HOW SHOULD IME DOCTORS APPORTION FOR PRE-EXISTING IMPAIRMENT USING THE AMA GUIDES AND RULE 20 GUIDELINES?

In West Virginia, Workers’ Compensation statutes provide that an employee who has a definitely ascertainable impairment resulting from an occupational or non-occupational injury, disease, or any other cause, whether or not disabling, and the employee thereafter receives an injury in the course of and resulting from his employment, the prior injury and the effect of the prior injury and aggravation shall not be taken into consideration in fixing the amount of compensation or impairment allowed by reason of the subsequent injury.  The statute provides that compensation, i.e., a permanent partial disability impairment rating, shall be awarded only in the amount that would have been allowable had the employee not had the pre-existing impairment

No provision in this particular code section requires that the degree of pre-existing impairment be definitely ascertained or rated prior to the injury received in the course of and resulting from the employment or that the benefits must have been specifically granted or paid for the pre-existing impairment.  Additionally, the degree of pre-existing impairment may be established at any time by competent medical evidence.  It is not clear in the rules or statutes whether a reduction of an award for a pre-existing degenerative impairment should be calculated after the application of the tables in Rule 20 for determining impairment in regard to the lumbar, thoracic, or cervical spine or before the application of these tables.

In West Virginia, with regard to permanent partial disability evaluations and awards, such assessments shall be determined based upon the range of motion model contained in the AMA Guides, 4th Edition.  Once an impairment level has been determined by range of motion assessment in regard to a claimant’s spine injury, that level will be compared with the ranges set forth in the corresponding tables for permanent impairment as found in Rule 20, W. Va. C.S.R. § 85-20 et seq.  Permanent partial disabilities in excess of the range provided in the appropriate category as identified by the rating physician are reduced to within the ranges set forth in these tables found in Rule 20.  A single injury or cumulative injuries that lead to permanent impairment to the lumbar, thoracic, or cervical spine area of one’s person shall cause an injured worker to be eligible to receive a permanent partial disability award within the ranges identified in the tables found in Rule 20.

The rating physician must identify the appropriate impairment category and then assign impairment within the appropriate range designated for that category.  Rule 20 provides that all evaluations, examinations, reports, and opinions with regard to the degree of permanent whole body medical impairment which an injured worker has suffered shall be conducted and imposed in accordance with the AMA Guides, 4th Edition.  Rule 20 does not specifically address allocation of physical impairment at any time but does dictate that degenerative conditions are not compensable.  Also, Rule 20 allows for an evaluating physician to deviate from the rule with sufficient explanation for the deviation.

In a memorandum decision issued by the West Virginia Supreme Court of Appeals on June 11, 2014, the Supreme Court reversed and remanded a decision of the Office of Judges and Board of Review based on an employer’s appeal and found that the Office of Judges inappropriately concluded that the reviewing doctor did not correctly apportion for the claimant’s pre-existing condition when she did so after applying the table for impairment found in Rule 20.  The Supreme Court specifically noted that the physician correctly and appropriately apportioned for a pre-existing impairment after applying the tables found in Rule 20.  Even though this is a memorandum decision that does not have any specific syllabus points, it certainly is the only decision we have from the high court which shows that apportionment for a pre-existing condition should be made after applying the tables of impairment for the lumbar, thoracic, or cervical spine found in Rule 20.

 

Alyssa Sloan focuses her practice in the defense of litigating claims involving workplace injuries and illnesses and related employment matters. She has represented employers in more than one thousand (1,000) protests before the Workers' Compensation Office of Judges and has extensive experience in the appellate practice of worker's compensation claims before both the West Virginia Workers' Compensation Board of Review and the West Virginia Supreme Court of Appeals.
 
» See more articles by Alyssa A. Sloan
» Read the full biography of Alyssa A. Sloan at Steptoe & Johnson