Permanent Physical Impairment Policy 21-250 | Effective Date: November 29, 2018

Purpose 

The purpose of this policy is to:

• Provide direction to WorkSafeNB staff when determining if an injured worker qualifies for a permanent physical impairment award (PPI award); and
• Communicate WorkSafeNB’s guidelines for determining the degree of permanent physical impairment and calculating the amount of the PPI award. 

Scope

This policy applies to injured workers demonstrating permanent physical impairment as a result of a compensable workplace accident or occupational disease that occurred on or after January 1, 1982.

It does not apply to workers injured before January 1, 1982, and who suffer a recurrence of injury after January 1, 1982.

Statements

1.0 General

Under the Workers’ Compensation Act (WC Act), injured workers are entitled to a lump sum payment in recognition of loss of opportunity when they suffer a permanent physical impairment as a result of a compensable accident or occupational disease on or after January 1, 1982.

Permanent physical impairment is a permanent loss of an anatomical structure or physical body function arising out of the injury resulting from a work-related injury.

WorkSafeNB provides a permanent physical impairment award (PPI award) upon determining that a worker’s compensable injury has resulted in a demonstrable, permanent physical impairment.

The PPI award is based on the injured worker’s permanent physical impairment rating, measured in accordance with an approved rating schedule as outlined in Regulation 82-165 Permanent Physical Impairment Rating Schedule. This regulation directs WorkSafeNB to use other approved rating guides when they are necessary for determining the impairment rating such as the American Medical Association Guides to Evaluation of Permanent Impairment (AMA Guides; latest edition). 

Impairment ratings are estimates determined by medical consensus that reflect the severity of the limitation of the body part. These impairment ratings also reflect the loss of opportunity that individuals experience in their ability to perform normal activities of daily living, self-care, physical activity, and/or sensory function.

A permanent physical impairment rating is not provided for psychological or mental impairment in the absence of a physical injury. Pain and suffering are not considered in impairment ratings, in the absence of a physical injury. They are only considered when they directly affect impairment of the body’s function.

The level of permanent physical impairment refers only to a person’s medical status, and not to the person’s ability or inability to work or perform other activities. A PPI award does not affect an injured worker’s entitlement to other benefits and it is not intended to be:

• Settlement of a claim;
• Compensation for loss of earnings; or
• Compensation for pain, suffering, or loss of enjoyment of life.

The following sections provide additional information related to:

• Determining if a permanent physical impairment exists;
• Assessing the degree of permanent physical impairment;
• Assigning a permanent physical impairment rating; and
• Reassessing the PPI award.

2.0 Determining if a Permanent Physical Impairment Exists

A permanent physical impairment may exist for injured workers who sustain a physical injury. Prior to determining if a permanent physical impairment exists for the injured worker, WorkSafeNB determines if the:

• Medical condition has stabilized or plateaued, meaning that there are no major interventions pending or planned; and
• Minimum time intervals as specified in Regulation 82-165 have elapsed between the injury or surgery, and the assessment of the permanent physical impairment.

Once WorkSafeNB is satisfied that the injury is reasonably stable and meets the minimum time intervals specified in Regulation 82-165, a WorkSafeNB-approved medical examiner determines whether the evidence supports that a physical impairment exists and is likely to be permanent. This evidence may consist of:

• Information related to the mechanism, nature, and intensity of injury;
• Medical information specific to the injured worker’s injury, which may include objective clinical and investigative findings;
• Peer-reviewed medical literature that indicates the expected level of impairment; or
• Other evidence supporting that the physical impairment is the result of the compensable injury.

If the evidence supports that a permanent physical impairment may exist, WorkSafeNB proceeds to assess the degree of permanent physical impairment and assigns an impairment for the purpose of calculating the PPI award.

2.1 Adjusting the Timing of the Award

WorkSafeNB may, at its discretion, adjust the timing of a PPI assessment, or perform a reassessment as needed, where medical evidence warrants doing so. The minimum waiting time (prescribed in regulation) may be waived if the severity of the injury or occupational disease is such that:

• The impairment rating is medically evident (for example, in brain or spinal cord injuries causing total impairment); and/or
• The medical condition has stabilized, with no major intervention intended or planned, and further treatment will not improve the condition.

