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The Pain Game: 3+0=0?!?!
by Don Barthel, Esq.
Per the AMA Guides, a 0% whole person impairment rating
(WPI) "is assigned... if the impairment has no significant organ or body system functional consequences and does not limit the performance of... activities of daily living." (AMA Guides, p. 5) Of course, a 0% WPI will rate out to 0% permanent disability (PD). This does not mean the injured worker was not injured; it simply means he or she has suffered no permanent impairment in his or her performance of ADLs.
The AMA Guides permit the evaluating physician to rate pain-related impairment. After doing a pain-related impairment rating, the physician may increase the body or organ impairment (such as for an arm or the back), by up to 3% WPI.
What if the body/organ impairment rating is 0% (such as a back injury that is assigned a DRE Category I impairment)? Can the physician nonetheless increase the spine impairment (0%) by up to 3% WPI to account for pain?
The answer is NO!
Although physicians statewide have been providing 1, 2 or 3% additional WPI where there is a 0% body and/or organ system rating, AMA Guides' editors have made clear that this contravenes AMA Guides' intent. Happily, this position has been adopted by the DEU Manager, Blair Megowan, who recently stated that "the 3% bump up on AMA ratings require a ratable injury and that the pain 3% [will] not be assessed on its own." (See California Coalition of Workers' Compensation, Member UPDATE, 5/25/05.)
If the body/organ impairment is 0%, do not allow the reporting physician to increase the WPI by providing an impairment figure for pain.
Don Barthel, Esq. is a founding partner of Bradford & Barthel, LLP.
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