GAF Scores: A 60-Second Seminar in Workers’ Compensation Claims Handling

Although several states do not recognize the compensability of psychiatric injury claims, here in California mental injuries have long been an integral part of our workers’ compensation system.

The medical authority used in California to diagnose psychiatric injury and disability is the Global Assessment of Functioning (GAF) Scale, found in Axis V (aka Chapter 5) of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, DSM-IV-TR.  It’s a chapter well worth reading and does not simply consist of advanced medical theories and formulas. Rather, Axis V consists of only three short paragraphs and is a quicker read than today’s blog.  Therefore, we highly recommend that Axis V be reviewed by every claim professional. 

For the most part, claims representatives are aware that a GAF score is used to identify psych injury and permanent disability.  However, when asked to explain what a GAF score is or how a score is determined, some are uncertain of the answer.  For the most part claims representatives are taught that GAF scores and PD percentages are inversely applied, where the lower the score the higher the disability, and vice-versa.  As the lowest GAF score is 0, we certainly hope claims professionals do not mistakenly believe that a score of 0 is equal to a 100% PD rating.  When a GAF score of 0 is identified all it means is that the medical examination was not completed.

Currently, we wish to alert claims administrators to beware of two major issues involving GAF scoring.  If either of the following issues is identified in an examination report, then clarification from the evaluating physician is required.

The first issue occurs when an AME or QME identifies a need for ongoing treatment.  The doctor further explains that until treatment is completed the worker will not be MMI.  However, to establish a disability baseline, a GAF score is provided.  Upon completion of treatment, one would anticipate the patient’s medical condition to have improved. If it does not improve but becomes worse, then an explanation is in order as it wouldn’t make sense for disability to have increased after treatment was provided.

The second issue involves a final examination report where a very significant PD is identified.  Such severe disability would usually describe the worker as being a danger to himself and/or others, or where the worker is psychotic or suicidal.  One must ask, “How could this be a final report when the description of mental disability is so great?”  The administrator should question if the worker is truly MMI.  In other words, “Will the patient remain suicidal or a danger to himself/herself and others for the rest of their life?“  If not, then MMI and PD are premature.  Also, if the patient is described as psychotic, suicidal or a danger to himself and others, then we must ask what happened after the examination concluded?  Was this dangerous psychotic patient simply allowed to leave the doctor’s office and drive away?  If upon conclusion of the examination the worker was not involuntarily admitted to a mental institution, then doubt is cast on the evaluating physician’s ability to assess mental disability under the GAF scoring system.

In conclusion, we at F+B once again recommend that every claim professional read Axis V, and become familiar with the GAF scoring system as well.  Should anyone have any questions with either Axis V or the GAF scale, feel free to contact the experts here at F+B for assistance.