Disability Rating Vs. Impairment Rating

As a physician, you will be called upon to assess injury that is sustained by a victim. This person may be a patient that you have treated for accident related injury or someone referred to you from a third party for a second opinion regarding any permanent injury.

Two completely different types of ratings may be rendered regarding a patient's injury. A disability rating pertains to the patient's ability to perform his occupational duties. A disability rating is typically performed by an occupational therapist. An impairment rating assesses the patient's physical loss to the body. As an example, an accountant who lost a leg will have a permanent impairment but no disability. A doctor of chiropractic is well qualified to assess a permanent impairment to the musculoskeletal system the body.

A complete orthopedic and neurological assessment must be performed to properly determine the level of physical impairment. This assessment includes a thorough review of the patient's history and diagnostic testing. Additional diagnostic testing may be required to accurately determine the level of impairment. The information from the patient's history, diagnostic evaluation, and diagnostic testing is correlated with the most recent edition of the American Medical Association Guides for the Evaluation of Permanent Impairment. A working knowledge of this Guide is necessary to properly determine the patient of level of impairment.

The most important question that any evaluating physician should ask when evaluating the patient pertaining to a permanent physical impairment is "is this impairment appropriate for the patient’s clinical condition?" A patient who was permanently confined to a chair was given a 5 percent, whole person, permanent physical impairment. A second patient that sustained a hyper flexion -- hyperextension injury to the C-Spine was given a 20 percent permanent physical impairment to haul person. Neither one of these permanent physical impairment ratings appear appropriate with the type of injury.

The evaluating physician must consider an overview of the scenario. The evaluating physician should consider some of the following:

1. Was an impairment rating requested?

2. Who requested the impairment rating?

3. Will the impairment rating have any significant effect on the outcome of any pending litigation?

4. Were there any positive diagnostic testing to substantiate the permanent physical impairment?

The following issues should be reviewed with the patient regarding a permanent physical impairment:

1. A permanent physical impairment is permanent. This remains part of the patient’s permanent clinical record.

2. When a person applies for insurance of any kind, they have a permanent injury associated with the musculoskeletal system and probably the spine. This is a negative consideration by most insurance companies.

3. When a person applies for a job, they also have a permanent injury. This may affect a patient's employability.

It is strongly recommended that a physician participate in an impairment evaluation conference to review the basics involved in the proper assessment of the permanently injured patient, if the physician plans on utilizing impairment rating as part of their practice. Periodic updates of the Guides should be reviewed for any significant changes.

About the Author
Michael Levinson, DC is in private clinical practice in Kennesaw, Georgia. Dr. Levinson is a graduate of New York Chiropractic College.

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