Incapacity Determination - PEP Step III
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Incapacity Determination - PEP Step III

Revised December 12, 2011

PEP Step III--Determining the severity of physical impairments
WAC 182-508-0060PEP Step III--Determining the severity of physical impairments. (Emergency rule effective 11/1/11.)

WAC 182-508-0060

WAC 182-508-0060

Effective October 14, 2012

WAC 182-508-0060 PEP Step III--Determining the severity of physical impairments.

The agency or the agency's designee must decide if the individual's physical impairment is serious enough to limit the individual's ability to be gainfully employed.  "Severity of a physical impairment" means the degree that an impairment restricts the individual from performing basic work-related activities (see WAC 182-508-0015).  Severity ratings range from one to five, with five being the most severe.  The agency or the agency's designee will assign severity ratings according to the table in WAC 182-508-0035.

(1)  The agency or the agency's designee assigns to each physical impairment a severity rating that is supported by medical evidence.

(2)  If the individual's physical impairment is rated two, and there is no mental impairment or a mental impairment that is rated one, the agency or the agency's designee denies incapacity.

(3)  If the individual's physical impairment is consistent with a severity rating of five, the agency or the agency's designee approves incapacity.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

Compare the severity rating given by the medical evidence provider with the objective evidence.

  1. When it is consistent, accept it.
  2. When it is not consistent,  raise or lower the rating after consulting medical sources and references. You must have clear and convincing reasons for adjusting a provider's severity rating. Always fully explain your clear and convincing reasons for not accepting the provider's rating in your notes.

NOTE:

If you lower the severity rating given by the provider and the result is a denial of benefits, you must explain this on the DSHS 14-118 so that the client receives adequate notice in the denial letter. That is, you must state that you lowered the severity rating and the clear and convincing reasons for your decision.
Modification Date: December 12, 2011