Permanent Partial DisabilitiesSelf-Insurance Claims Adjudication GuidelinesPageDefinition. 3Loss of Bodily Function . 3Theory of Reserve Power . 3Tooth Loss . 3PPD Ratings . 4Pain and PPD Awards . 4Who Can Rate . 4Rating Reports . 5Types of PPD Ratings . 5Specified PPD . 5Pay at the Level Rated . 6Unspecified PPD . 6Injuries on or After October 1, 1974 . 6Injuries from July 1, 1971 through September 30, 1974 . 7PPD Award Limits . 7Self-Insured Employers’ Authority . 7Payment of PPD Awards . 8Timely PPD Payments . 8Advances . 8Scheduled Payments . 8Dates of Injury Prior to June 15, 2011 . 8Dates of Injury on or After June 15, 2011 . 8Lump Sum Payments . 8Minor Worker . 9Incarcerated Worker . 9Deceased Worker . 9Liens. 10Board or Court Orders for PPD . 10PPD Awards for Mental Health. 11Pre-Existing Conditions . 11Asymptomatic Condition . 11Symptomatic and Disabling Condition . 11Permanent Partial Disabilities – August 2019Page 1 of 13

Additional PPD Under the Same Claim . 12PPD Paid Under a Different Claim . 12Remaining Amputation Value. 13Permanent Partial Disabilities – August 2019Page 2 of 13

DefinitionPermanent partial disability (PPD) is defined by RCW 51.08.150 as “loss of either one foot, oneleg, one hand, one arm, one eye, one or more fingers, one or more toes, any dislocation whereligaments were severed where repair is not complete, or any other injury known in surgery to bepermanent partial disability”.The courts have further defined PPD to include the following: A condition arising from the injury that is fixed, lasting and stable.oIf further improvement is possible with medical treatment, it is not a permanentimpairment.oA condition can be fixed and still require palliative treatment.Any impairment of physical or mental function which detracts from the worker’s physicalor mental efficiency and thus hinders the worker in the ordinary pursuits of life.Loss of Bodily FunctionWAC 296-20-19000PPD is based on loss of bodily function. The dollar amounts for PPD awards are set bylegislature. The worker may dispute the rating itself, but not the dollar value of the rating. Theamount of the PPD award is based on the schedule of benefits in effect on the date of injury.Loss of wages and other economic considerations are not taken into account in individual claims.The legislature is presumed to have taken into account the general effect of specific types ofinjuries on wage loss when determining the PPD award schedule.Theory of Reserve PowerRCW 51.32.080(3), WAC 296-20-220PPD can be considered for a loss of function without disability. A worker is entitled to a PPDaward for the loss of a body part even if a remaining body part can fully cover the functional loss(e.g., loss of an organ not causing disability) (Kostida v. Dept of L&I). This case denied thetheory of a reserve power. In the case of body areas or systems which are category ratings orunspecified disabilities, with the exception of loss of hearing or vision, these PPD awards arerated based on a percentage of total bodily impairment (TBI).Tooth LossPPD is paid to a worker who loses one or more teeth as a result of an industrial injury. The PPDis awarded only for original teeth, whether or not the tooth is replaced by a bridge or denture.PPD is awarded at one-half percent TBI for each tooth lost.Permanent Partial Disabilities – August 2019Page 3 of 13

PPD RatingsThe rating of PPD is based on medical opinion in accordance with department rules (WACs),such as the category system or other nationally recognized rating systems, such as the AmericanMedical Association (AMA) guidelines.PPD includes both objective findings and subjective symptoms caused by the injury, eitherdirectly or by aggravation. The condition(s) must be causally related to the injury on a moreprobable than not basis.The rating does not need to include the exact terminology as written in the statute or WACs,provided it can be reasonably interpreted.Pain and PPD AwardsWAC 296-20-19030The AMA Guides to the Evaluation of Permanent Impairment and the category system bothincorporate subjective complaints. Subjective complaints, such as pain, cannot be objectivelyvalidated or measured. When rating PPD, reliance is primarily placed on objective findings.Who Can RateRCW 51.32.112, WAC 296-20-2010Qualified attending providers or independent medical examiners may rate a worker’simpairment. The rating should not be done until treatment is completed and the condition ismedically stable.Provider Type Currently Licensed In:Medicine and surgeryOsteopathic medicine and surgeryPodiatric medicine and ysician’s Assistant (PA)Advanced Registered Nurse Practitioners (ARNP),Including Psychiatric ARNPsAble to rate?YesYesYesYesYes, if department-approvedconsultant or IME examinerNoNoNoNoIf the rating is done by an independent medical examiner, the report must be sent to the attendingprovider for review. The attending provider’s opinion may, depending on the medical evidencepresented, be given more weight by the Board of Industrial Insurance Appeals and Courts thanone or more independent examiners. The attending provider:Permanent Partial Disabilities – August 2019Page 4 of 13

