Fillable Desk Aid 14 Apportionment Calculation Worksheet (Colorado DORA)

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Desk Aid 14 Apportionment Calculation Worksheet (Colorado DORA)

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No Do NOT apportion
Yes Proceed to Step
2 if the condition is an injury . If it is an occupational disease see footnote.
1
Step 2:
The date of the
current injury
is:
Before July 1, 2008 Apportion - proceed to Step 4
After July 1, 2008 Proceed to Step 3
Step 3:
The previous condition is work related Apportion - proceed to Step 4
The previous condition is non-work related and is disabling
2
Apportion - proceed to Step 4
The previous condition is non-work related and is NOT disabling
2
→ No apportionment, provide a case
specific impairment
3
rating (includes the current injury only) - refer to complete impairment report
Step 4:
Apportion by subtracting the previous impairment rating from the current total rating. The current total
rating includes the previous condition and current condition. Preferably subtracting like from like, i.e. ROM
from ROM
Step 5:
Current apportioned rating:
Spine
Current Total Previous Apportioned
Table 53 %WP
ROM %WP
Nerve
(Convert Extremity to WP) % ext % ext % ext %WP
Final Combined
Apportioned Rating
%WP
Patient Name:
Date of Injury:
Step 1:
Is there medical documentation or objective evidence of
a
previous condition of the same body
part
that would qualify for a rating?
1
If the condition is an occupational disease, directly proceed to apportionment. We suggest consulting an expert
as occupational disease conditions are apportioned using different standards.
2
“Disabled” requires information that the prior injury was identified, treated and independently disabling at the
time of the current injury. Disabled includes conditions which adversely impact the patient’s ability to perform
their job (work restrictions), or limits the patient’s access to other jobs (permanent work restrictions)
3
The case specific rating includes only the current work related diagnosis. If pre-injury ROM measurements are
available, or the opposite pre-injury limb has no pathology, the ROM portion of the case specific rating may be
individually adjusted or normalized accordingly, when appropriate.
DK14 Rev 12/18
Page 1 of 2
COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT
DIVISION OF WORKERS' COMPENSATION
Apportionment Calculation Worksheet
Lower Extremity
"subtract like from like"
Current Total Previous
Apportioned
ROM % LE
Nerve % LE
Other % LE
Final Combined
Apportioned Rating
% LE %WP
Other Current Total Previous Apportioned
% ext %WP
% ext %WP
% ext %WP
Final Combined
Apportioned Rating
% ext %WP
Example:
The patient had a previous lumbar strain/sprain with Table 53 diagnostic rating of 5% and 5% ROM impairment.
The current injury involves L4-5 disc herniation, unoperated. Current ROM rating is 10%. Remember for Table
53 Sections II, III and IV, the available sub values cannot be combined as these values are designed to represent
progression of the disease state that has occurred. Thus, as a condition worsens, the Table 53 diagnosis changes
within these sections but combining is not allowed when accounting for the patient's current impairment.
Spine Current Total Previous Apportioned
Table 53
IIC: 7%
IIB: 5%
2 %WP
ROM
10% 5%
5 %WP
Nerve
(Convert Extremity to WP) % ext % ext % ext %WP
Final Combined
Apportioned Rating
7 %WP
Upper Extremity
"subtract like from like"
Current Total Previous Apportioned
ROM % UE
Nerve % UE
Other % UE
Final Combined
Apportioned Rating
% UE %WP
Upper Extremity
"subtract like from like"
Current Total Previous Apportioned
ROM % UE
Nerve % UE
Other % UE
Final Combined
Apportioned Rating
% UE %WP
DK14 Rev 12/18
Page 2 of 2
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Desk Aid 14 Apportionment Calculation Worksheet (Colorado DORA)

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Completed 27 January 2021

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