Psychiatric Evaluation of Workers' Compensation Claimants Part 1

Saturday, April 22, 2006 | 0

The following article is the first in a series examining the medical-legal analysis of psychiatric workers' compensation claims. Though parts of this series are geared specifically to California and the rating of psychiatric permanent impairment under the California system, there are many parts applicable to the overall analysis of such claims.

By Rene Folse JD, Ph.D.

1) The Schedule for Rating Permanent Disabilities

This schedule was amended on January 1, 2005 by administrative regulation which makes it California law. The schedule must be followed word for word, and in the event of ambiguities, there will be litigation and court decisions interpreting the language. For our purposes, there are not yet any court cases, so we must carefully parse the language and attempt to apply it word for word.

The Schedule then articulates that the AMA Guides, 5th edition is to be used because of the following language in the labor code. Labor Code section 4660, amended effective April 19, 2004, provides:

(b)(1) For purposes of this section, the "nature of the physical injury or disfigurement" shall incorporate the descriptions and measurements of physical impairments and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition).

Please note that the language of section 4660 does not specify non physical (psychiatric) injuries are to be rated under the AMA Guides, and indeed, the AMA Guides chapter on psychiatric injury does not afford any schema to specify a Whole Person Impairment for psychiatric injury. Thus, Andrea Hoch (The Administrative Director who compile the Schedule) chose for psychiatric injuries only to ignore the AMA Guide Chapter all together, and instead she chose to use the GAF Scale.

Exact Language From the Schedule (This must be read and followed exactly)

4. Rating Psychiatric Impairment

Psychiatric impairment shall be evaluated by the physician using the Global Assessment of Function (GAF) scale shown below. The resultant GAF score shall then be converted to a whole person impairment rating using the GAF conversion table below.

(a) Instructions for Determining a GAF score:

STEP 1: Starting at the top level of the GAF scale, evaluate each range by asking "is either the individual's symptom severity OR level of functioning worse than what is indicated in the range description?"

STEP 2: Keep moving down the scale until the range that best matches the individual's symptom severity OR the level of functioning is reached, whichever is worse.

STEP 3: Look at the next lower range as a double-check against having stopped prematurely. This range should be too severe on both symptom severity and level of functioning. If it is, the appropriate range has been reached (continue with step 4). If not, go back to step 2 and continue moving down the scale.

STEP 4: To determine the specific GAF rating within the selected 10 point range, consider whether the individual is functioning at the higher or lower end of the 10 point range. For example, consider an individual who hears voices that do not influence his behavior (e.g., someone with long-standing Schizophrenia who accepts his hallucinations as part of his illness). If the voices occur relatively infrequently (once a week or less) a rating of 39 or 40 might be most appropriate. In contrast, if the individual hears voices almost continuously, a rating of 31 or 32 would be more appropriate.

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(b) Global Assessment of Functioning (GAF) Scale Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations.

(The Schedule then specifies the GAF scale word for word from the DSM-IVTR, notice the language above that the correct level is either symptoms or functioning which ever is the lower. You do not have to have both, just one. Thus I prefer to use the GAF scale that is divided in two sections, functioning and symptoms because the steps above requires an analysis of each separately)

Once you find the correct GAF using the four steps above, you then assign a WPI from the following scale.

Impairment

Locate the GAF score in the linked table (PDF format) and read across to determine the corresponding whole person impairment (WPI) rating.

Click for GAF Chart.

For a list of references used in the preparation of this article series and for general research, click here.

Rene Thomas Folse is a California attorney who has practiced workers' compensation law for over 30 years, and is a California licensed clinical psychologist. Rene is a member of WorkCompSchool's faculty and educational technical team. He can be reached at rene@workcompcentral.com.

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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.