Incapacity Determination - Assignment of Severity Ratings

How Severity Ratings are Assigned for HEN Referral Incapacity 

Clarifying Information

  1. When the provider does not give a severity rating:
    1. Review the medical evidence. Use reference sources, facts present in the medical evidence, and your professional judgment to assign a severity rating that is consistent with the objective medical evidence and severity definitions in WAC 388-447-0020 and 388-447-0040; or
    2. Refer the case to a Medical Consultant for assistance with interpreting the medical information.
  2. When the severity rating given by the provider is supported by the objective findings, accept the rating.
  3. You may adjust the provider's ratings if you have clear and convincing reasons why the rating should be adjusted (e.g. rating is not consistent with the objective medical evidence). If the adjusted rating results in the person having only one impairment with a severity rating less than three, deny incapacity at Step 1 (see WAC388-447-0030).