Colombian Disability Decree 917: Rating Manual | Althox
Colombia's legal framework for social security and disability benefits is meticulously structured to ensure fair and consistent evaluation of individuals' loss of earning capacity. At the heart of this system lies Decree 917 of 1999, a pivotal regulation that established the Single Manual for Disability Rating. This decree, issued by the Presidency of the Republic, fundamentally reshaped how disability is assessed across various sectors in the country, providing a standardized methodology for determining the extent of an individual's functional limitations and their impact on their ability to work.
The significance of Decree 917 cannot be overstated. It serves as the primary guide for medical and legal professionals, employers, and individuals seeking to understand and navigate the complexities of disability qualification. By defining key terms, outlining procedures, and establishing precise criteria, the decree aims to bring uniformity and transparency to a process that directly affects the lives and livelihoods of countless Colombians. This comprehensive analysis delves into the core tenets of Decree 917, focusing on its scope, fundamental definitions, and the intricate methodology for disability assessment as stipulated in its initial articles.
The official document of Decree 917 of 1999, symbolizing the legal foundation for disability assessment in Colombia.
Table of Contents
- Scope of Application (Article 1)
- Key Definitions (Article 2)
- Date of Declaration of Loss of Work Capacity (Article 3)
- Qualification Requirements and Procedures (Article 4)
- Determination of Permanent Partial Disability (Article 5)
- Rating the State of Disability (Article 6)
- Qualifying Criteria for Integral Disability (Article 7)
- Percentage Distribution of Criteria (Article 8)
- General Instructions for Qualifiers (Article 9)
Scope of Application (Article 1)
Article 1 of Decree 917 of 1999 clearly delineates the broad application of the Single Manual for Disability Rating. This manual is not limited to a specific segment of the population but extends its reach to encompass all inhabitants of Colombia. This universal scope underscores the government's commitment to providing a consistent framework for assessing loss of earning capacity, regardless of an individual's employment status or background.
The decree specifically targets workers across various sectors, including public, official, semi-official entities at all levels, as well as the private sector. The primary objective is to determine the loss of earning capacity arising from any cause, aligning with the provisions of Law 100 of 1993, Decree-Law 1295 of 1994, and Law 361 of 1997. This integration with existing legislation ensures a cohesive and comprehensive approach to social security and disability rights.
Article 1. SCOPE. The Unique Handbook for the disability rating contained in this decree applies to all inhabitants of the country, workers from the public, official, semi official, in all its orders, and the private sector in general, to determine loss of earning capacity from all sources, in accordance with the provisions of Articles 38, following and consistent Law 100 of 1993, 46 Decree-Law 1295 of 1994 and the 5th. Law 361/97.
Key Definitions (Article 2)
To ensure clarity and precision in the application of the manual, Article 2 provides crucial definitions for terms central to disability assessment. These definitions standardize the language used by all parties involved, from medical experts to legal practitioners and affected individuals. Understanding these terms is fundamental to grasping the decree's operational aspects.
The definitions cover various states of reduced work capacity, distinguishing between different levels of impairment and their implications for an individual's ability to perform a regular job. These distinctions are vital for determining the appropriate benefits and support mechanisms under the social security system.
ARTICLE 2. DEFINITIONS OF DISABILITY, PERMANENT DISABILITY PARTIAL WORK CAPACITY AND WORK DAILY. For purposes of the application and enforcement of this decree, Adopt the following definitions:
a) Disability: Disability is considered with the person who for any reason, any origin, not caused intentionally, had lost 50% or more of their working capacity.
b) Permanent partial disability, permanent disability is considered partial to the person who for any reason, any origin, present a loss of earning capacity equal to or greater than 5% and below 50%.
c) Capacity for Work: means an individual's work capacity all the skills, abilities, skills and / or potential physical, mental and social, allowing you to perform in a regular job.
d) Regular job: work is understood as usual that office, work or occupation performed by the individual capacity for work, training and / or technical or vocational training, receiving compensation equivalent to salary or income, and which listed the Social Security System.
These definitions establish clear thresholds for what constitutes disability and permanent partial disability, based on the percentage of lost earning capacity. The concept of "Capacity for Work" is broadly defined to include physical, mental, and social abilities, highlighting a holistic view of an individual's potential. Furthermore, "Regular Job" specifies the type of employment relevant for these assessments, emphasizing compensation and social security affiliation.
Date of Declaration of Loss of Work Capacity (Article 3)
Article 3 addresses a critical aspect of disability qualification: the precise date on which the loss of work capacity is deemed to have occurred permanently and definitively. This date is crucial for various legal and administrative purposes, including the commencement of benefits and the calculation of entitlements. The decree emphasizes the need for robust documentation to support this declaration.
The article mandates that this date must be substantiated by medical records, clinical histories, and diagnostic support. It also clarifies that while an individual is receiving temporary disability allowance, claims for benefits arising from permanent disability are not applicable. This provision ensures a clear distinction between temporary and permanent states of incapacity.
