West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-20 - Medical Management Of Claims, Guidelines For Impairment Evaluations, Evidence, And Ratings, And Ranges Of Permanent Partial Disability Awards › Section 85-20-12 - Psychiatric compensability, treatment and impairment ratings. (Effective Date: January 20, 2006

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Purpose.
				The purpose of this section is to develop guidelines for the determination of
				compensability, treatment, evaluation and permanent impairment rating of
				claimants for psychiatric disabilities arising from injuries sustained in the
				course of and resulting from employment. This rule is applicable to evidence
				submitted by any party to a claim and to evidence gathered by the commission,
				Insurance Commissioner, private carrier or self-insured employer, whichever is
				applicable.
12.2. Definitions. As
				used in these rules, the following terms have the stated meanings unless the
				context of a specific use clearly indicates another meaning is intended.
a. "Work injury-related psychiatric
				disorders" means those psychiatric disorders caused by or aggravated by a work
				injury or disease. Attached as Exhibit A is a list of psychiatric diagnoses
				which are, by definition, not significantly contributed to by a work-related
				injury, unless the disorder ends in the phrase "due to a general medical
				condition" where the general medical condition is caused by the work-related
				injury. In order to be regarded as work-related, symptoms of an injury-related
				psychiatric diagnosis must be manifest within 6 months of the injury or
				significant injury-related complication based on credible medical
				evidence.
b. "Causation legal
				standard" means a physical, chemical, or biologic factor contributed to the
				occurrence of a medically identifiable condition. A medical determination is
				required to confirm the feasibility of the contributing factor could result in
				the occurrence of the condition (AMA Guides 4th Ed., Glossary).
c. "Aggravation, legal standard" means a
				physical, chemical, biological or medical condition significantly contributing
				to the worsening of a condition in such a way that the degree of permanent
				impairment increased by more than 3%. (AMA Guides 4th Ed., Glossary). For the
				impact to merit allocation of permanent impairment, the ultimate increase of
				impairment at MMI must at least be 3%.
d. "Apportionment" means a distribution or
				allocation of causation among multiple factors that caused or significantly
				contributed to the injury or disease and existing impairment.
e. "Psychiatric impairment" means the loss
				of, loss of use of, or derangement of mental, emotional or brain
				functioning.
f. "Permanent
				psychiatric impairment" means impairment that has reached maximum medical
				improvement which is static or well stabilized with or without psychiatric
				treatment or that is not likely to remit despite psychiatric treatment of the
				impairing condition.
g. "Permanent
				partial psychiatric impairment" means impairment that is assigned a percentage
				of impairment rating from the W. Va. Workers' Compensation Impairment
				Guidelines for Psychiatric Impairment (Exhibit B).
h. "Temporary total psychiatric impairment"
				means a psychiatric condition that in and of itself, or in combination with a
				physical condition, makes the claimant unable to function in the work setting,
				but for which the claimant has not reached maximum medical
				improvement.
i. "Maximum medical
				improvement, psychiatric (stabilized psychiatric condition)" means a condition
				or state that is well-stabilized and unlikely to change substantially in the
				next year, with or without medical treatment. Over time, there may be some
				change; however, further recovery or deterioration is not anticipated.
				Evaluators should recognize that many psychiatric disorders improve to a state
				of maximum medical improvement within nine months of the onset of reasonable
				management.