Impairment Ratings

Rating Services I Offer :

1. Impairment Ratings (utilizing the 5th Edition Guide Book)
2. Review of Impairment Ratings to determine accuracy (did you get as much as you should have?)
3. Claim Re-openings (If your condition is worse than it was when your claim was closed, and you feel you need additional treatment and/or surgery, I can help.)
4. A determination that you have a ratable impairment from your industrial injury. (If your claim was closed and your treating physician indicated "no ratable impairment," but you feel you do have a permanent impairment, I can help.)

---

My Impairment Rating Goals and Protocols:

I provide thorough, unrushed examinations that strictly follow the protocols outlined in the AMA Guides to the Evaluation of Permanent Impairment.  My reports are accurate, detailed, and well-supported—reflecting an objective application of the Guides, not favoring either the insurance carrier or the injured worker.

Any gray areas or potentially controversial aspects of the evaluation are clearly explained, ensuring full transparency.  My rationale for the impairment percentages assigned is well-documented and leaves little room for uncertainty.

---

Dr. David  Rovetti's Qualifications:

Dr. David Rovetti’s Qualifications:  Forty years of active clinical chiropractic practice in Reno, Nevada including five years as director of the Work Hardening Program at Work & Injury Rehabilitation Center in Reno.  I was qualified as a Nevada Rating Physician by the Nevada Department of Industrial Relations in 1997 and have performed over 1800 Impairment Ratings since. I am certified as an expert witness in impairment ratings at the appeals level in the Nevada Worker’s Compensation System.  I completed a course entitled “Advanced Workers’ Compensation in Nevada” in November 1998, and I have a working knowledge of Nevada Worker’s Compensation law: NRS and NAC 616c.  I have testified before the Nevada Department of Industrial Regulations regarding changes in regulations affecting impairment rating evaluations.

I reference and utilize the following impairment rating guides and helps: “AMA Guides to the Evaluation of Permanent Impairment” (4th, 5th, and 6th Editions), “The Guides Newsletter”, “AMA Practical Guide to Range of Motion Assessment”, “How to Use the AMA Guides” by American College of Occupational Medicine, “The Guides Casebook”, Weekly Impairment Evaluation Tips (via internet) by Christopher Brigham, MD, and DIR’s 5/26/98 impairment rating Q&A seminar with Dr. Brigham (teleconferenced to Reno and transcribed by DIR). I have served 14 years on the Chiropractic Physician’s Board of Nevada being appointed by Governor Miller, Governor Gibbons, and Governor Sandoval.  Impairment Rating teaching experience include three-hour presentations to attorneys and claims examiners in 2003 on the changes from 4th Edition to 5th Edition of the Guides, a 2004 presentation to Association of Self-insured Employers on the 5th Edition; and a 2006 presentation to attorneys “10 Things Attorneys Should Know about Impairment Ratings.”  In December, 2008, I presented a 12-hour continuing education “How-To” course to DC’s and attorneys on impairment ratings.  I have reviewed over 1200 ratings, served 18 months on the Nevada Department of Industrial Regulation’s PPD Review Panel 2006-2007, and was re-appointed to the Review Panel in 2025 and currently serves on it.  I recently (September 2025) did a 60-minute Impairment Rating presentation to over 200 doctors and insurance adjusters entitled, “Getting It Right: Avoiding Rating Errors and Addressing Frequently Asked Questions.” 

---

Work Comp Attorneys in Northern Nevada:

Cory A. Santos, Sr. (775) 520-4222 Website

Herb Santos, Jr. (775) 323-5200 Website

Jay Short (775) 786-2006 Website

Robert Kilby (775) 337-6670 Website

Beth Levinson (775) 329-2223

Charles Diaz (775) 324-6443 Website

Joel Santos (775) 323-1084 Website

Trent McAuliffe (775) 786-5444 Website

Save Time: Print out the Questionnaire, complete it at home, and bring it with you.  Click here

Nevada Impairment Rating Frequently Asked Questions:

How much compensation will I receive for my impairment?

Your employer (or their insurance company) is required to compensate you for your loss of work efficiency due to your permanent impairment.  In Nevada, this compensation is based on a formula set by the Legislature and takes into account:

1. Your average monthly wage at the time of injury
2. Your age (how many years you have left until age 70, which is considered the end of your "work life")
3. Your impairment rating (as a percentage)

As a rough estimate, if you’re 35 years old and your average monthly wage was $1,000, you’ll receive about $1,000 per percent of impairment.  Younger individuals typically receive more, and older individuals receive less.  Higher wage earners (up to a cap of around $4,500/month) will receive proportionately more.

