Workers Compensation – Scheduled Loss of Use
If you are injured on your job and have been told you need “Scheduled Loss of use” (SLU) for your injury, you have come to the right place! You maybe entitled for a cash benefit that pays you according to the Workers’ Compensation Board guidelines.
We will explain how we evaluate you for SLU. A medical report is submitted by us to the Workers’ Compensation Board for “Scheduled Loss of use” for your injury. This report abides by the current Permanent Impairment Guidelines and attests that you have reached maximum medical improvement.
Our report states that because of your injury on-the-job injury, you have suffered a loss of function in the injured body part that will last forever. We abide by Workers’ Compensation Guidelines for Determining Impairment. This article is based on New York state workers compensation guidelines.
When it comes to making treatment decisions, we always put the needs of their patients first. Our knowledge of current research and developments in our field is essential to providing the best care. We are aware of changes in insurance coverage and regulations, and we ensure high standard of quality care.
If you have been treated by us,we decide when you reach maximum medical improvement (MMI). MMI is reached after the treatment is over and you are no longer improving. Permanent disability is evaluated when a permanent impairment remains after a patient has reached maximum medical improvement. This is the time to do
“Scheduled Loss of use”.
“Disability” is a term used in to describe how a job accident has affected a patient’s capacity to work. The level of disability is determined by the Workers’ Compensation Law Judge based on the available medical evidence and other pertinent data. Your doctor, an employer’s medical consultant, or an independent medical examiner may all provide medical evidence.
Disability and impairment are distinguished from one another. We, as medical providers, make the sole medical determination of “impairment”. Impairment is defined as any anatomical or functional defect or loss. A thorough medical examination and a precise, unbiased assessment of function are necessary for an effective diagnosis of impairment.
These Guidelines give us a consistent method for assessing a person’s disability brought on by a work-related injury or sickness that has been medically verified.
Workers’ Compensation Disability and Its Benefits:
Workers’ compensation disability benefits are payments made to employees who are injured on the job or become ill as a result of their job. To an eligible worker and his or her family, workers’ compensation provides medical, income replacement, and death benefits.
Some states require employers to provide workers’ compensation coverage for their employees, while other states do not. Even in states where employers aren’t required to provide coverage, employees may still be able to get benefits through private insurance or workers’ compensation.
Each state has its own Workers’ Compensation Board that oversees the program and resolves disputes. By accepting workers’ compensation benefits, the employee waives the right to sue their employer for damages. In some cases, employees may be covered by federal programs, such as the Longshore and Harbor Workers’ Compensation Program or the Federal Employees’ Compensation Program.
The compensation may include partial salary repayment and coverage of medical costs. Workers’ compensation is not the same as unemployment benefits or disability insurance.
State-mandated insurance programs are typically mandatory for most employers. An employee may be entitled to a variety of benefits as a result of workers’ compensation.
Medications and lost wages can be covered by these benefits. Workers’ compensation can also help to provide for retraining or rehabilitation if an employee is unable to return to their previous job.
Below are some important benefits to consider in this regard:
Workers’ compensation can provide partial salary replacement for employees who are unable to work as a result of their injury or illness. The amount of salary replacement will vary depending on the state in which you live, but typically workers can receive up to two-thirds of their regular pay.
ii. Survivor Benefits And Healthcare Cost Reimbursement:
Medical expenses and rehabilitation costs may also be covered under workers’ compensation in addition to salaries. In most cases, workers’ compensation will reimburse employees for some of their medical expenses. Surviving family members of employees who die from work-related injuries or illnesses may also receive workers’ compensation benefits.
iii. Recipients Waive The Right To Sue:
Upon accepting workers’ compensation benefits, employees sign away their right to sue their employer for damages. This agreement protects both workers and employers by providing workers with a certain degree of financial security while limiting the amount of liability that employers may face due to negligence lawsuits.
Workers’ Compensation Vs. Disability Insurance:
The main difference between workers’ compensation and disability insurance is that workers’ compensation is mandatory in most states, while disability insurance is not.
Employees with workers’ compensation are covered for lost wages and medical expenses, whereas disability insurance replaces a portion of an employee’s income when they are unable to work.
Disability insurance is typically purchased by the employee, while workers’ compensation is provided by the employer. Also, workers’ compensation benefits usually last for a short time, but disability insurance benefits can last forever.
How Is Disability Determined?
