This article explains how to calculate an impairment rating for a COVID-19 workers’ compensation claim. But first, I must, once again, do all that I can do to encourage each of you to get vaccinated.
I get that this is a politicized disease process. Some healthcare professionals disagree with vaccination. However, after reviewing numerous articles opposing vaccination, none met the standard of competent, peer-reviewed, evidence-based medical literature.
I cannot condone passing up getting the vaccine unless there is a specific clinical indication not to.
Now for the good stuff. As previously reported, COVID can be an accepted compensable injury from a clinical perspective and a legal (presumption) perspective.
If the diagnosis has been established as a compensable injury, then you need to develop a specific checklist of noted symptoms and actual sequelae(lasting effects) of the disease.
Track and note symptoms, physical examination findings, and laboratory values during subsequent clinical assessment of the disease process.
Creating a COVID-19 Impairment Rating Checklist
Researchers have linked COVID-19 to damage in several organ systems, including:
- Brain injury, such as anoxia after pulmonary or cardiac complications
- Heart disease, including atrial fibrillation
- Pulmonary disease, including pneumonia, congestive heart failure, or pulmonary edema
- Kidney disease, including acute kidney injury and acute tubular necrosis
Review each progress note carefully. Record reported symptoms—document physical examination findings. Identify relevant laboratory data. This process helps streamline the impairment rating evaluation and supports the final whole-person impairment rating.
At maximum medical improvement, any organ system that is not affected by the compensable injury should be excluded from the final whole person impairment rating.
With respect to each involved organ system, extremely specific testing needs to be completed, tracked, and followed.
Brain Injury and Neurological Impairment
As an example, Chapter 4 outlines the question you must answer for a brain injury.
What specific neurologic functional losses are noted? And more importantly, what objective clinical data support an injury to the brain responsible for those losses?
Issues such as aphasia (or other communication disturbances) are an impairing event. Progress notes should clearly document the level of communication loss using objective findings and indicate whether the impairment is reasonably considered permanent.
More specifically, is there a disturbance in the overall mental status or integrative functioning relative to brain activity?
Section 4.1b requires 10 separate assessments. 10 separate assessments. The impairment rating provider assigning an award for a brain injury needs to address all 10 components. Additional concerns, such as episodic neurologic disorders, can also add to the COVID-19 brain injury impairment.
Cardiac Impairment Considerations
Chapter 6 outlines the impairment rating parameters for cardiac conditions.
The distinction between a vascular issue, a valvular issue, or a muscular issue needs to be made. Testing, such as an echocardiogram, to establish the ejection fraction, would be necessary to calculate the appropriate whole-person impairment rating.
If there is an extensive period of congestive heart failure resulting in cardiomyopathy, this finding would be an additional consideration with respect to the final whole-person impairment rating.
Pulmonary System Evaluation
Chapter 5 addresses the pulmonary system, which is typically the most affected organ system.
Comprehensive pulmonary function testing helps determine the appropriate impairment class. Key measurements include FEV1, forced vital capacity (FVC), and oxygen diffusing capacity (DCO), compared with normal reference values.
Kidney and Urinary System Impairment
Lastly, Chapter 11 would address if there was an acute kidney injury or another urinary tract compromise. Under Section 11.1, impairment is determined by evaluating the patient’s functional losses together with laboratory findings, including creatinine clearance levels.
This would be another reason to track the laboratory studies with each subsequent progress note addressing this pathology.
Calculating the Final Whole Person Impairment Rating
Please remember that clinicians assign each organ system a whole-person impairment rating, then calculate the final award by combining these values via the “combined value chart”.
Impairment calculations depend on three key factors:
- The functions affected by the infection
- The patient’s response to treatment
- The function of each organ system at maximum medical improvement
Given the nature of these other organ systems, if there is any modest functional loss of two or more systems, one is easily looking at a greater than 15% whole person impairment rating.
Frequently Asked Questions
Can COVID-19 result in a permanent impairment rating?
Yes. COVID-19 may result in a permanent impairment rating when objective medical evidence demonstrates lasting impairment to one or more organ systems.
Which organ systems are commonly affected by COVID-19?
Commonly affected organ systems include the brain, heart, lungs, and kidneys.
What should be documented throughout treatment?
Clinicians should document symptoms, physical exam findings, laboratory results, diagnostic testing, and functional limitations throughout treatment.
How is a whole-person impairment rating calculated?
Each affected organ system receives an impairment value. Clinicians calculate the final rating using the Combined Values Chart.
When should an organ system be excluded from the impairment rating?
If maximum medical improvement has been reached and objective evidence does not support injury to a specific organ system, clinicians should exclude that system from the final impairment calculation.