Keep in mind—this is a ballpark figure.  Your actual compensation will be calculated by the insurance company using the exact formula and details of your case.

How is this percentage of impairment calculated?

In Nevada, the protocols and formulas to determine and calculate the percentage of impairment are found in the  AMA’s Guides to the Evaluation of Permanent Impairment – 5th Edition  (usually simply referred to as the “Guides”).  By Nevada law (and currently over 40 other states), this is the book that must be followed to determine the percentage of impairment.  Some states use the Guides – 6th Edition.  A few years ago, the Nevada Legislature considered updating to the 6th Edition but decided to continue with the 5th.  I don’t expect any changes from using the 5th Edition anytime soon.

Will my claim be closed after this evaluation?

Yes.  If you believe your claim should still remain open, you must appeal the decision to close your case with a “Request for Hearing Form” the insurer sent you with your appointment letter for your impairment rating appointment and will send you again after the rating examination.  According to the current worker’s compensation law in Nevada, if your condition worsens proven with objective tests, and you have a specific reason for the re-opening (i.e., additional surgery, additional therapy, second opinion evaluation, etc.) your claim can be re-opened.  After one year of being closed, your claim can be re-opened not only for a worsening of your condition but also for a change in circumstances.  It is difficult to re-open a claim simply because there is more pain (see Do You Need to Re-open Your Case above).

What’s the difference between “Impairment” and “Disability”?

Impairment refers to the loss of use or function of a part of your body—how much is physically missing, limited, or no longer working properly. It’s based on objective medical findings and is expressed as a percentage using the AMA Guides.

Disability, on the other hand, refers to how that impairment affects your ability to do your job.

Here’s a simple way to think about it: If you had a completely generic job that didn’t require more than average lifting, standing, walking, or other physical activity, your impairment would roughly equal your disability.  But since most jobs aren't generic, your actual disability can be higher or lower than your impairment—depending on how much your specific job relies on the affected body part.

If your disability seems much greater or much less than your impairment, it probably means your job involves either heavy use or almost no use of the body part that’s been injured.

What happens after the Impairment Rating?

After your impairment rating is completed:

1. The rating physician has up to 14 days to submit the report to the insurance company (though I typically send mine within 2–3 days).
2. The insurance company then has 14 days from receiving the report to send you a letter with your impairment results.

That letter must include a copy of the doctor’s impairment report and will detail the settlement compensation being offered.

Once you accept the settlement:

• Your claim is considered closed, and generally, no further treatment or exams will be covered under the workers’ compensation system.
• However, in Nevada, you have lifetime re-opening rights if your condition worsens or there is a change in circumstances (like needing surgery or experiencing reduced function).

Important:  If you disagree with the impairment rating, you must appeal within 70 days of receiving the insurance company’s letter.  If you do not, the rating will be considered accepted by law.

Why have I been scheduled for a PPD Impairment Rating?

When your medical condition is stable and there is an indication of a permanent impairment of the injured body part, the insurance company must arrange for an impairment rating evaluation (also known as a PPD Evaluation) to determine the degree of your impairment.

Should I choose a doctor from the insurance company’s list, or have them use the state’s rotation list?

Short answer:  If I’m on the list, choose me.   If I’m not, ask the insurance company to use me or use a rating doctor from the Nevada Department of Industrial Relations’ (DIR) rotation list, usually simply referred to as "the List."

Long answer:  Before deciding, take a moment to review my credentials and qualifications.  If you believe I can provide a fair and accurate rating—and you value a doctor who enjoys this work and takes it seriously—I’d appreciate being chosen.

Some of the doctors on the insurance company’s list are there because they tend to give conservative (lower) impairment ratings.  If you’re working with an experienced workers' compensation attorney, they’ll usually know which doctors to avoid and can help guide you in making the best choice.

How long will the PPD evaluation take?

After you complete paperwork, a rating examination will usually take between 20 and 30 minutes. If there are several body parts, it may take longer. I have found that carpal tunnel syndrome, neck conditions, and back conditions take the longest; elbow, one finger or toe, and hearing loss take only a few minutes.

May I have someone else in the examination room with me?

In my office, certainly yes.  Rating physicians are not required to allow that, however.  Some doctors are adamant that no one else witnesses the examination.  My opinion is that if the examination is thorough, unbiased, and in accordance with the protocol of the “Guides,” why object to other people in the room or even a video of the whole evaluation?

