Assessment of disability under the Social Security Industrial Injuries Benefit Scheme

Transcription

1 Occup Mod. Vol., No. 2, pp. 1-11, 199 Copyright 199 Rapid Science Pubfehers for SOM Printed in Great Britain. All rights reserved -/9 CLINICAL ASSESSMENT IN THE WORKPLACE Assessment of disability under the Social Security Industrial Injuries Benefit Scheme A. Brooks and F. G. Ward DSS Benefits Agency Policy Group, UK Key words: Assessment; benefit; disablement Occup. Med. Vol..1-11, 199 Received November 199. This paper outlines the principles involved in the assessment of disability under the State Industrial Injuries Scheme provisions in the UK. There are some differences when considering the respiratory diseases and these are mentioned. Assessment of disablement is not easy and medical boards have some leeway on reaching a decision. Assessment is largely ultimately a matter of clinical judgement. Assessments of disablement for Industrial Injuries purposes are carried out by Adjudicating Medical Authorities (AMA). These are independent statutory authorities consisting of one, or two or more, doctors. When examined by an AMA the individual is compared with a person of the same age and sex whose physical and mental condition is normal. Special circumstances such as loss of earnings or the effect of the disablement on hobbies can not be considered in the assessment of disablement. Prescribed degrees of disablement for certain conditions such as amputations at various levels are laid down in Social Security (General Benefit) Regulations (see Appendix 1 attached) but the AMA has the discretion to increase or reduce these assessments where it would be fair to do so. In addition, the AMA has for guidance, notes on types of assessment for certain injuries which have been given by Medical Appeal Tribunals (MAT). The MAT is the tribunal to which an appeal against an AMA decision may be made. Appendix 2 describes these assessments. In assessing disablement the AMA will attempt to equate the level of disablement to the types of assessment in appendices 1 and 2. For example, the AMA will ask itself, how does this man's knee injury equate Correspondence and reprint requests to: AUTHOR: PLEASE PRO- VIDE CORRESPONDENCE ADDRESS. to an ankylosis of the knee or does it equate to an amputation of the leg, and if so, at what level? There are clearly many cases such as disablement from cardiac, respiratory abdominal and psychiatric conditions, where the guides in appendices 1 and 2 cannot be applied. The doctors who carry out assessments of disablement are given intensive training on the factors to be taken into account in assessing what constitutes a proper level of assessment as based upon the medical evidence. A rough guide to assessment is shown below. 1-% -1% 1-% -% -% -% over % very mild mild mid-moderate moderate moderately severe severe very severe The disabilities taken into account are those resulting from the loss of function arising from the industrial injury. If there is another effective cause of the disablement to which the claimant would have been subject if the accident had never happened (e.g., a pre-existing condition giving rise to the same type of disablement) then this must be excluded from the assessment. In practice this is done by making offsets for pre-existing conditions. If the disability resulting from the accident is made worse by some injury or disease which is not directly as a result of the accident, the assessment may in certain circumstances be increased to take account of the worsening. Assessments of less than 1% do not attract benefit. However, if there are other assessments in force they may be aggregated and if the total assessment reaches 1% or above, benefit will be payable. For assessments in the respiratory diseases, the same general principles apply, but one or two differences

2 A. Brooks and F. G. Ward Assessment of disabaity 11 are present. The principle of off-setting described above is not used (i.e. where an assessment for a pre-existing condition is possible it is excluded from the assessment). In the respiratory diseases an assessment is made for the prescribed disease and if another disease is present as well, a figure is determined for the interaction between the prescribed disease and the other respiratory disease but which does not include the total assessed disablement for the non-prescribed disease. The guide to assessments above also applies. Clearly with respiratory diseases it is not possible to measure gradations in levels of disablement in steps of 1%, and it is more realistic to have five bands. No hard and fast rules are laid down but suggested guidelines are laid down as below: Suggested levels of disablement From -% disablement Short of breath on walking one third to half a mile on the level. Slight dyspnoea on climbing stairs. Cannot keep up with workmates walking on level ground. Lung function tests show deficit of -% (from predicted value). From -% disablement Can walk only - yards on the level. Short of breath after climbing a flight of stairs. (If male, cannot keep up with his wife on level ground). Lung function tests reduced by around %. From -% disablement Can only walk -1 yards on the level. Has to stop two or three times climbing a flight of stairs. Lung function tests reduced by %. 1% disablement Short of breath on undressing or talking. Lung function (if performed) reduced by around %. Under % is equivalent to no disablement. In reading a figure medical boards would take into account the clinical picture including X-rays where appropriate as well as lung function tests. In asthma cases the effect and the level of treatment is taken into account, treatment requirements being useful guides to disability. Much interest at present is centring around the use of quality of life questionnaires and it is likely that they will play a more important part in the future. It is now clear that while FEVi is a good measure of lung function, it is not a good indicator of disability.

