A Guide to the Assessment of Traumatic Injuries and Occupational Diseases for Work Injury Compensation

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1 A Guide to the Assessment of Traumatic Injuries and Occupational Diseases for Work Injury Compensation

2 A Guide to the Assessment of Traumatic Injuries and Occupational Diseases for Work Injury Compensation FIFTH EDITION (REVISED) Compiled by Work Injury Compensation Medical Board Ministry of Manpower Singapore

3 First Edition June 1978 Second Edition June 1987 Third Edition October 1990 Fourth Edition February 1999 Fifth Edition December 2006 Fifth Edition (Revised) June 2011 Work Injury Compensation Medical Board Ministry of Manpower Singapore All rights reserved. No part of this publication may be reproduced in any form or by any means, including photocopying and recording, without the written permission of the copyright holder, application for which should be addressed to the publisher. Such written permission must also be obtained before any part of this publication is stored in retrieval system of any nature.

4 (Revised) Work Injury Compensation Medical Board Prof V Prem Kumar, Chairman, Work Injury Compensation Medical Board and Senior Consultant, 3

5 PREFACE TO THE FIFTH EDITION (2011) (REVISED) The fourth edition (1999) saw a major revision of the guide of more than 25 years by the inclusion of assessment of neurological disorders (mainly peripheral nervous system), specific injuries affecting the limbs and spine (diagnosis based estimates) as well as the assessment of the hearing, respiratory, renal and hepatic functions. The fifth edition is another major revision which further expands the scope of the guide by adding new chapters for the assessment of the disorders of the central nervous system, gastro digestive tract and visual function. Significant updates and revisions have also been made to the existing chapters particularly on the assessment of renal function, respiratory function and upper and lower limb function. These amendments were made following feedback from specialists on the existing guide and to align with newer developments in the assessment of such disorders. This revision was made with guidance from the newly formed Work Injury Compensation Medical Board as well as from the various specialists. We would like to thank all the contributors for making this revision possible. We would also like to thank the Singapore Orthopaedic Association and the Singapore Society of Hand Surgery for their valuable feedback in this revision. The 5 th edition of the guide should be used for the assessment of all work-related injuries and occupational diseases with effect from 1 st January 2007 (date of assessment). This will apply to all initial assessments done on or after 1 st January 2007 (irrespective of the date of injury). For objection cases (i.e. those requiring re-assessment by the Work Injury Compensation Medical Board), where the initial assessment was based on the 4 th edition of the guide, the assessment should continue to be based on the 4 th edition for consistency. The 5 th edition may be referred to in such cases where there is no guidance given in the previous edition. Even with the expanded scope, the guide would still not cover all injuries and all systems for practical reasons. For injuries or systems not included in this guide (e.g. oral/maxillofacial, skin, psychological, etc), reference should be made to the latest edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment. Work Injury Compensation Medical Board 4

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7 For work injury compensation purposes under the Work Injury Compensation Act, medical assessment of the degree of disability is required only for permanent incapacity and not for temporary incapacity. It is the residual incapacity which the assessing doctor considers to be stable and not likely to progress or improve further at the time of the medical evaluation. A reasonable timeframe for the stabilisation of medical conditions is three months, as long as no further medical intervention is required or the conditions will not improve or deteriorate. Under the Work Injury Compensation Act, the worker is entitled to be paid full earnings up to 14 days if not hospitalised and 60 days if hospitalised. He is further entitled to receive two-thirds of his monthly earnings per month for up to one year. It should be noted a worker with no permanent incapacity is still entitled to monetary benefits for temporary incapacity. 6

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10 different joints and injured parts. The total percentage incapacity is 37%, by combining 11%, 10%, 9%, 4%, 4%, 3%, 3% (a simple addition would have given a total of 42%). The total does not exceed that for the loss of one hand. Assessment of Permanent Incapacity for middle finger DIP joint ROM 10º = 6% PIP joint ROM 20º = 6% Reduced sensation over finger tip = 2.5% Combined = 14.5% (Note: For computation of permanent incapacity involving fractions, the whole numbers should be combined first and fractions added back later. In this case, combine 6%, 6% and 2% to give 14%; 0.5% is then added back to give 14.5%.) Compare with amputation of middle finger Loss of 3 phalanges = 12% As the combined Permanent Incapacity of individual parts should not > whole body part, the Permanent Incapacity awarded = 12%. 9

