ALBERTA PERMANENT CLINICAL IMPAIRMENT GUIDE - Workers ...

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THE LOWER EXTREMITIESRATING SCHEDULE1. Amputations WholePersonRating (%)a Disarticulation at the hip or a short stump requiringan ischial bearing prosthesisEach 65b. Amputation at thigh levelc. Disarticulation at the knee or a short B.K. stumpd. Amputation of part of the lower leg, suitable for aB.K. prosthesise. Amputation at the ankle, end bearingf. Amputation through the footg. Amputation of all toesh. Amputation of great toe (entire)i. Amputation of distal phalanx of great toej. Amputation of toes (other than great toes)2. Complete Immobility of Jointsa. Hipb. Kneec. Ankle (loss of dorsiflexion and plantar flexion only)d. Subtalar arthrodesis (loss of inversion and eversiononly)e. Triple arthrodesis (talocalcaneal, talonavicular, andcalcaneal cuboid)f. Great toe, both jointsg. Great toe, distal jointEachEachEachEachEachEach FootEachEachEach ToeEachEachEachEachEachEachEach5045352510 - 2552.510.53025126.257.52.50.5Page 30COPYRIGHT 2006 All Rights Reserved October 1, 2006
THE LOWER EXTREMITIES3. Replacement Arthroplastya. Hipb. KneeRated at 50% of the value for complete immobility ofthe joint replaced. This rating usually includes anyresulting loss in range of movement of the joint. Forpoor result, an additional judgement award may beapplied.4. Shortening of a Leg2.5 cm. (1 inch)5 cm. (2 inches)7.5 cm. (3 inches)5. DenervationEachEach1512.51.5615Peroneal nerve, complete Each 12Page 31COPYRIGHT 2006 All Rights Reserved October 1, 2006
Page 1 and 2: ALBERTAPERMANENT CLINICALIMPAIRMENT
Page 3 and 4: Table of ContentsFingers/Hands(cont
Page 5 and 6: Table of Contents8 CardiovascularSy
Page 7 and 8: I. IntroductionDETERMINING PERMANEN
Page 9 and 10: Figure 1: DETERMINING PERMANENT DIS
Page 11 and 12: Figure 2: THE PERMANENT CLINICAL IM
Page 13 and 14: Rating Permanent Clinical Impairmen
Page 15 and 16: 3. For combinations of accidents po
Page 17 and 18: FINGERS/HANDSFINGERS/HANDSI. Introd
Page 19 and 20: FINGERS/HANDS7. To obtain the PCI t
Page 21 and 22: FINGERS/HANDS7. To calculate the ra
Page 23 and 24: FINGERS/HANDSCHART 1 - THUMB AND/OR
Page 25 and 26: FINGERS/HANDSCHART 2 - TWO FINGERSP
Page 27 and 28: FINGERS/HANDSCHART 3 - THREE FINGER
Page 29 and 30: FINGERS/HANDSCHART 4 - FOUR FINGERS
Page 31 and 32: FINGERS/HANDSStep Two:Rate the dist
Page 33 and 34: EXAMPLE 2Situation:FINGERS/HANDSLef
Page 35 and 36: FINGERS/HANDSStep Six:Adjust the to
Page 37 and 38: FINGERS/HANDSStep Twelve: Rate the
Page 39 and 40: THE UPPER EXTREMITIESIII.Specific R
Page 41 and 42: THE UPPER EXTREMITIESRATING SCHEDUL
Page 43 and 44: THE LOWER EXTREMITIESTHE LOWER EXTR
Page 45: THE LOWER EXTREMITIESC. Denervation
Page 49 and 50: THE SPINEAn increase greater than 1
Page 51 and 52: THE SPINEThoracic and Lumbar Spine1
Page 53 and 54: HEARING LOSSD. The calculated PCI r
Page 55 and 56: HEARING LOSSHEARING LOSS TABLE 1 -
Page 57 and 58: VISIONE. Combine the impairments in
Page 59 and 60: VISIONEXAMPLESEXAMPLE 1:IMPAIRMENTS
Page 61 and 62: VISIONRATING SCHEDULE IIWHOLE PERSO
Page 63 and 64: SKINSKINI. IntroductionA. The skin
Page 65 and 66: SKINTABLE I - FUNCTIONAL IMPAIRMENT
Page 67 and 68: THE CARDIOVASCULAR SYSTEMTHE CARDIO
Page 69 and 70: THE CARDIOVASCULAR SYSTEMb) laborat
Page 71 and 72: THE RESPIRATORY SYSTEMTHE RESPIRATO
Page 73 and 74: THE RESPIRATORY SYSTEMi. chronic in
Page 75 and 76: THE RESPIRATORY SYSTEMSCHEDULE II -
Page 77 and 78: THE RESPIRATORY SYSTEMClass IV SEVE
Page 79 and 80: THE BRAINTHE BRAINI. IntroductionA.
Page 81 and 82: THE BRAINiv. for disturbances of co
Page 83 and 84: MENTAL IMPAIRMENTloss as well as gi
Page 85 and 86: MENTAL IMPAIRMENTCLASS II MINIMAL I
Page 87 and 88: MENTAL IMPAIRMENTCLASS IV MODERATE
Page 89 and 90: MISCELLANEOUS CONDITIONSMISCELLANEO
Page 91 and 92: APPENDIXCOMBINED VALUES CHARTAPPEND
Page 93 and 94: APPENDIXCOMBINED VALUES CHARTPart 2
Page 95 and 96: APPENDIXCOMBINED VALUES CHARTPart 4
Page 97 and 98:
Part 6 - Range: 75 - 99 x 76 - 99AP
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