Category: Medical Treatment (Page 29 of 36)

Workers compensation LNI claim PPD rating

Permanent Partial Disability (PPD) rating in Workers’ Compensation and L&I claims

What’s my L&I claim case worth? I get this question all the time. The answer is always the same: It depends. One way to determine the value of a work injury L&I claim case is based on the Permanent Partial Disability or PPD award. And, the same holds true for a workers’ compensation claim with private insurance companies and self-insured employers.

What is Permanent Partial Disability or PPD?

PPD is a monetary award that some injured workers receive when L&I closes their claim. In short, if the injured worker has: (a) Reached maximum medical improvement; (b) Continues to experience permanent residuals from the industrial injury or occupational disease; and (c) Is still capable of working, then a PPD award may be appropriate.

PPD award rating is based upon medical evidence. When the body part involved in the work injury is one that cannot be amputated, the PPD rating usually uses categories of impairment from the Washington Administrative Code or Washington Administrative Code (WAC). However, if the body part could potentially be amputated, the PPD is rated according to criteria from the American Medical Association (AMA) Guides to the Valuation of Impairment.

Who can provide PPD rating for my claim?

Within the medical provider network or MPN, some providers feel comfortable and are willing to provide PPD ratings. Yet, others do not. Consequently, from my perspective, it is always ideal when the attending provider (AP) that’s assigned to the claim is willing to rate the PPD. This is because that provider usually has the best sense of the injured worker’s permanent residuals from the work injury.

If an AP does not do PPD ratings, they will usually refer the injured worker to a provider that does. Alternatively, they can request an Independent Medical Examination (IME).

How much is my right arm worth?

On a personal note, before you continue reading, please know that I’m very uncomfortable placing a monetary value on parts of the body. The human body is sacred. Body parts are priceless. However, this is the world and the reality we live in.

Injured workers often want to know what the monetary value of the PPD will be. It is important to know that the value is a set number that varies based upon the date of injury. L&I publishes a “Permanent Partial Disability Award Schedule” that lists PPD values based on the date of injury. For example, the value of a 10% right arm PPD for a person injured on December 31, 2015 is $12,004.04. Here, it’s because 100% of the value of an arm for a 2015 date of injury is $120,040.41. However, without a medical opinion rating the PPD, it is virtually impossible to estimate the dollars-and-cents value for the award.

Workers compensation LNI claims help and problems

Solving Problems and Overcoming Roadblocks in Your Workers’ Compensation or L&I Claim

/ L&I attorney / 0 Comments

If you don’t succeed the first time, then you should try and try again. I think this should be the motto for injured workers dealing with their L&I claim as they navigate their workers compensation claim process and issues.

The Industrial Insurance Act (RCW 51) was created to provide “sure and certain” relief for people injured at work. However, this doesn’t mean that workers’ compensation claims go smoothly or without roadblocks. Far from it. In fact, much of what I do is figuring out the best way to navigate obstacles that arise in L&I claims and self-insured employer claims.

L&I and workers’ compensation claims are full of tough obstacles

Whether it is getting treatment authorized, a condition accepted, or finding resolution to a conflict that has arisen, problem solving is my job. I’ll be the first to admit that sometimes problem solving feels more like trial and error. This isn’t because I don’t know what I am doing. It is because over the years I’ve learned that there’s almost always more than one way to solve a workers’ compensation problem. The key is finding the most successful approach, which is usually based on the unique facts and circumstances of the case at hand.

One L&I case in particular

Explicitly, since October, I’ve been trying to solve a series of issues in one particular case. I’ve had difficult conversations with my own client. I’ve had even more difficult conversations with the Claim Manager at the Department of Labor and Industries (L&I). Moreover, I had some loud and rough calls with assistant attorney generals and their paralegals representing L&I.

While I was able to get my client on board with some aspects of my plan, other pieces remained an unresolved challenge. On no less than six separate occasions since October, my proposals were formally rejected. Each time, I went back to the drawing board to try and develop a plan that would succeed. I clearly am not allowed to disclose specific details about this case. However, I’m pleased to report that today I managed to successfully resolve all the remaining issues. Interestingly, the solution wasn’t much different than what I had proposed about ten months ago. Yet, this time around, I just needed to take the right approach, at the right time.