Is presumed to be more familiar with the overall course of the injury, able to average outgood days and bad days. Has to have been treating the worker for some period of time before their opinion carriesgreater weight. May not carry greater weight if they are not a specialist in the area of medicine involvedor qualified to do rating examinations.Rating ReportsWAC 296-20-2010, WAC 296-23-377An impairment rating report must contain the following: A statement that the worker has reached maximum medical improvement and that nofurther curative treatment is recommended. Pertinent details of the physical examination performed (both positive and negativefindings). Pertinent results of any diagnostic test performed (both positive and negative findings).Include copies of any pertinent tests or studies ordered as part of the exam. A rating consistent with the findings and a statement of the system on which the ratingwas based (e.g., AMA Guides, 5th edition; category rating system). Rationale for the rating supported by objective findings. For ratings using the AMAGuides, the rational must state the tables, figures and page numbers on which the ratingwas based.Types of PPD RatingsThere are two types of permanent partial disabilities.Specified PPDRCW 51.32.080Specified disabilities are listed in RCW 51.32.080(1)(a). They are limited to amputation or lossof function of extremities, loss of hearing or loss of vision. Impairment for the loss of function ofextremities, as well as partial loss of hearing or vision, is rated using a nationally recognizedimpairment rating guide (AMA Guides to the Evaluation of Permanent Impairment) unlessotherwise precluded by department rule. When a specified disability is not a completeamputation or total loss of vision or hearing, the disability is rated as a percentage of impairedfunction as compared to an amputation or total loss of function of the ear, eye, or limb at theappropriate level (joint). Schedules for specified PPDs can be found online.Permanent Partial Disabilities – August 2019Page 5 of 13

Loss of vision is rated as a percentage of visual acuity without correction. 20/200 or greater isconsidered to be 100 percent loss of visual acuity.Pay at the Level RatedPPD awards must be paid at the level rated by the provider. The department prefers the ratingexaminer provide the PPD rating closest to the injured body part. However, it is not uncommonfor some providers to rate for an entire extremity. For example: An injured worker has an ankle injury and the doctor provides a rating of 5% at the ankle(syme). The PPD would be paid at that level. An injured worker has a right knee injury and the doctor provides a rating of 2% of theright lower extremity. The PPD would be paid at the leg above the knee joint with shortthigh stump.The AMA Guides 5th edition is currently in use. The current AMA guidelines do not provide arating table for the knee or the elbow level. Therefore, the knee and elbow must be rated at thefull extremity level.Example: If the examiner provided a rating of 2% of the leg at or above knee joint withfunctional stump, clarification from provider would be needed.If the examiner provides a non-specific rating, obtain clarification or use the rating at the highestpoint. Don’t make assumptions on the rating. If a worker has a laceration on the tip of the indexfinger and the rating is 5% of the index finger, the PPD would be paid for the entire finger (indexfinger at metacarpophalangeal joint or with resection of metacarpal bone).Unspecified PPDRCW 51.32.080Unspecified disabilities include, but are not limited to, internal injuries, back injuries, mentalhealth conditions, respiratory disorders, and other disorders affecting the internal organs. Theseratings are currently rated in accordance with WAC 296-20-200 through WAC 296-20-690,using the category rating system. Schedules for unspecified PPDs (categories) can be foundonline.Injuries on or after October 1, 1974For injuries on or after October 1, 1974 the category rating system outlined in WACs 296-20-230through 296-20-660 is used to rate unspecified disabilities. For conditions rated by the category system, a percentage rating is not acceptable. Categories describe levels of physical and mental impairments.Permanent Partial Disabilities – August 2019Page 6 of 13