The determination of whether an individual has a disability is made on a case-by-case basis. Depending on the state, medical information about impairments will be used to determine whether injured workers have permanent disabilities that affect their ability to perform certain tasks – or even to work.
Having a major life activity impeded does not necessarily qualify as disabled. Rather, an individual only needs to be limited in their ability to perform the activity when compared to most people who are not disabled.
Once an employee has established that they are disabled, they will need to file a claim with their state’s workers’ compensation board. A board of experts will review the claim and determine how much benefits should be awarded based on the findings.
Forms of Disability Under the Workers’ Compensation Law
The following categories of disability are recognized by this law in workers’ compensation cases:
- Temporary total disability: A situation where an employee becomes temporarily unable to perform any aspect of their regular work duties while recovering from an illness. The worker can resume work after the recovery period has ended.
- Permanent total disability: This type of Injury prevents an employee from working in the capacity for which they were trained. Depending on the state, benefits are provided for life or retirement.
- Temporary partial disability: In this situation, an employee cannot perform their regular responsibilities. The Employer doesn’t pay the full salary to the employee since they cannot do the entire job.
- Permanent partial disability: Despite being able to return to work, an employee has some permanent impairment that makes it impossible for the employee to work as they did before the injury.
Permanent disability is evaluated when a permanent impairment remains after a patient has reached maximum medical improvement (MMI). These guidelines were developed in order to assess impairment of permanent disabilities
Maximum Medical Improvement (MMI)
A determination of MMI is made based on a medical opinion that the patient has fully recovered from the work-related illness or injury and that no further improvement is likely to occur.
The need for palliative or symptomatic treatment does not preclude a finding of MMI. In cases that do not involve surgery or fractures, MMI cannot be determined prior to 6 months from the date of injury or disablement, unless otherwise stated or agreed to by the parties.
When determining MMI, the treating physician will examine the injured worker’s progress and residual symptoms, as well as their expected course of treatment in the areas of physical therapy and occupational therapy. Once MMI is reached, the physician will provide a full report to the workers’ compensation insurance carrier.
The insurance carrier will then use this information to calculate the appropriate PPD benefits. In some cases, an independent medical evaluation may be requested to confirm the physician’s determination of MMI. Sometimes, a person may never reach MMI and require lifelong care. However, for most people, MMI is an achievable goal to help them get back on their feet after an injury.
Our responsibility as your physician
The patient’s medical condition, level of impairment, and functional capacities are evaluated by us in accordance with their best professional judgment and reported to the Board and the parties.
These Guidelines offer specific standards for judging a medical condition’s impairment, with more emphasis placed on unbiased findings. It is the obligation of the medical practitioner to provide medical data that the Board will take into account when making a legal decision evaluation of disability.
We look to the objective findings of the physical examination and data in the patient’s medical records rather than inferring findings or manifestations that are not obtained from the physical examination or test reports. In order to determine impairment, this methodology aims to promote consistency, predictability, and inter-rater reliability.
We carry out the following in order to compile a report on permanent impairment:
- Determine the body area or system that is impacted (include chapter, table number, class, and severity level for non-schedule disabilities) and study the Guidelines
- Examine the pertinent medical history and records.
- Conduct a comprehensive physical examination.
- A goniometer is used by us to measure active range of motion (ROM). Three repeat measurements must be conducted to determine the maximum range of active motion.
- If applicable, deficits should be assessed by comparison to the baseline reading of the contralateral member. When the opposite side is unavailable for comparison or has a prior injury, using the contralateral is inappropriate.
- Report the work-related medical diagnosis (es) and examination findings, with the proper citations of the pertinent medical history, examination, and test results.
- To determine a level of impairment, abide by the suggestions.
- Analyze the effect of the impairment(s) on the patient’s functional and exertional skills in the case of a non-schedule permanent disability. Read the 2012 New York State Guidelines for Determining Permanent Impairment and Loss of Wage-Earning Capacity for guidelines on medical impairment and functional assessment.
- The sum value of a number of range-of-motion deficits shouldn’t be greater than the value of a joint with complete ankylosis when calculating the value of a schedule loss of use. A main member’s total number of ankylosed joints is not allowed to exceed the cost of amputation. However, due to loading, digits might go over these limits.
