremity joints, including the shoulders, elbows, hips, and knees, with at least one of the following:
    • Acute or chronic inflammatory objective results of at least one joint, including swelling, effusion, color or temperature change, tenderness, painful range of motion, etc.
    • Progressive and severe degenerative arthritis evidenced on x-ray imaging studies.
    • Minimal or no improvement after exhausting all medical and surgical treatment modalities.

2. Chronic and painful distal extremity condition, including the hands and feet, with at least one of the following:

    • Complex regional pain syndrome (reflex sympathetic dystrophy), Sudeck’s
      atrophy, or chronic painful extremity syndrome.
    • Chronic swelling, atrophy, dysesthesias, hypersensitivity, skin color, or temperature changes (mottling) objective results.
    • Osteoporosis evidenced on x-ray imaging studies.
    • Minimal or no improvement after exhausting all chronic pain treatment modalities.

3. Long bones malunion
4. Femur head or other bone aseptic necrosis.
5. Severe and persistent instability of major joints, such as the knee joint.
6. Advanced Paget’s disease.
7. Tumors.
8. Caisson’s disease involves the joints.
9. Persistent ulcerations, draining sinuses.
10. Recurrent dislocations in the shoulders.
11. Amputations with neuromas or poorly healed stumps.
12. Failed joint replacement such as total hip or knee and shoulder replacements.

Please refer to your state’s Workers’ Compensation Board website or speak with your Workers’ Compensation attorney for more information.

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