The rating provider selects the category that most closely describes the worker’scondition. The department assigns percentages to each category. These percentages represent acomparison of the disability to total bodily impairment (TBI). The legislature assigns maximum monetary value to unspecified disability as comparedto TBI.The department has the authority to assign percentages to the different categories (WAC 296-20670). This is an administrative function and is not subject to appeal. The worker may appeal thecategory that is awarded but not the percentage assigned to that category.Injuries from July 1, 1971 through September 30, 1974The category rating system cannot be applied to injuries prior to October 1, 1974. For injuriesduring the period July 1, 1971 through September 30, 1974, unspecified injuries are rated as apercentage of total bodily impairment (TBI). TBI is equivalent to loss of function of the whole person in the AMA rating system. With TBI, the examiner is comparing the effects of any injury with total physicaldisability and estimating a percentage.PPD Award LimitsThe maximum allowed for unspecified disabilities means the combined awards for unspecifieddisabilities paid on a claim cannot exceed the limit in effect for that claim. This limit does notapply to specified disabilities.If injury results in the amputation or total paralysis of both legs, both arms, one leg and one arm,or total loss of vision, and the worker is able to work, the claim should not be closed with a PPDaward. The worker is entitled to receive total permanent disability (pension) benefits withoutregard to ability to work. At the time the worker’s condition becomes fixed, the claim should bereferred to the department’s pension adjudicator for consideration (RCW 51.08.160).Self-Insured Employers’ AuthorityRCW 51.32.055, WAC 296-15-450(2)Self-insured employers have the authority to close PPD claims in some cases. See Claim Closurein the Miscellaneous Claim Issues chapter.Permanent Partial Disabilities – August 2019Page 7 of 13

Payment of PPD AwardsTimely PPD PaymentsWAC 296-15-450(6) and (9)When a claim is closed with PPD, the award, or first payment, must be paid: Within five working days of claim closure by a self-insured employer, or Without delay if the department closed the claim.AdvancesThe department has no jurisdiction over PPD advances prior to closure. Workers must direct anyrequest for an advance to the self-insured employer.Scheduled PaymentsRCW 51.32.080When a PPD award is more than three times the state’s average monthly wage at the date ofinjury, a down payment of that amount is made. A schedule of down payments can be foundonline. The balance of the award is paid in monthly installments equal to the worker’s monthlytime-loss compensation (at the time of closure).Dates of Injury Prior to June 15, 2011Interest must be paid on the unpaid balance of:Injury DatePrior to July 1, 1971July 1, 1971 through June 30, 1982July 1, 1982 through June 14, 2011Interest per Annum5%6%8%Dates of Injury on or After June 15, 2011RCW 51.32.080 eliminated the payment of interest on the unpaid balance.For all dates of injury, a copy of the Schedule of Future Payments for the Balance of the PPDAward must be submitted to the worker and the department. For dates of injury on or afterJune 15, 2011, the interest column should be left blank.Lump Sum PaymentsPPD awards that are less than the down payment amount must be paid in a lump sum payment.Permanent Partial Disabilities – August 2019Page 8 of 13

Awards that are larger than the down payment amount must be paid out in monthly installments.If a worker wants to have a scheduled award paid out in a lump sum, a written request must bemade to the department. Only the department can approve a lump sum payment (cash out) ofthese awards. Approval of the payment will not be made until the closing order is final.Minor WorkerRCW 51.04.070PPD payments to a minor worker (under age 18) must be made to the parent or legal guardianunless written authorization has been given by the parent or legal guardian to make payment tothe minor worker.Incarcerated WorkerRCW 51.32.040(3)PPD award payments will not be paid to a worker who is confined in any institution underconviction and sentence. The worker will not be paid the PPD until they are released. However,the order awarding the PPD and closing the claim can be issued.Exceptions: If the worker has any beneficiaries (RCW 51.08.020), the PPD award is paid to thebeneficiaries while the worker is incarcerated. Willoughby v. Dept. of L&I established the right of prisoners incarcerated in state DOCprisons who have no beneficiaries and/or are unlikely to be released to receive PPDawards while they are still confined. PPD awards are sent to the workers in care of DOC(RCW 51.32.380). This exception does not apply to prisoners incarcerated by other statesor by federal, county or city jails.Once the worker is released any further payment due should be sent to the worker.Deceased WorkerRCW 51.32.040(2)If a worker dies from a cause other than the injury and would have been entitled to a PPD dueto the effects of the injury, the PPD award is payable to the surviving spouse or children. If thereis no surviving spouse or child, the award shall be paid consistent with the terms of the worker’swill or, if they died without a will, consistent with the terms of RCW 11.04.015.The courts have ruled that a worker’s condition at the time of death would have been stable orfixed, so that it would be reasonable to assume the worker’s condition would not have improved.A rating of the amount of PPD should have been made prior to the worker’s death, or theattending provider should be able to provide a rating based on the medical records. The ratingmust be credible.Permanent Partial Disabilities – August 2019Page 9 of 13

