Determine impairment

The Impairment Determination Criteria section helps you focus on the specific job class selected (Sedentary, Light, Medium, Heavy, and Very Heavy). Based on your findings, you can determine functionality and make claim determinations. With this approach, you can look at each claim holistically, evaluate each claim on its own merits, and handle all claims fairly and consistently.

To access this section

• Select the Impairment Determination Criteria link from the index of clinical content on the Duration tab.

• Or, scroll down to the Impairment Determination Criteria section on the Duration tab.

From here, view the different sections of subjective, objective, and diagnostic information. The Notes area provides additional information on return-to-work restrictions and limitation and it also addresses specialty topics such as safety-sensitive work.

To determine impairment

1. Look at your individual claim and try to determine what you need clarity on.

2. Start with the Job Class (if known), for example, Sedentary/Light Work.

3. Review the Subjective Findings section in the provider Notes area for information that would preclude the claimant from being able to perform those specific job duties.

4. Next, review the Physical Examination Findings section to ensure that the diagnosis is supported by objective findings consistent for that diagnosis. This section will often include range of motion findings and special tests that may be indicated for the condition.

5. If applicable, review the Diagnostic Testing section to ensure that the diagnosis is supported by the test results.

Based on your findings—can the claimant perform their specific job duties?