Once a North Carolina workers' compensation patient's condition has stabilized, the treating or rating physician records the permanent impairment rating on Form 25R. Ratings are entered as a percentage for each member, from individual fingers and toes to the hand, arm, foot, leg and back, supporting the carrier's scheduled-loss compensation. The form states that its use is required under the Workers' Compensation Act.
The rating physician completes the whole form, including impairment percentages, the MMI and restriction answers, and any teeth, vision, hearing or disfigurement findings, then signs with printed name and federal tax ID. Employee, employer and carrier details at the top identify the claim.
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Evaluation for Permanent Impairment
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The treating or rating physician who evaluates the employee's permanent impairment. The physician enters a percentage of impairment for each affected member, answers the MMI and restriction questions for the rated body part, adds comments if needed, and signs. The form is returned to the carrier, with a copy to the employee or attorney.
North Carolina uses the Industrial Commission's Rating Guide, which notes that AMA whole-person ratings cannot be readily translated to its system. The physician's job is only to state what percentage of a member or system is impaired; the Commission converts that percentage into an award of compensation weeks.
Yes. It has a hearing section, with the scale used and percentage loss for each ear plus attached audiograms and calculations, and a vision section recorded without corrective lenses at distance and near. It also covers teeth, disfigurement of the face, head or body, and permanent impairment of any other organ or body part.