The Headache of Head Injuries in Workers’ Comp

Head injuries are one of the hardest types of injuries to rate in workers’ compensation. This isn’t surprising, as the head is quite a complicated piece of machinery. While we wait for neuroscientists to tell us exactly how the brain works, we have to make do with the tools we have in order to figure out how a workplace injury is affecting the life of the injured worker.

Impairment Rating using the AMA Guides 5th Edition for Head Injuries

Head injuries can have significant consequences on an individual’s overall health and functionality. When assessing the impairment caused by head injuries, medical professionals often refer to the American Medical Association’s (AMA) Guides to the Evaluation of Permanent Impairment, 5th Edition. This widely accepted reference provides comprehensive guidelines for rating impairments across various body systems, including the Central Nervous System (CNS) affected by head injuries.

Central Nervous System Impairment (Chapter 13):

In the AMA Guides 5th Edition, head injuries that result in cognitive impairments, such as dementia, are evaluated under the CNS chapter. Specifically, the dementia section, which includes Table 13-15 through 13-16, assesses the impact on Activities of Daily Living (ADL) related to memory, orientation, problem-solving, community affairs, home and hobbies, and personal care. The maximum impairment rating for CNS-related impairments is 70% Whole Person Impairment (WPI).

Post Traumatic Headaches (Chapter 18):

Post traumatic headaches resulting from head injuries are assessed under the Pain chapter (Chapter 18). The severity and impact of these headaches on the individual’s ADL are used to determine the impairment rating. The maximum rating for post traumatic headaches is 3% WPI.

Post Traumatic Depression and Anxiety (Chapter 14):

Head injuries can also lead to mental and behavioral disorders, such as post-traumatic depression and anxiety. These conditions are evaluated in Chapter 14, which utilizes the Global Assessment Functioning (GAF) scale. The GAF scale offers a maximum impairment value of 90% WPI for these disorders.

Hearing Loss, Tinnitus, and Vertigo (Chapter 11):

If hearing loss, tinnitus (ringing in the ears), or vertigo is present due to the head injury, these conditions are rated under Chapter 11. Hearing loss is given a maximum impairment rating of 35% WPI, while tinnitus may be ratable at an additional 2% WPI.

Vision Loss (Chapter 12):

Vision loss resulting from head injuries is evaluated in Chapter 12, which specifically addresses the Visual System. The impairment rating for vision loss can go up to 100%, representing essentially total blindness.

Combining Impairments (Combining Table Page 604 – 606):

After assessing impairments across various chapters related to head injuries, a combined rating is determined to provide a comprehensive evaluation of the individual’s overall impairment. The Combining Table on pages 604 to 606 of the AMA Guides 5th Edition is utilized to calculate the total WPI based on the specific impairments identified in the evaluation.

In conclusion, the AMA Guides 5th Edition offers a standardized and comprehensive framework for assessing impairment resulting from head injuries. Different aspects of the injury, such as cognitive, physical, and emotional impairments, are evaluated separately using specific chapters. By considering each impairment individually and then combining them, medical professionals can provide a more accurate and objective assessment of the overall impairment experienced by the individual. This evaluation is essential for determining appropriate treatment, rehabilitation, and disability benefits for those affected by head injuries.

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