Will the examination hurt?

Some parts of the examination involve assessing range of motion, which can cause mild discomfort—especially at the limits of motion.  I understand that injured workers have already been through a lot, so I take every step possible to make the exam as gentle and comfortable as I can.

That said, a small amount of discomfort may be unavoidable, and some people feel a bit sore the following day due to the movements involved.  If any particular motion or touch is especially painful for you, please let me know beforehand so we can proceed with care.

What is determined in these ratings?

The only thing that comes out of the examination is a “percentage of whole person impairment.” This is a number (percent) that indicates how much you are impaired because of your residual problems. If the impairment is large, and you are unable to return to your pre-injury job, you may be entitled to vocational rehabilitation. The percent of impairment is a factor used to determine how much money you will receive for your impairment. Also, should you want to re-open your case in the future, you will need to show that your condition is worse than it was when it was closed, i.e., at the time of the PPD evaluation. This evaluation will determine very important needed information about your current status should you need to re-open your case.

What Impairment Ratings do not determine:

1) What the physical limits of your work are;

2) What further treatment will benefit you;

3) What additional treatment you are entitled to;

4) If you should be off work or not; or

5) If your condition is going to improve from this point.

How is my pain related to my impairment rating?

Surprisingly, not much.  Because pain is highly subjective—and can vary widely between individuals with the same injury—the AMA Guides rely more on objective findings to determine impairment.  These include:

• Measurable loss of range of motion

• Sensation changes or neurological findings

• Documented impact on activities of daily living (ADLs)

• Diagnoses supported by objective tests such as X-rays, MRIs, or nerve conduction studies

One notable exception is for joint replacements, like the knee or hip, where pain is factored into the impairment rating.

So while your pain is very real and important clinically, it usually plays only a limited role in determining your permanent impairment percentage.

Can I get a copy of my rating?

As with all medical records, you are entitled to receive copies of your records. However, according to Nevada Law NRS 616C.490(5), the insurer must send you a copy of the impairment rating report. If you need a copy directly from my office, I charge $.60 per page plus actual postage charges. Most reports are six to ten pages long. You may call our office make arrangements to have it sent to you. But, again, by law, the insurer must provide you with a copy.

How long will it take to get the results and compensation from the insurance company?

By law, the impairment rating doctor has 14 days to send the report to the insurance company—unless there’s a valid reason for a delay.

Once the insurance company receives the report, they have another 14 days to notify you of your settlement offer.

That said, I typically complete and send my reports within 3–5 days, so things often move faster on my end.

What if I disagree with my rating percentage?

If you or if your insurance company disagree with the rating percentage,  a second rating can be requested. Whoever requests the new rating must pay for it. The current cost of a rating is approximately $995.  If you request the new rating and it is more percentage than the prior one, you may be entitled to a refund of the cost of the rating.  I recommend consulting a work-comp attorney (see list below) if you want to formally disagree with your rating.  Also, consult with a work-comp attorney if the insurance company is sending you to another rating because they disagree with the rating.

What is the difference between “Impairment” and “Disability?”

Impairment is basically how much of your body is missing or unusable. Disability is how the impairment affects your occupation or job. Another way to look at that is that if you had a completely generic job where you did not lift, sit, stand, walk, push, pull, travel, etc. more than average, then your impairment would equal your disability. However, almost no one has a totally generic job, so the percent of impairment will be higher or lower than the disability depending on the duties of the job and how much the impaired body part is used for the job. If your impairment isn’t even close to your disability, then you most likely have a specialized job where you either constantly use or almost never use the affected body part.

How do I get more information?

The State of Nevada’s Department of Industrial Regulation – Worker’s Compensation website gives a quick reference for employees and other interested parties.  It is a one-stop compilation of the most helpful Worker’s Compensation Web links with information about Nevada’s Workers’ Compensation System from a worker’s perspective.

For the actual laws on impairment ratings in Nevada:

http://www.leg.state.nv.us/NRS/NRS-616C.html#NRS616CSec085

http://www.leg.state.nv.us/NAC/NAC-616C.html#NAC616CSec460

If you have a specific question not listed, I would be happy to help. The best way is to email your question to me at: 

 [email protected] or submit a question in the “Contact Us” box.  Please include your phone number and I will probably give you a call (unless the answer only requires a simple email response).

If you are scheduled with me for a rating, print out my patient questionnaire and complete it in advance:   Click Here