ARTICLE 3. DATE OF DECLARATION OF THE STRUCTURE OR LOSS OF WORKING CAPACITY. The date on which the individual generates a loss in their ability to work on a permanent and final. For any contingency, this date must be documented with medical records, clinical and diagnostic support, and may be earlier or correspond to the date of qualification. In any case, while the person receiving temporary disability allowance, there is no place to claim the benefits arising from disability.
Qualification Requirements and Procedures (Article 4)
Article 4 outlines the fundamental requirements and procedures that qualifiers must follow when assessing disability. The opinion generated from this process is a critical piece of evidence, encapsulating the expert evaluators' findings regarding the degree of permanent partial disability, total disability, or even death. This opinion must be grounded in both factual considerations and scientific diagnosis.
The process involves several key steps:
- Factual Considerations: Relate the events leading to the accident, illness, or death, including manner, time, and place.
- Clinical Diagnosis: A technical-scientific diagnosis supported by clinical history, occupational history, and necessary diagnostic aids.
- Determination of Loss: Once a clinical diagnosis is established, the loss of work capacity is determined using the manual's procedures. This must be done by scientifically, technically, and ethically qualified professionals.
- Integral Disability Rating: The final rating is recorded in the opinion, specifying the origin of the condition, the degree of loss, the date of disability structuring, and the reasoning based on diagnostic reports.
- Appeal Mechanisms: The opinion must include mechanisms for concerned parties to exercise remedies, ensuring objectivity and the right to dispute its contents.
Meticulous documentation, including medical and legal records, is essential for a comprehensive disability assessment.
ARTICLE 4. REQUIREMENTS AND PROCEDURES FOR QUALIFICATION ON THE BASIS OF DISABILITY AND OPINION. For purposes of qualifying disability, the qualifiers will be guided by requirements and procedures in this manual to give an opinion. Should note that this opinion is the document that, as a matter of evidence, contains the concept emit expert raters on the degree of permanent partial disability, disablement or death of a member and be based on:
a) Considerations of factual about the situation is being assessed, which relate the events that led to the accident, illness or death, indicating the circumstances of manner, time and place within which they occurred, and CLINICAL DIAGNOSIS technical-scientific, supported by clinical history, occupational history and diagnostic aids required in accordance with the specificity of the problem.
b) Established a clinical diagnosis, we proceed to determine the loss of working capacity of the individual, through procedures defined in this manual. In any case, this determination must be made by the managers with qualified scientific, technical and ethically, with their respective official academic recognition. In case you need concepts, additional examinations or tests shall be performed and recorded in the terms set out in this manual.
c) Given that a loss of earning capacity, it made the INTEGRAL OF THE DISABILITY RATING, which is recorded in the opinion, in the forms and instructions that for that purpose by the Ministry of Labour and Social Security, which must be registered at least: the origin of illness, accident or death, the degree of loss of earning capacity caused by the accident or illness, the date format of the disability and the reasoning based on diagnostic and other reports additives, such as reporting the accident or the death certificate, if applicable.
d) The opinion must contain mechanisms to allow those concerned to exercise the remedies provided under the current rules, in order to ensure an objective dispute its contents in case of disagreement, both in substance and in terms of procedure.
PARAGRAPH . The normal consequences of aging, alone, with no pathology on aggregate, do not generate failure for the purposes of qualifying for disability in the Social Security System. Should co-exist with such pathology consequences may include within the definition of agreement with the impairment, disability and handicap for.
Determination of Permanent Partial Disability (Article 5)
Article 5 specifies the entities responsible for determining and evaluating permanent partial disability. This distributed responsibility ensures that different aspects of social security and healthcare are involved in the assessment process, providing multiple layers of review and expertise. The primary entities tasked with this crucial role are Professional Risk Managers and Health Promoting Enterprises (EPS) along with Subsidized Regime Administrators (ARS).
Professional Risk Managers (ARPs in Spanish) assess loss of earning capacity for work-related accidents and occupational diseases, adhering strictly to the Single Qualification Manual. Health Promoting Enterprises (EPS) and Subsidized Regime Administrators (ARS) are responsible for evaluating loss of earning capacity for general illness or non-occupational accidents. These entities must utilize multidisciplinary teams to ensure a comprehensive assessment. In cases of dispute regarding the extent or origin of the limitation, the matter is referred to the Disability Rating Boards.
ARTICLE 5. DETERMINATION OF PERMANENT PARTIAL DISABILITY. The determination of the statement, evaluation, review, grade and source of permanent partial disability, will be made by:
1. The Professional Risk Managers, in accordance with the provisions of article 42 Decree-Law 1295 of 1994, through their own or contract labor committees. They should evaluate the loss of earning capacity, based on this single qualification Manual Disability, in order to ensure access to the rights that persons affiliated to social security.