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30 Figure14: Impairment due to total transverse sensory loss of digits (numbers at tips of digits) and total longitudinal sensory loss of radial and ulnar sides of digits (numbers at sides of digits). For partial sensory loss the impairment would be 50% of these numbers. 4% Radial (R) 11% 7% Ulnar (U) 3% (R) 2% (U) 3% (R) 2% 2% (R) (U) 1% (R) 1% (U) 2% (U) 3% 5% 5% 3% 29

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33 2 nd metacarpal 4 % 3 rd metacarpal 4 % 4 th metacarpal 2 % 5 th metacarpal 2 % 32

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37 Loss of 2 nd toe Three phalanges and 2 nd metatarsal 7% Three phalanges 3% Two phalanges 2% One phalanx 1% Loss of 3 rd toe Three phalanges and 3 rd metatarsal 7% Three phalanges 3% Two phalanges 2% One phalanx 1% Loss of 4 th toe Three phalanges and 4 th metatarsal 7% Three phalanges 3% Two phalanges 2% One phalanx 1% Loss of 5 th toe Three phalanges and 5 th metatarsal 7% Three phalanges 3% Two phalanges 2% One phalanx 1% Loss of metatarsals First 10% Second, third, fourth or fifth 4% 36

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53 2 nd metatarsal 2 % 3 rd metatarsal 2 % 4 th metatarsal 2 % 2 nd toe 1 % 3 rd toe 1 % 4 th toe 1 % 5 th toe 1 % 52

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55 Second metatarsal - phalangeal Third metatarsal - phalangeal Fourth metatarsal - phalangeal Fifth metatarsal - phalangeal 54

56 Additional compensation for Permanent Total Incapacity (100%) Under the Third Schedule of the Work Injury Compensation Act, "where the injured employee is certified by a medical practitioner to have suffered from permanent total incapacity, additional compensation shall be paid amounting to one quarter of the amount which is otherwise payable." 55

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71 Additional compensation for Permanent Total Incapacity (100%) Under the Third Schedule of the Work Injury Compensation Act, "where the injured employee is certified by a medical practitioner to have suffered from permanent total incapacity, additional compensation shall be paid amounting to one quarter of the amount which is otherwise payable." 70

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77 For paralyzed limbs or part of a limb, the First Schedule of the Act states that total permanent loss of use of a member shall be treated as loss of that member. Rate each limb as per amputation of limbs. Total impairment cannot exceed 100%. If both upper limbs are involved (i.e. 100%), additional 25% to be provided for under the Third Schedule of the Act

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80 Non-perception of light, light perception, hand movements, counting fingers 79

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82 1. A Guide to the Work Injury Compensation Benefits and Claim Process, 2008, Ministry of Manpower and Workplace Safety and Health Council. 2. Guides to the Evaluation of Permanent Impairment, Sixth Edition, 2008, American Medical Association, ed. Robert D. Rondinelli. 3. Work Injury Compensation Act (Chapter 354),

83 COMBINED VALUES CHART The values are derived from the formula: A+B (1 A) = combined value of A and B, where A and B are the decimal equivalents of the impairment ratings. In the chart all values are expressed as percents. To combine any two impairment values, locate the larger of the values on the side of the chart and read along that row until you come to the column indicated by the smaller value at the bottom of the chart. At the intersection of the row and the column is the combined value For example, to combine 35% and 20% read down the side of the chart until you come to the larger value, 35% Then read across the 35% row until you come to the column indicated by 20% at the bottom of the chart. At the intersection of the row and column is the number 48. Therefore, 35% combined with 20% is 48%. Due to the construction of this chart the larger impairment value must be identified at the side of the chart If three or more impairment values are to be combined, select the two highest values and find their combined value as above. Then use that value and the third value to locate the combined value of all. This process can be repeated indefinitely, the final value in each instance being the combination of all the previous values. In each step of this process the larger impairment value must be identified at the side of the chart. Refer to Page 9 (Part III Use of Combined Values Chart) for example

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85 COMBINED VALUES CHART (continued)

86 WORK INJURY COMPENSATION ACT, 2008 Percentage of loss of earning capacity 85

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90 A Guide to the Assessment of Traumatic Injuries and Occupational Diseases for Work Injury Compensation

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