Types of Final Evaluation Examinations
Final evaluation examinations for the following award categories will be conducted by examining medical professionals:
A Schedule Award for:
- Impairment of extremities (including nervous system impairment that impacts use of extremities)
- Loss of vision
- Loss of hearing
- Facial disfigurement
- Non-Schedule Award for:
- Classification as permanent partial disability
- Classification as permanent total disability
So, these two types of final evaluation examinations can be conducted by examining medical professionals. These awards are not based on a schedule but on the extent of the disability and its impact on the injured worker’s ability to earn a living.
In both cases, the examination must be conducted by a medical professional to determine the extent of the injury and the appropriate course of treatment.
No matter which type of final evaluation examination you choose, it is essential to remember that these examinations are designed to help you improve your skills and knowledge as a medical professional.
The Workers’ Compensation Board must give its approval to the provider to be an authorized provider of the board before we can evaluate a patient who is located in New York or conduct an evaluation there.
Any evaluation carried out by medical professionals outside of New York must also adhere to these Guidelines, including the use of any forms the Chair may have recommended
A schedule award is paid for residual, long-term physical and functional disabilities and not for an actual injury. The following medical standards must be met before a claim is finally adjusted by a schedule award:
- There must be a permanent impairment of an extremity, permanent loss of vision or hearing, or permanent facial disfigurement, as defined by law.
- The impairment must involve anatomical or functional loss such as physical damage to bone, muscles, cartilage, tendons, nerves, blood vessels, and other tissues.
- The applicant must have made the most progress medically.
- Before a claim is deemed appropriate for scheduling examination of an extremity or extremities involved in the same accident, no residual impairments must exist in the systemic area (i.e., head, neck, back, etc.).
Workers’ Compensation Law specifies the value for a percentage loss or loss of use of body parts. The amount of the schedule award is based on the extent of the disability and the number of weeks of healing time allowed. An individual who is unable to work because of a permanent disability can receive disability benefits.
To qualify for a schedule award, you must be able to provide proof that your disability is directly related to your work injury. The severity of the disability must also prevent you from being able to work. Schedule awards are intended to provide financial assistance to injured workers who cannot return to their previous job or find employment in another field.
Non-Schedule Awards (Classification)
Permanent impairments that are not covered by a schedule, such as diseases of the heart, lungs, skin, or brain, as well as impairments of the extremities that are not eligible for a schedule award as stated below, are considered non-schedule awards. Schedule Impairments Subject to Classification Examples of extremity impairments not covered by a schedule award
- Conditions involving the major joints of the extremities, such as the shoulders, elbow, hips, and knees, which are progressive and extremely painful and include one or more of the following:
- Objective signs of acute or chronic inflammation in one or more joints, including swelling, effusion, changes in color or temperature, soreness, and painful range of motion, among others.
- Progression and severe degenerative arthritis as seen on X-rays.
- Minimal or no improvement following the use of all available medical and surgical treatment options.
- Distal extremities, such as the hands and feet, are frequently affected by chronic pain of an extremity, which may include one or more of the following:
- Chronic painful extremities syndrome, Sudeck’s atrophy, or Complex Regional Pain Syndrome (reflex sympathetic dystrophy).
- Observable symptoms such as persistent edema, atrophy, dysesthesias, hypersensitivity, or variations in the color and temperature of the skin, such as mottling.
- Signs of osteoporosis on X-rays.
- Little to no reported improvement following the patient’s use of all available chronic pain treatment modalities.
- The lengthy bones’ failure to union.
- Aseptic necrosis of other bones, such as the femur head.
- Serious and ongoing joint instability, particularly in the knee or other important joints.
- Severe Paget’s illness.
- Joint-related Caisson’s disease is number eight.
- Constant ulcerations and sinus drainage
- Constant joint dislocations (shoulders).
- Patients with neuromas or poorly healing stumps.
- Joint replacements, such as total knee, total hip and total shoulder replacements, which have failed.
Abbreviation Codes used by Workers compensation board-
|DIP||Distal interphalangeal joint|
|PIP||Proximal interphalangeal joint|
|SLU||Schedule loss of use|
|ANCR||Accident Notice Casual Relation|
|ODNCR||Occupational Disease Notice Casual Relation|
|Per NYS Statute:|
|First finger||Index finger|
|Second Finger||Middle / Long Finger|
|Third Finger||Ring Finger|
|Fourth Finger||Small / Little / Pinky Finger|
|≤||Less than or equal to|
|≥||Greater than or equal to|
Please refer to the Workers Compensation Board website of your state or speak with your Workers Compensation attorney for more information.