Classification Process (Non-Schedule Permanent Disabilities):
The process for classifying injured workers (claimants) in non-schedule permanent partial disability cases is designed to address the relevant medical and non-medical (vocational) factors that are considered in determining loss of wage earning capacity in an efficient and timely manner.
As mentioned in Subject Number 046-472, the Board has modified medical Form C-4.3 (Doctor's Report of MMI/Permanent Impairment) and created a new non-medical Form VDF-1 (Vocational Data Form) in support of the 2012 Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity. These two forms play an integral role in the classification process (non-schedule permanent disabilities) for both represented and unrepresented claimants.
Step 1: Receipt of Medical Report
For both represented and unrepresented claimants, the process begins when the Board receives a medical opinion(s) from either or both the carrier or the injured worker's health care provider that indicates that the claimant has reached maximum medical improvement (MMI) and has a permanent, non-schedule medical impairment. The medical opinion(s) from either or both medical "parties" should also include the claimant's impairment rating and functional abilities/losses. It is important to note that the Board encourages the parties to discuss and attempt to reach agreement on the claimant's impairment, functional abilities, and loss of wage earning capacity throughout the process.
- Medical Opinions from Both Parties Agree or Parties Stipulate to Medical: If the Board receives medical opinions from both parties that agree on MMI, impairment and function or if the parties stipulate to medical facts (by submitting the C-300.5 Stipulation Agreement), the Board will schedule a hearing, or parties may use the Walk-in Stipulation Calendar process. At the hearing, the parties can develop the record on vocational factors and the WC Law Judge will issue a decision on loss of wage earning capacity.
- One Medical Opinion Received: If the Board receives only one medical opinion on MMI/Non-schedule Permanency, it will send the other party a letter that advises the party that it can: (1) accept the original medical opinion or (2) submit conflicting medical evidence on any of the issues. The Board will also schedule a hearing for medical development/scheduling of testimony.
Step 2: Resolving Medical Conflicts and Determining Loss of Wage Earning Capacity
- Initial Hearing: If the Board receives conflicting medical opinions on MMI and/or Non-schedule Permanency, the Board will calendar an initial hearing for medical development/scheduling of testimony. At this initial hearing, the WC Law Judge will review the classification process, make findings as appropriate and direct medical development as necessary. If medical development is necessary and the claimant is unrepresented, the WC Law Judge will schedule a subsequent hearing with live medical testimony in lieu of directing depositions.
Note: Deposition transcripts should address the relevant outstanding issues which may include whether or not the claimant has reached maximum medical improvement, classification as a non-schedule permanent partial disability, the severity rating of the claimant's medical impairment, and the claimant's functional capabilities/exertional abilities as provided by the 2012 Guidelines for Determining Impairment and Loss of Wage Earning Capacity. The deposition transcripts should be submitted by the date designated in the Notice of Decision.
The WC Law Judge will schedule the Permanency/Classification hearing (with medical evidence and lay testimony regarding vocational factors) approximately 90 days from the date of the initial hearing to allow time for the submission of deposition transcripts, as well as to ensure that the WC Law Judge has time to review the deposition transcripts off calendar and in advance of the hearing.
- Permanency/Classification Hearing: The WC Law Judge will review the medical depositions prior to the hearing. At the hearing, the WC Law Judge will take live lay testimony on vocational factors and hear summations. After considering all the medical and non-medical evidence, the judge will issue a decision on loss of wage earning capacity.
Note: If at any point the parties reach agreement or stipulate to the medical evidence, the parties should submit a C-300.5 Stipulation Agreement. The Board will schedule a hearing and the WC Law Judge conducting the hearing will issue a decision on loss of wage earning capacity.