The spouse or dependents can make a request for the PPD to be paid to them within one year ofthe worker’s death, regardless of any closing orders issued even if they are final and binding.The spouse must be married to the worker at the time of death but did not have to be married tothe worker on the date of injury.LiensRCW 51.32.040(1), RCW 74.20A.260PPD awards are not affected by Office of Financial Recovery (OFR) liens resulting from receiptof public assistance benefits by a worker. However they are subject to Division of Child Support(DCS) liens (formerly called Office of Support Enforcement or OSE). The lien is submitted bythe Department of Social and Health Services (DSHS) Order to Withhold and Deliver formwhich subjects up to 50 percent of the net proceeds of the PPD payment be paid to DCS.Prior to paying a PPD award on a claim with a DCS lien, telephone contact should be made withthe DCS support officer who filed the lien to determine the current amount due DCS. Thesupport officer’s telephone and office location are on the Order to Withhold and Deliver.The maximum amount payable on the lien is determined by multiplying the net PPD payable(after deductions for previous awards, advances, overpayments, etc.) by 50 percent. If the lien isgreater than 50 percent of the net award, only 50 percent can be paid. DCS liens also apply toscheduled PPD payments that have not been mailed at the time the lien is received. Themaximum payable is 50 percent of the remaining balance of the award at the time the lien isreceived.Failure to honor a DCS lien may result in a penalty assessed by DSHS against the self-insuredemployer in the amount of the monies due.Out of State LiensThe department does not recognize out of state liens. If an out of state lien request is received,notify the requesting party out of state liens are not honored and refer the requester to:Division of Child SupportPO Box 11520Tacoma, WA 98411(360) 664-5321(800) 922-4306www.DSHS.WA.Gov/DCSBoard or Court Orders for PPDWhen PPD is awarded from a Board of Industrial Insurance Appeals (BIIA) or higher courtorder, the entire award for PPD should be paid in a lump sum if the worker would have receivedthe award by the time the order was entered, had it been awarded at the time of closure.Permanent Partial Disabilities – August 2019Page 10 of 13

PPD Awards for Mental HealthWAC 296-20-330, WAC 296-20-340The courts have considered that a degree of worry or brooding over the economic consequencesof an injury is not uncommon and was probably taken into consideration by the legislature whensetting PPD award limits. The pattern of adjustment before an industrial injury or occupationaldisease serves as the base line for all assessments of whether there has been a permanentimpairment due to the industrial injury or occupational disease. For there to be a compensablePPD due to mental health impairment, it must be in excess of what is normally expected.Pre-Existing ConditionsRCW 51.32.080(5)Asymptomatic ConditionIf an injury aggravated or “lighted up” a pre-existing asymptomatic condition, the entireresulting impairment is attributed to the injury rather than to the pre-existing condition. In theMiller v. Dept. of L&I decision, it states that a congenital defect or structural weakness does notin itself constitute a disability if it does not interfere with working capacity, notwithstanding thefact it presumably constitutes a loss of bodily function. This decision concludes that: “ . if anyinjury, within the statutory meaning, lights up or makes active a latent or quiescent infirmity orweakened physical condition occasioned by disease, then the resulting disability is to beattributed to the injury, and not to the pre-existing physical condition.”Examples: The worker fell off a ladder at work injuring their back. The claim is ready for closurewith a Category 3 lumbar rating, with Category 2 due to pre-existing degenerative discdisease. The worker was not being treated for the degenerative disc disease and it was notpreventing them from doing their normal job and daily activities. The worker is entitledto the entire Category 3 PPD. The worker was lifting a box and felt pain in their mid-back. The diagnosis is thoracicsprain. Examination revealed a pre-existing asymptomatic scoliosis. The IME ratedCategory 2 permanent dorsal area impairments. The scoliosis was asymptomatic at thetime of injury therefore the worker is entitled to the entire Category 2 PPD.Symptomatic and Disabling ConditionIncreased disability resulting from an injury that aggravated or “lighted up” a pre-existingsymptomatic and disabling condition may be segregated once the amount of pre-existingdisability has been established by medical opinion.Permanent Partial Disabilities – August 2019Page 11 of 13