3 11 Occup Med Vol., 199 APPENDIX 1. Schedule 2 to the Social Security (General Benefit) Regulations 1 Prescribed degrees of disablement Description of injury Degree of disablement 1. Loss of both hands or amputation at 1% higher sites 2. Loss of a hand and a foot 1%. Double amputation through leg or thigh, 1% or amputation through leg or thigh on one side and loss of other foot. Loss of sight to such an extent as to 1% render the claimant unable to perform any work for which eyesight is essential. Very severe facial disfiguration 1%. Absolute deafness 1%. Forequarter or hindquarter amputation 1% Amputation cases upper limbs (either arm). Amputation through shoulder joint 9% 9. Amputation below shoulder with stump % less than.cm from tip of acromion 1. Amputation from.cm from tip of % acromion to less than 11.cm below tip of olecranon 11. Loss of a hand or of the thumb and % four fingers of one hand or amputation from 11.cm below tip of olecranon. Loss of thumb % 1. Loss of thumb and its metacarpal bone % 1. Loss of four fingers of one hand % 1. Loss of three fingers of one hand % 1. Loss of two fingers of one hand % 1. Loss of terminal phalanx of thumb % Amputation Cases Lower Limbs 1. Amputation of both feet resulting in 9% end-bearing stumps 19. Amputation through both feet proximal % to the metatarso-phalangeal joint. Loss of all toes of both feet through the % metatarso-phalangeal joint 21. Loss of all toes of both feet proximal to % the proximal inter-phalangeal joint. Loss of all toes of both feet distal to the % proximal inter-phalangeal joint 2. Amputation at hip 9%. Amputation below hip with stump not % exceeding 1 centimetres in length measured from tip of great trochanter. Amputation below hip and above knee % with stump exceeding 1 centimetres in length measured from tip of great trochanter, or at knee not resulting in end-bearing stump. Amputation at knee resulting in % end-bearing stump or below knee with stump not exceeding 9 centimetres 2. Amputation below knee with stump % exceeding 9 centimetres but not exceeding 1 centimetres Description of injury Degree of disablement. Amputation below knee with stump % exceeding 1 centimetres 29. Amputation of one foot resulting in % end-bearing stump. Amputation through one foot proximal % to the metatarso-phalangeal joint 1. Loss of all toes of one foot through the % metatarso-phalangeal joint Other injuries:. Loss of one eye, without complications, % the other being normal. Loss of vision of one eye, without % complications or disfigurement of eyeball, the other being normal Loss of: A. Fingers of right or left hand Index finger:. Whole 1%. Two phalanges 11% One phalanx 9%. Guillotine amputation of tip without % Middle-finger:. Whole % 9. Two phalanges 9%. One phalanx % 1. Guillotine amputation of tip without % Ring or little finger:. Whole %. Two phalanges %. One phalanx %. Guillotine amputation of tip without 2% B. Toes of right or left foot Great toe:. Through metatarso-phalangeal joint 1%. Part, with some % Any other toe:. Through metatarso-phalangeal joint % 9. Part, with some 1% Two toes of one foot, excluding great toe:. Through metatarso-phalangeal joint % 1. Part, with some 2% Three toes of one foot, excluding great toe:. Through metatarso-phalangeal joint %. Part, with some % Four toes of one foot, excluding great toe:. Through metatarso-phalangeal joint 9%. Part, with some %

4 A. Brooks and F G. Ward: Assessment of disability 11 Appendix 2 Part 1: Notes of types of assessments for certain non-scheduled injuries given by Medical Appeal Tribunals 1. Ankyloses in the optimum position Shoulder Elbow Wrist Hip Knee Ankle % % % % % % 2. Deafness for deafness caused by industrial accident only see Appendix for loss of hearing due to Prescribed Disease A1 (Occupational Deafness) Degree of hearing attained Shout not beyond 1 metre Conversational voice not over cm Conversational voice not over 1 metre Conversational voice not over 2 metres Conversational voice not over metres (a) one ear totally deaf (b) otherwise Notes on assessments for deafness For both ears used together % % % % % < % Where the hearing in one ear is normal, complete deafness in the other affects the detection of the direction of sound and decisions of Medical Appeal Tribunals indicate a minimum assessment of % is reasonable. A case in which the right ear heard a conversational voice at 2 metres ( feet), the left ear a conversational voice at cms (lfoot) and both ears together a conversational voice at 1 metre ( feet), should therefore be recorded: Right: CV 2 metres Left: CV cms Right and Left: 1 metre Assessment = per cent iii. The assessments given above apply to the deafness only. Any additional factors such as vertigo, tinnitus or chronic suppuration, may warrant an addition to the assessment. If so, this should be made clear in the Adjudicating Medical Authority's report.. Assessments involving loss of tissue i. Splenectomy: Increasing evidence shows that the removal of the spleen may lower natural resistance to certain organisms and removal of the spleen also involves loss of tissue. Medical Appeal Tribunals having taken these factors into account have assessed the degree of disablement resulting from the removal of the spleen at between 2-%. ii. Orchidectomy: The removal of a testicle involves tissue loss and loss of reserve useful function which constitutes a small permanent loss of faculty. Medical Appeal Tribunals have assessed the degree of disablement resulting from the removal of a testicle at between 2-%. iii. Nephrectomy: The Commissioner held in decision R(I) 1/ that where a person loses a kidney then as a matter of law it must necessarily mean that there is a loss of faculty. The extent of disablement resulting from that loss of faculty is for the medical authorities to determine and in this respect regard must be had to the loss of reserve useful function. Where the other kidney is functioning normally Medical Appeal Tribunals have assessed the degree of disablement at between -1%. vi. Aphakic eyes: Unilateral aphakia with reasonable correction by a contact lens: 1-%. Bilateral aphakia with reasonable correction by a contact lens: -%. Part 2: Valuation table reproduced from Report of the 1th International Congress of Ophthalmology, 1. Reduction of Vision: Compensation Rates (Figures in percentages) / / /9 /9 / /1 / / / / / /1 1/ -1/ / / / / /. 1 / / / / 1/ / 1/ / NOTE: These assessments are for defective vision without special features and are based on the visual defect as measured, AFTER CORRECTION WITH GLASSES by the ordinary test only.

5 11 Occup. Med Vol., 199 Appendix. Occupational deafness. The binaural disablement may be read directly off the scale below 1,2,, khz average Pure tone HL' Worse ear Pure tone HL' db Better ear The pure tone hearing levels refer to the 1, 2, khz average (HL) db