Personal notes

Today’s perseverance to try and try again really paid off. I secured time loss compensation benefits to an injured worker that desperately needed them. To satisfy their mounting debt, to make some urgent payments, and to get a brief temporary break. Equally important, we now have some much-needed breathing room. We are already preparing to tackle the next roadblock that we’re anticipating in this complicated L&I claim.

Complex Regional Pain Syndrome (CRPS) LNI workmans compensation claim

Complex Regional Pain Syndrome (CRPS) in L&I Workers’ Compensation Claims

/ L&I attorney / 2 Comments

In workers’ compensation we see all kinds of work injuries and occupational diseases resulting in various medical diagnoses. These things are never easy, no matter what the diagnosis. However, some conditions seem to have a straighter claim path than others. Complex Regional Pain Syndrome (CRPS), for one, is a diagnosis that often leads to an irregular and challenging claim path.

L&I treatment guideline for CRPS

It seems that CRPS is a somewhat controversial diagnosis. The medical community is still working to better understand the condition. However, L&I does recognize CRPS as a medical diagnosis and has a treatment guideline for it. According to L&I, there are two sub-types of CRPS. Type I is what used to be called RSD, while type II used to be called Causalgia. The central difference between CRPS type I and type II is that type II occurs following a known peripheral nerve injury. On the other hand, type I occurs in the absence of any known nerve injury.

CRPS is a relatively uncommon condition. Also, it is not necessarily the right diagnosis for individuals with widespread pain in an extremity. Typically, true CRPS develops within 2 months of an injury in a single extremity. Symptoms include burning pain and severe pain caused by something that is typically not painful (such as a breeze or very light touch). Other symptoms are swelling, irregular or asymmetrical temperature and color of the limb, irregular or asymmetrical sweating of the limb, and skin, nail and hair changes in the impacted limb. While not required, a three-phase bone scan with a characteristic pattern of abnormality can help confirm the diagnosis.

Challenges with Complex Regional Pain Syndrome

One of the reasons I think CRPS becomes so challenging in workers’ compensation is because it is best treated early. Unfortunately, there are often many administrative claim related hurdles to be crossed before the condition is accepted. Consequently, early detection and treatment might not occur. CRPS is difficult because it produces extreme pain.

It makes it difficult for those who suffered a work injury to use the impacted limb. However, inactivity only worsens the condition. Therefore, studies have shown that early mobilization of a limb following an injury or surgery can help prevent CRPS. Yet, if symptoms do occur, the most effective treatment is early pain control and mobilization or restoring physical function. According to L&I, individuals with CRPS “must commit themselves to physical restoration on a 24-hour per day basis”. This is not an easy feat to accomplish.

L&I has divided treatment into six-week phases and will authorize a maximum of three phases. The first phase should include up to 5 sympathetic blocks to help control pain. The second phase should include up to 3 sympathetic blocks to help control pain. An additional 3 blocks may be authorized in the third phase as well. In addition to pain control through sympathetic blocks, the treatment phases should also include therapy and other pain control. The goal of therapy is physical restoration of function. The pain control is so that the injured worker can participate in therapy more fully.

Conclusions

In my experience the Department prefers for CRPS treatment phases to be carried out through a SIMP program (i.e., Structured Intensive Multidisciplinary Program). However, there are a limited number of SIMP programs throughout the State. It is not always practical for an injured worker to travel to a SIMP program for up to 18 weeks of treatment. In these cases, it can be quite difficult to coordinate treatment recommendations and authorizations efficiently.

I believe that L&I is actively trying to improve this process. I can attest firsthand to the fact that the Medical Director’s office often becomes very involved in CRPS. The goal seems to be to help treatment providers stay on track in moving these claims forward and reducing the long term disabling effects of the condition. However, the fact remains that claims involving CRPS are often irregular and challenging. More information about CRPS and the L&I Medical Treatment Guidelines can be found on the L&I website.