2.2 Paying a PPI Award to an Injured Worker’s Estate

If the injured worker dies prior to receiving a PPI award, WorkSafeNB will pay the award to the injured worker’s estate provided:

• The injured worker, prior to death, was assessed by WorkSafeNB as having a permanent impairment as a result of the workplace accident or occupational disease; or
• There is sufficient medical information available, after the injured worker dies, for WorkSafeNB’s medical examiner to conduct a paper review and determine that the injured worker lived with an impairment and the degree of that impairment.

In both cases there must be evidence to demonstrate that the injured worker lived with the permanent impairment prior to death.

3.0 Assessing the Degree of Permanent Physical Impairment

A WorkSafeNB-approved medical examiner completes an assessment to determine the degree of the permanent physical impairment resulting from a work-related injury or occupational disease. WorkSafeNB requires the medical examiner to:

• Be designated as a Certified Independent Medical Examiner by the American Board of Independent Medical Examiners or its equivalent; and
• Have no physician-patient relationship with the injured worker.

In consultation with WorkSafeNB, WorkSafeNB-approved medical examiner determines whether an assessment will consist of a paper review or a physical examination.

A paper review may be sufficient to assess the degree of permanent physical impairment when the evidence confirms that:

• The impairment rating can be assigned to the work-related injury or occupational disease based on the evidence provided in the file (e.g. brain or spinal cord injuries, finger amputation); or
• Sufficient information exists to establish the degree of the permanent physical impairment (e.g. hearing or vision loss).

To appropriately assign the impairment rating, a physical examination may be required when the evidence on file is insufficient to establish the degree of permanent physical impairment or when Regulation 82-165 assigns a range to the impairment rating according to the body part.

4.0 Assigning a Permanent Physical Impairment Rating

WorkSafeNB relies on the assessment (paper review or physical examination) to identify the degree of permanent physical impairment, in order to assign an impairment rating. WorkSafeNB assigns an impairment rating using Regulation 82-165 or alternate authorities, including the AMA Guides, as needed.

When alternate authorities are consulted to assign an impairment rating, WorkSafeNB ensures that the assigned rating is consistent and does not exceed the ratings outlined in Regulation 82-165 for the same body part.

The schedule outlined in Regulation 82-165 assigns a percentage value to the impairment rating. This percentage of impairment is then used in calculating the PPI award.

Impairment ratings are based solely on demonstrated permanent loss of body function. The following factors are not considered in the rating:

• Surgical treatment;
• Pain and suffering beyond that which is directly linked to tissue damage causing the impairment;
• Age, education, or other social factors;
• Ability or inability to work; and/or
• Loss of employment or earnings arising from the compensable injury or impairment.

With the exception of the special schedule for loss of hearing and loss of vision, the minimum impairment rating required for a PPI award is 1% of total body impairment. The maximum impairment rating cannot exceed 100%.

4.1 Calculating the PPI Award

WorkSafeNB calculates the PPI award by multiplying the injured worker’s impairment rating by the maximum annual earnings for the accident year.

The minimum award is $500 and the maximum award cannot exceed the maximum annual earnings for the year of the work-related accident.

4.2 Whole-body Permanent Physical Impairments

Regulation 82-165 defines physical impairment in terms of percentage of total or whole-body impairment.

When assigning an impairment rating for more than one body area, the WorkSafeNB-approved medical examiner assigns a rating to each individual body area, and then combines both ratings using the combined value charts in the AMA Guides to determine the whole-body impairment rating of the injured worker. The maximum PPI award cannot exceed 100%.

4.3 Pre-existing Conditions

When a pre-existing condition is aggravated by a workplace injury, WorkSafeNB determines the injured worker’s PPI award taking into account the impairment resulting from the aggravation of the pre-existing condition. Impairment resulting from an existing non-compensable condition is not included in the determination of the injured worker’s PPI award. For more information on pre-existing conditions, see Policy 21-101 Pre-existing Conditions.

5.0 Reassessing the PPI Award

In certain cases, injured workers may be eligible to have their PPI award reassessed if:

• A change has occurred in the level of physical impairment of the compensable injury or disease since the last assessment;
• An additional body part has been affected by the original work-related injury; or
• The compensable injury or disease has aggravated the prior non-compensable condition.

If the reassessment results in a higher percentage of impairment, WorkSafeNB recalculates the PPI award based on the new impairment rating and multiples it by the maximum annual earnings for the year in which the accident occurred. The difference between the original assessed award and the new assessment is paid to the injured worker.