Permanent impairment claim – combining components of impairments of limbs

We have noticed a reasonably regular error made by doctors in assessing permanent impairment of limbs when there are several components to the impairment of that limb. It involves ignoring chapter 2.8 of the SIRA Impairment Guides in respect of upper extremity assessments and chapter 3.6 in respect of lower extremity impairments.

Chapter 2.8 states that regional impairments of the same limb (e.g. several upper extremity impairments – UEI’s) should be combined before converting to percentage of WPI.

Chapter 3.6 states regional impairments of the same limb (e.g. several lower extremity impairments-LEI’s) should be combined before converting to a percentage of whole person impairment.

For example if there are several components in respect of a knee injury, Table 17.33 of the AMA5 guides should be applied by looking at the impairment components and their LEI’s. Those LEI’s are then ‘combined’ using the AMA5 combined values table. Then Table 17.3 of the AMA5 guides is used to convert the total lower extremity impairment (LEI) to whole person impairment. It is incorrect to combine the WPI assessments of the individual components.

For example if there is a finding of moderate cruciate ligament laxity (7% WPI/17% LEI) and patellar subluxation (3% WPI/7% LEI) the correct approach is to “combine” 17% with 7% (producing a “combined” 23% LEI) and then apply Table 17.3 to convert that to 9% WPI. It is incorrect to merely combine 7% WPI with 3% WPI to produce 10% WPI.

Download the Hicksons App for the latest Solution: “Tip of the Week: Getting it Right – the correct method to combine multiple regional impairments of the same limb” 

Post by John Smidmore