Everything About Nevada Impairment Ratings

RATING SERVICES I OFFER:

1. Impairment Ratings (utilizing the 5th and 6th 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 comprehensive, non-rushed examinations that are in accordance with the protocols in the “Guides.”  My reports are accurate, well-documented, and well-explained.  They are not sided to the insurance company or to the injured worker, but are accurate to the “Guides.”  I explain in detail any gray areas or possible controversial areas in the examination/report.  There is usually no doubt as to my rationale or opinions for the percentages I determine.

QUALIFICATIONS:

Dr. David Rovetti’s Qualifications: Thirty-six 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 1500 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 616. 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 600 ratings, and have served 18-months on the Nevada Department of Industrial Regulation’s PPD Review Panel 2006-2007.

Print out my qualifications

Work Comp Attorneys in Northern Nevada:

Herb Santos, Jr 323-5200 Website

Jay Short 786-2006 

Robert Kilby 337-6670 Website

Beth Levinson 329-2223

Charles Diaz 324-6443 Website

Joel Santos 323-1084 Website

Trent McAuliffe 786-5444

Here are some frequently asked questions regarding these ratings:

Why am I asked to go to an 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 on the list the insurance company sent me, or should I choose the option for the insurance company to get the rating doctor off the state’s rotation list?

Short answer: If I am on the list, choose me; if I’m not on the list, opt for the insurance company to request the Department of Industrial Relations picks your rating physician off the state’s rotation list. Long answer: Check my qualifications and see if you would be confident that you will receive a fair rating with me. I enjoy doing these ratings and would appreciate your choosing me. Some names on the insurance company’s list are there because they consistently give rather conservative ratings. If you have an experienced work comp attorney, they will know the names of doctors on the list that you should stay away from.

How long will a 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?

Many parts of the examination require range of motion investigation that may be somewhat painful at certain points. As a matter of comfort for the injured workers, who have already gone through enough pain, I do all I can to keep the examination as painless as possible. However, some discomfort may be unavoidable. Occasionally, people feel some temporary soreness the day after the evaluation because of the movements required in the examination. I recommend that if there is any particular movement or touch that causes excruciating pain, notify the examiner well in advance.

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 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 much compensation ($) will I get for my impairment?

Your employer, or their insurance company, is responsible for compensating you for “decreased work efficiency” for the rest of your work life because of your permanent impairment. Your work life has been determined by the Nevada Legislature to be until you are age 70. The monetary compensation you may receive has also been determined by the Nevada Legislature in a formula that takes into account 1) your monthly wage at the time of injury, 2) the amount of work-life you have left (70 minus your age), and 3) the percent of impairment. A ball-park estimate of the monetary compensation you may receive is if you are age 35 and your average monthly income is $1000, you will get $1000 per percent of impairment. Younger people will get more, older will get less. Higher wage earners (up to a max of about $4000 per month) will get proportionately more.

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.

How is my pain related to my impairment?

Actually, not much. Because pain is subjective and can be greater in some people than others for the same injury, the Guides rely on other more objective indicators such as range of motion, sensation changes, documented problems with activities of daily living, and diagnoses given by your treating physician that are derived from objective tests such as x-rays (radiographs), MRIs, or nerve tests. Exceptions for pain as part of the rating is for knee or hip replacements.

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.

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 will send you after this 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.

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

By law, the impairment rating physician has 14 days to send the impairment rating report to the insurance company (unless there is a good reason he/she is unable to). The insurance company has 14 days after receiving the report from the doctor to notify you of the settlement. I can usually get my report to the insurance company within 2-3 days.

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 $750. 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.

What happens after the Impairment Rating?

After the rating is performed, it will take the rating physician up to, but not longer than, 14 days to submit a report to the insurance company. The insurance company has 14 days after the receipt of the report to send you a letter informing you of the results of the rating. The letter from the insurance company, by law, must include a copy of the doctor’s impairment rating report. When you accept the settlement compensation, your claim will be closed and usually no further treatment or examinations will be paid for within the worker’s compensation system. You may re-open your case if your condition worsens or there is a “change in circumstances” of your case. In Nevada, you have lifetime re-opening rights.

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 NorthwestRenoChiropractic@gmail.com 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