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Chronic Pain Disability Rating Schedule


Claims
 
Application Date
This policy applies to all accidents prior to January 2, 1990, and to entitlement periods starting from March 27, 1986. (See Retroactivity)
Published
14-Oct-2009
Subject
Disabilities|Impairments Resulting from Accidents
Title
Chronic Pain Disability Rating Schedule
Document No.
15-04-04

Document sections:| Guidelines | References |

Guidelines

Holistic approach

When assessing a worker for a permanent chronic pain disability (CPD), all aspects of the work-related impairment are considered, e.g., the organic, psychological, and psychiatric components of the disability. For details, see 15-04-03, Chronic Pain Disability.

Global impairment rating

Because the rating is holistic, any impairment related to the identified organic or psychiatric source will be accounted for in the global impairment rating. To add the organic component to the CPD rating would be to recognize, twice, the part of the impairment due to the organic source. Therefore, there can be no "stacking" of a CPD-related impairment on top of an organically-related impairment if the two relate to the same injury.

Since the CPD policy does not allow for the stacking of benefits, a CPD award supersedes and replaces any prior award a worker may have had (permanent or provisional) for organic and/or psychiatric conditions of post-traumatic stress disorder or conversion disorder. Of course, a worker who has suffered two separate injuries may have both a CPD award and an organic award. For example, a worker may have a finger amputation (organic) from one accident and a CPD resulting from a separate, work-related back injury.

Preparing for rating

Scheduling

The worker should be listed for rating at the 6 month point, taking into consideration the general principles for determining maximum medical recovery (MMR) to ensure that individual differences have been considered in each case (see 11-01-05, Determining Maximum Medical Recovery (MMR)).

Social work report

A social work report is usually necessary for the rating team unless similar information is already on file.

If such information is not available, the rating team will request a social worker's report at the same time as the worker is scheduled for rating. The rating team will collect the necessary documentation once the case has been referred for rating.

Benefit status

The WSIB recognizes that it is difficult for a worker to go from full benefits to a reduced amount (pension only) after rating. However, it is expected that this will occur often in chronic pain cases, and rating must not be postponed on this account.

A worker may be in receipt of temporary total compensation at the time of rating, but is generally considered to have reached maximum medical recovery (MMR) 6 months after the usual healing time. When a worker reaches MMR, the pre-1989 Workers' Compensation Act requires that the WSIB assess the worker's permanent disability based on impairment of earning capacity.

A worker with a permanent disability pension may be considered for a temporary supplement under s.45(5) of the pre-1989 Workers' Compensation Act.

Rating schedule

The rating is conducted by a rating team that includes a doctor familiar with the rating of organic, psychological, and psychiatric disabilities. A social worker's report, if available, is considered in the rating process.

The Psychotraumatic and Behavioural Disorders Rating Schedule is used to assess permanent disability awards for workers with CPD (see 15-04-02, Psychotraumatic Disability).

Term of award

Permanent

A permanent disability award for CPD is usually a life-time award. However, the WSIB reserves the right to conduct periodic reviews to determine whether a worker should be re-rated either to continue, terminate, increase, or decrease the permanent disability award.

Provisional

A provisional award may be made when it is evident that a residual disability is present, yet may not prove to be permanent. The duration of a provisional award may be one, two, or three years, after which the worker's CPD will be re-evaluated.

Other conditions

The following conditions are considered for permanent disability benefits under the CPD rating schedule

  • Fibromyalgia Syndrome
  • Somatoform Pain Disorder, and
  • Post-Traumatic Head Pain.

For details, see 15-04-03, Chronic Pain Disability.

Treatment after rating

Section 45(5) of the pre-1989 Workers' Compensation Act contemplates that a medical rehabilitation program may be desirable subsequent to rating, and if so, a temporary supplement may be paid if the worker passes the threshold test for such a supplement.

The possibility of a further course of medical treatment commencing or continuing subsequent to rating does not postpone the rating at the end of 6 months after the usual healing time of the worker's original injury.

Vocational rehabilitation

Section 45(5) of the pre-1989 and s.135 of the 1989 Workers' Compensation Act contemplate vocational rehabilitation subsequent to rating. If such a program would aid the worker in returning to some type of employment, a program may be initiated.

Social rehabilitation

If social rehabilitation is desirable, a program will be initiated.

Application date

This policy applies to all accidents prior to January 2, 1990, and to entitlement periods starting from March 27, 1986. (See Retroactivity)

Retroactivity

At the rating stage for CPD, it is not feasible to trace all factors contributing to a worker's overall impairment of earning capacity in order to determine the proportion of the award due to organic elements and/or a psychiatric condition of post-traumatic stress disorder or conversion disorder in relation to the proportion due to psychogenic pain elements. The whole-person approach to the assessment of CPD allows the WSIB to assess a worker's overall impairment of earning capacity against the CPD rating schedule without regard for what portion of the CPD was attributable to what cause.

Situations may arise where a worker is suffering from an identified organic condition and/or psychiatric conditions of post-traumatic stress disorder or conversion disorder that arose prior to March 27, 1986, as well as from psychogenic pain. In such cases, only the worker's impairment of earning capacity arising from the psychogenic pain elements is affected by the March 27, 1986 retroactivity date. The worker's impairment of earning capacity arising from the organic condition and/or psychiatric condition of post-traumatic stress disorder or conversion disorder is fully retroactive to the date of the accident or onset of the disability, whichever is later.

Therefore, once a whole-person pension has been set, and an identified organic condition and/or psychiatric condition of post-traumatic stress disorder or conversion disorder, the decision maker must apportion that whole-person pension to reflect the portion of the pension most appropriately attributable to the CPD. The retroactivity date of March 26, 1986 is applied accordingly.

The WSIB is obligated to determine apportionment in applying the retroactivity date for the CPD policy. To aid decision-makers, the rating team will recommend the most appropriate breakdown between the organic and/or psychiatric pain and the psychogenic pain.

The recommendation of the rating team and the decision-maker's judgement are based on the outcome of the worker's assessment and the documentation on file.

Document history

This document replaces 15-04-04 dated October 12, 2004.
This document was previously published as:
03-03-06 dated October 30, 1990.

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References

Legislative authority

Workers' Compensation Act, R.S.O., 1980
Sections 3(1), 40(1), 40(2), 45(12) of the pre-1989 and
section 135 of the 1989 Workers' Compensation Act

Minute

Administrative
#1, September 18, 2009, Page 476

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