What Do You Know about North Dakota Permanent Impairment Evaluations?

Compliance Corner

Bismarck, ND (WorkersCompensation.com) -- If you're looking for the rules regarding permanent impairment evaluations, they're at your fingertips with a Simply Research subscription.

If you haven't signed up for SR yet, here are a few highlights of what you can find there.

Evaluation Standards

Permanent impairment evaluations must be performed in accordance with the sixth edition of American Medical Association Guides to the Evaluation of Permanent Impairment.

All permanent impairment reports must include the opinion of the health care provider on the cause of the impairment and must contain an apportionment if the impairment is caused by both work-related and non-work-related injuries or conditions.

Provider Requirements

Evaluations must be scheduled with a health care provider who has the training and experience necessary to conduct an evaluation of permanent impairment and apply the AMA Guides. A permanent impairment evaluation conducted by the employee's treating health care provider or any health care provider who has treated the injured employee for the work-related injury may not be used.

What if there is a dispute? In that case, all objective medical documentation regarding the dispute will be considered by specialists who have the knowledge, training, and experience in the application of the AMA Guides.

Workers' Comp 101: What's a "medical dispute" under North Dakota law? It means that an employee has reached maximum medical improvement in connection with a work injury and has been evaluated for permanent impairment, and there is a disagreement between health care providers arising from the physical evaluation that affects the amount of the award. The dispute to be reviewed must clearly summarize the underlying medical condition. It does not include disputes regarding proper interpretation or application of the AMA Guides. It also does not include disputes arising from an impairment percentage rating or an impairment opinion given by a health care provider when the health care provider is not trained in the AMA Guides and when the health care provider's impairment rating or impairment opinion do not meet the requirements of subsection 5 of North Dakota Century Code section 65-05-12.2.

Audits

After the provider issues a permanent impairment rating, an audit is conducted and a decision awarding or denying permanent impairment benefits is made, subject to the following:

+ A permanent impairment award may not be made upon a rating solely under chapter 3 of the AMA Guides.

+ Mental and behavioral disorders are not independently compensable and are encompassed within the rating for physical.

+ In chapters that included assessment of the functional history as one of the nonkey factors to adjust the final impairment rating within a class using a self-report tool, the examining health care provider is to score the self-report tool and assess results for consistency and credibility before adjusting the impairment rating higher or lower than the default value. The evaluation health care provider must provider must provide rationale for deciding that functional test results are clinically consistent and credible.

+ A functional history grade modifier may be applied only to the single, highest diagnosis-based impairment.

+ All permanent impairment reports must include an apportionment if the impairment is caused by both work and non-work injuries or conditions.

Pollicization

Pollicization procedures will be rated as a scheduled injury and may not be rated as a whole body impairment.

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