Example:The worker was involved in a non-work related car accident 3 months before his injury atwork. He was receiving treatment and had restrictions related to the car accident. Heaggravated his cervical condition when he fell at work. When his workers compensationclaim was ready to close he was rated at Category 3 cervical impairment with Category 2from the car accident. His claim will be closed with a Category 3 award, less Category 2cervical.Note: Self-insured employers should request closure from the department in these cases as thereis a segregation of a pre-existing PPD.Additional PPD Under the Same ClaimWhen a worker received a PPD award and the order has become final and binding, the extent ofthe disability present on the date of closure can no longer be disputed. If the claim is reopenedfor a worsening of the worker’s condition, contentions of increase disability are limited to theextent of any increased impairment. An order closing the claim after reopening, where the PPDaward was previously granted under the same claim, should indicate the total percentage ofdisability (previous award percentage of increased disability). The prior monetary award issubtracted to determine the current amount due.Example:The worker’s claim was closed with a 5% PPD on the left knee; the claim was laterreopened for additional surgery and is ready for closure with a 12% PPD on the left knee.The claim will be closed with a 12% PPD less the 5% previously paid on the claim.PPD Paid Under a Different ClaimPrior monetary awards paid under a different claim cannot be subtracted from a current award. Ineffect, that would recompensate a worker for a prior injury at a higher rate if a different PPDschedule (from a different date of injury) was involved. Pre-existing awards will be reduced fromthe new award, but only for the same body part, and rated at the same level. TBI percentages canbe subtracted from TBI percentages and category percentages from category percentages.The closing order will reflect the percentage of increased disability resulting from the currentclaim and the monetary award due. Note: Self-insured employers should request closure fromthe department in these cases as there is a reduction of a pre-existing PPD.Examples: The worker has a previous claim that closed with a Category 2 cervical PPD. A newclaim is filed and is ready for closure with a Category 3 cervical rating. The new claimwill be closed with a Category 3 PPD less the pre-existing Category 2 PPD.Permanent Partial Disabilities – August 2019Page 12 of 13

The worker has a previous claim for a right ankle injury that closed with 4% impairmentto the right ankle. A new claim is filed five years later for a right ankle injury. The IMEgives a rating of 15% of the right ankle with a 4% pre-existing impairment to the rightankle. The new claim will close with a 15% PPD less the 4% pre-existing PPD. The worker has a previous claim that closed with a 2% right upper extremity PPD for anelbow injury. A new claim was filed for a shoulder injury and at closure is rated a 5%right upper extremity PPD for the shoulder. The new claim will be closed with a 5% PPDfor the right upper extremity with no reduction for the previous PPD because the newinjury was not for the same body part.Remaining Amputation ValueRemaining amputation value must be calculated for PPD for a worker with a pre-existingamputation at a lower level, or a single injury that causes amputation and additional disability tothe same extremity at a higher level (Ringhouse v. Dept. of L&I). An amputation is an unrepairable severing of a limb at any level. Remaining amputation value is calculated in thefollowing cases: In the same injury, a worker sustains an amputation as well as permanent disability at alevel higher to the amputation level of the same extremity.Example: On date of injury, a worker catches his right hand in a piece of machinery andtraumatically amputates his right index finger at the metacarpophalangeal (MCP) joint.The worker also sustained a rotator cuff tear in his right shoulder. A worker sustains impairment to an extremity and has had a previous amputation to theinjured extremity.Example: The worker has his right little finger amputated as a child due to an injury. Onthe date of injury, the worker sustained an injury to his right elbow. A worker sustains a further amputation of an extremity. The worker had previouslysustained an amputation to the same extremity.Example: The worker had a left index finger amputation at the distal interphalangeal(DIP) joint as a child. On the date of injury, the worker’s left index was traumaticallyamputated at the proximal interphalangeal (PIP) joint.The PPD order will state the full award for an amputation at the appropriate level and show thededuction in cash for the monetary value of the previous amputation computed from the scheduleof benefits in effect at the time of the recent injury. Note: Self-insured employers should requestclosure from the department in these cases as there is a reduction of a pre-existing PPD.Permanent Partial Disabilities – August 2019Page 13 of 13

The AMA Guides 5th edition is currently in use. The current AMA guidelines do not provide a rating table for the knee or the elbow level. Therefore, the knee and elbow must be rated at the full extremi