Workers' Compensation

CA: WCAB Issues En Banc on WPI and Formal PD Rating Instructions

Blackledge v. Bank of America (en banc, 6/3/2010)

The Appeals Board held that, in the context of determining whole person impairments (WPI) and issuing formal permanent disability rating instructions, the respective roles of the physician, WCJ, and rater are as follows:

(1) the physician assesses the injured employee’s whole person impairment percentage(s) by a report that sets forth facts and reasoning to support its conclusions and that comports with the AMA Guides and case law;

(2) the WCJ frames instructions, based on substantial medical evidence, that specifically and fully describe the whole person impairment(s) to be rated; in addition, the instructions may ask the rater to offer an expert opinion on what whole person impairment(s) should or should not be rated;

(3) the rater issues a recommended permanent disability rating based solely on the WCJ’s formal rating instructions; unless specifically instructed to do so, the rater has no authority to issue a rating based on the rater’s own assessment of whether the whole person impairment rating(s) referred to in the instructions are based on substantial evidence or are consistent with the AMA Guides;

(4) the WCJ is not bound by the rater’s recommended permanent disability rating and may elect to independently rate an employee’s permanent disability; however, the WCJ’s rating still must be based on substantial evidence;

(5) potential AMA Guides rating problems may be minimized by the early and proper use of non-formal ratings; and

(6) there must be no ex parte communication between the WCJ and the assigned rater.

 

Read the case:

Cynthia Blackledge v. Bank of America and Ace America Insurance Company