1.
Definitions:
a. Amputations and loss as used
in subsection 11 of North Dakota Century Code section 65-05-12.2.
"Amputation of a thumb" means disarticulation at the
metacarpal phalangeal joint.
"Amputation of the second or distal phalanx of the thumb"
means disarticulation at or proximal to the interphalangeal joint.
"Amputation of the first finger" means disarticulation at the
metacarpal phalangeal joint.
"Amputation of the middle or second phalanx of the first
finger" means disarticulation at or proximal to the proximal interphalangeal
joint.
"Amputation of the third or distal phalanx of the first
finger" means disarticulation at or proximal to the distal interphalangeal
joint.
"Amputation of the second finger" means disarticulation at
the metacarpal phalangeal joint.
"Amputation of the middle or second phalanx of the second
finger" means disarticulation at or proximal to the proximal interphalangeal
joint.
"Amputation of the third or distal phalanx of the second
finger" means disarticulation at or proximal to the distal interphalangeal
joint.
"Amputation of the third finger" means disarticulation at the
metacarpal phalangeal joint.
"Amputation of the middle or second phalanx of the third
finger" means disarticulation at or proximal to the proximal interphalangeal
joint.
"Amputation of the fourth finger" means disartriculation at
the metacarpal phalangeal joint.
"Amputation of the middle or second phalanx of the fourth
finger" means disarticulation at or proximal to the proximal interphalangeal
joint.
"Amputation of the leg at the hip" means disarticulation at
or distal to the hip joint (separation of the head of the femur from the
acetabulum).
"Amputation of the leg at or above the knee" means
disarticulation at or proximal to the knee joint (separation of the femur from
the tibia).
"Amputation of the leg at or above the ankle" means
disarticulation at or proximal to the ankle joint (separation of the tibia from
the talus).
"Amputation of a great toe" means disarticulation at the
metatarsal phalangeal joint.
"Amputation of the second or distal phalanx of the great toe"
means disarticulation at or proximal to the interphalangeal joint.
"Amputation of any other toe" means disarticulation at the
metatarsal phalangeal joint.
"Loss of an eye" means enucleation of the eye.
b. "Maximum medical improvement"
means the injured employee's recovery has progressed to the point where
substantial further improvement is unlikely, based on reasonable medical
probability and clinical findings indicate the medical condition is
stable.
c. "Medical dispute" means
an employee has reached maximum medical improvement in connection with a work
injury and has been evaluated for permanent impairment, and there is a
disagreement between health care providers arising from the physical evaluation
that affects the amount of the award. The dispute to be reviewed must clearly
summarize the underlying medical condition. It does not include disputes
regarding proper interpretation or application of the American medical
association guides to the evaluation of permanent impairment, sixth edition. It
does not include disputes arising from an impairment percentage rating or an
impairment opinion given by a health care provider when the health care
provider is not trained in the American medical association guides to the
evaluation of permanent impairment, sixth edition, and when the health care
provider's impairment percentage rating or impairment opinion do not meet the
requirements of subsection 5 of North Dakota Century Code section
65-05-12.2.
d. "Potentially
eligible for an impairment award" means the medical evidence in the claim file
indicates an injured employee has reached maximum medical improvement and has a
permanent impairment caused by the work injury that will likely result in a
monetary impairment award.
e.
"Treating health care provider" means an allied health care professional who
has physically examined or provided direct care or treatment to the injured
employee.
2. Permanent
impairment evaluations must be performed in accordance with the American
medical association guides to the evaluation of permanent impairment, sixth
edition, and modified by this section. All permanent impairment reports must
include the opinion of the health care provider on the cause of the impairment
and must contain an apportionment if the impairment is caused by both
work-related and non-work-related injuries or conditions.
3. The organization shall schedule an
evaluation with a health care provider who has the training and experience
necessary to conduct an evaluation of permanent impairment and apply the
American medical association guides to the evaluation of permanent impairment,
sixth edition. The organization may not use nor consider a permanent impairment
evaluation conducted by the employee's treating health care provider or any
health care provider who has treated the injured employee for the work-related
injury. In the event of a medical dispute, the organization will identify
qualified specialists and submit all objective medical documentation regarding
the dispute to specialists who have the knowledge, training, and experience in
the application of the American medical association guides to the evaluation of
permanent impairment, sixth edition.
4. Upon receiving a permanent impairment
rating report from the health care provider, the organization shall audit the
report and shall issue a decision awarding or denying permanent impairment
benefits.
a. Pain impairment ratings. A
permanent impairment award may not be made upon a rating solely under chapter 3
of the sixth edition.
b. Mental and
behavioral disorders are not independently compensable and are encompassed
within the rating for physical impairment.
c. In chapters that include assessment of the
functional history as one of the nonkey factors to adjust the final impairment
rating within a class by using a self-report tool, the examining health care
provider is to score the self-report tool and assess results for consistency
and credibility before adjusting the impairment rating higher or lower than the
default value. The evaluating health care provider must provide rationale for
deciding that functional test results are clinically consistent and
credible.
d. A functional history
grade modifier may be applied only to the single, highest diagnosis-based
impairment.
e. All permanent
impairment reports must include an apportionment if the impairment is caused by
both work and non-work injuries or conditions.
5. Pollicization procedures will be rated as
an impairment under subsection 11 of North Dakota Century Code section
65-05-12.2, relating to scheduled injury, and may not be rated as a whole body
impairment, unless otherwise specified under subsection 11 of North Dakota
Century Code section 65-05-12.2.
Notes
N.D. Admin Code
92-01-02-25
Effective November 1,
1991; amended effective January 1, 1996; April 1, 1997; May 1, 1998; May 1,
2000; May 1, 2002; July 1, 2004; July 1, 2006; April 1, 2009; July 1, 2010;
April 1, 2012.
Amended by
Administrative
Rules Supplement 2017-365, July 2017, effective
7/1/2017.
Amended by
Administrative
Rules Supplement 367, January 2018, effective
1/1/2018.
Amended by
Administrative
Rules Supplement 376, April 2020, effective
4/1/2020.
Amended by
Administrative
Rules Supplement 2023-391, January 2024, effective
1/1/2024.
General Authority: NDCC 65-02-08
Law Implemented: NDCC
65-05-12.2