Are Hernias Ratable?

By Jason Weinstock on January 19, 2013

 Inguinal hernias are common work-related injuries for men, often caused by increased abdominal pressure during heavy  lifting. According to the November/December 2012 AMA Guides Newsletter, men have a 27% lifetime risk of an inguinal hernia.  Genetics, overall body conditioning, and development of a person’s abdominal musculature have a lot to do with risk of a hernia.

 If an injured worker feels sudden pain and immediately notices a protrusion in the abdomen, and the worker promptly reports the injury, a claim is usually accepted.  It is when the injured worker delays in reporting the injury that the workers’ compensation administrator and employer question whether the hernia was caused by job activities.  The injured worker can avoid problems simply by speaking up immediately following a work injury and by following the procedures for filing a claim.  

Surgery, usually involving a mesh repair,  is scheduled quickly after a claim is accepted.  Most surgeons take their patients off heavy physical work for at least 7 to 14 days.  Most surgeries are successful, and there is no remaining protrusion or defect that can be felt in the abdomen.  A successful surgery should not entitle the injured worker to a rating evaluation.

If,however, the surgery was not successful, and there is still a protrusion or palpable defect, the injured worker may have a ratable impairment under the AMA Guides to Evaluation of Permanent Impairment 5th Edition.   A rating is not scheduled simply because there was a surgery.  Nor is a rating scheduled because a treating surgeon gives the injured worker some permanent work restrictions.  

In order for there to be a ratable impairment under the AMA Guides, there must still be a protrusion or palpable defect present when the rating physician does a physical exam.   If the hernia surgery was done correctly, there shouldn’t still be a protrusion or palpable defect unless there were complications.  The extent of the palpable defect will determine the class of impairment.  For example, a slight protrusion would place the claimant in a Class ! impairment, allowing the rating doctor to assign 0 to 9% whole person impairment.  

Secondly, in addition to a remaining palpable defect, the rating doctor must determine the extent to which the hernia interferes with activities of daily living.   If the hernia does not interfere with most activities of daily living, the rating doctor would place the impairment at the lower end of a Class I impairment.  

Most injured workers who have asked whether they should be rated for impairment complain about pain that never subsides after the surgical repair.  While they may not have a remaining protrusion or palpable defect,  it is possible that a rating doctor might find a small percentage of impairment for a  nerve entrapment in the abdomen after their hernia repair.   

If you have an accepted claim for an inguinal hernia, and you question whether you should have a rating evaluation, the first step is to obtain a complete copy of your records from your treating surgeon. Do that quickly.  Then ask a knowledgeable attorney to review your records for an opinion whether you do or don’t have a likely impairment under the AMA Guides.   Keep in mind that you only have 70 days to file an appeal of the insurer’s determination letter to close your claim without a ratable impairment.  

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