Understanding Disability: For Insurance Adjusters

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Question: Dr. Alchemy, Based on limited range of motion for the neck in the PR-4 exam, can the injured worker return to usual and customary work duties? (This worker was provided an impairment rating WPI value, but no work limitations were clinically indicated).  Sincerely, DS

Answer: Dear DS, Impairment and disability are two independent concepts. Impairment value is a loss of an organ system or function to which a number value is assigned, whereas, “disability” is an ability to meet social or occupational demands. An individual may have impairment but no disability, or the reverse may be true.

A great example here is a knee injury with a meniscus tear. If I choose to not have surgery, but have range of motion above the ratable guidelines, I have a non-ratable knee, BUT I may not be able to stand, squat or lift to the requirements of the job. So, no impairment, but disability (eg. work limitation).

Same knee example as above, but I have surgery this time and a partial meniscus debridement is performed. My knee is perfect post operatively and no pain. I return work no problems. My impairment, however, is 1% WPI based on DBE table rating in Chapter 17, Lower Extremity Table 17-33 etc.

Summary, when an impairment value is incorporated into the California Permanent Disability Rating  (PDR) calculation, true “disability” may or may not be present.

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What is the technical definition of disability?

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Whether you’re a doctor, an attorney, or an insurance adjuster, a precise definition of disability is essential in impairment rating. However, for such an important term its technical definition often goes unexamined.

What You Need to Know About Disability

  1. Disability is an inability to meet social, occupational, personal, or statutory requirements because of impairment.
  2. Disability is different than impairment.
  3. Someone may have disability at home but not at work. Likewise, an individual may have disability at work, but not at home.
  4. A physician may provide an opinion on disability if he/she has expertise and is acquainted with the individual’s work activities and activities of daily living.
  5. An impairment evaluation is only one aspect of determining disability. A disability evaluation includes information about skill, education, job history, adaptability, age, environment requirements and modifications.

Time for an Example

Consider this: a 43 year old man performs sedentary clerical work. He has a permanent impairment from an amputation of the right leg below the knee. He cannot climb stairs in his home. Is he disabled from occupational demands? No. He performs clerical work that doesn’t require him to walk around. Is he disabled from personal demands? Yes! His activities of daily living are affected. Feel free to email us if you have any questions about disability and impairment rating.

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