2. Health Promoting Enterprises (EPS) and the Subsidised Regime Administrators (ARS) in accordance with the provisions of article 5. Act 361 of 1997, will assess the loss of earning capacity, based on the Single User Rating Disabilities provided in this Decree, in order to ensure access to rights that people have with limitation. For this purpose, these entities must have a multidisciplinary team responsible for such status, in accordance with the regulations for that purpose issued by the Ministry of Health. In case of dispute about the extent and origin of the limitation determined, it will go to the Boards of the disability rating, according to the procedures defined by the standards prevailing in the area.
Rating the State of Disability (Article 6)
The ultimate authority for rating and issuing opinions on the state of disability rests with the Disability Rating Boards. Article 6 details the specific cases these boards handle, highlighting their role as arbiters in complex or disputed situations. Their decisions are pivotal in determining an individual's access to social security benefits and legal protections.
The Disability Rating Boards are tasked with a range of responsibilities, including:
- Rating and reviewing loss of earning capacity and permanent partial disability in case of dispute.
- Rating the origin, degree, date of structuring, and reviewing the state of disability.
- Classifying the origin of accidents and diseases based on relevant laws.
- Classifying the origin of death in case of dispute.
The opinions issued by these boards must accurately reflect the case records and the deliberations of their members, ensuring transparency and accountability. The individual concerned has the right to accept the opinion or appeal it to competent authorities.
ARTICLE 6. RATING THE STATE OF DISABILITY. The rating and issue an opinion on the state of disability corresponds to the Disability Rating Board, who will hear the following cases:
a) The rating and review of the loss of earning capacity and permanent partial disability, in case of dispute.
b) The rating of origin, degree, date of structuring and reviewing the state of disability.
c) The classification of the origin of the accident and disease, based on Law 100 of 1993, Decree Law 1295 of 1994 and other regulations, in case of dispute.
d) The classification of the origin of death in case of dispute.
Meetings of the Disability Rating must issue the opinion of the disability which, in all cases accurately reflect the contents of the record of each case reviewed by it and the outcome of the deliberations of the members in charge of branding. Similarly, corresponding to the respective Board member reporting the opinion, who can accept it or appeal it to the competent authorities.
Qualifying Criteria for Integral Disability (Article 7)
Article 7 introduces the three core components considered for the integral rating of disability: Deficiency, Disability, and Handicap. These criteria provide a comprehensive framework for assessing an individual's condition, moving beyond mere medical diagnosis to include functional limitations and societal disadvantages. This holistic approach recognizes that disability is a multifaceted phenomenon.
Each component addresses a different level of impact:
- Deficiency: Focuses on the organ or system level, representing a pathological condition.
- Disability: Addresses the individual level, reflecting restrictions in performing activities.
- Handicap: Considers the societal level, highlighting disadvantages in fulfilling social roles.
These distinctions are crucial for a nuanced understanding of an individual's overall loss of earning capacity and for tailoring appropriate support.
ARTICLE 7. QUALIFYING CRITERIA FOR THE COMPREHENSIVE DISABILITY. For purposes of the integral rating of disability are taken into account the biological functional components, psychological and social human being, understood in terms of the consequences of illness, accident or age, and defined as follows:
a) DEFICIENCY: Deficiency means any loss or abnormality of structure or psychological, physiological or anatomical, which can be temporary or permanent, among which include the existence or occurrence of an anomaly, defect or loss caused by member, organ, tissue or other body structure, as well as proprietary systems of mental function. Represents the manifestation of a pathological condition and in principle reflects disturbances at the organ.
b) DISABILITY: Disability means any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being caused by a deficiency, characterized by excesses or deficiencies in the performance and behavior in a normal or routine activity, which can be temporary or permanent, reversible or irreversible, and progressive or regressive. Represents the objectification of the deficiency and therefore reflects changes to the level of the individual.
c) DISABILITY: Disability means any disadvantage for a given individual, resulting from an impairment or disability that limits or prevents the performance of a role, which is normal for you based on age, sex, factors social, cultural and occupational. It is characterized by the difference between performance and expectations of the individual himself or group to which it belongs. Represents the socialization of impairment and disability as it reflects the cultural, social, economic, environmental and occupational, that for the individual arising from the presence of them and alter their environment.
Percentage Distribution of Criteria (Article 8)
Article 8 provides a critical quantitative framework for the integral disability rating by assigning percentage weights to the Deficiency, Disability, and Handicap criteria. This distribution ensures that each aspect contributes proportionately to the total loss of earning capacity, culminating in a 100% total score. This structured approach aims to provide a standardized and objective assessment.
The maximum ranges for these scores are clearly defined, as shown in the table below. It is important to note the interdependency of these criteria; specifically, if there is no deficiency, or its value is zero, no disability or handicap can be described, resulting in a zero loss of earning capacity.
The complex interplay of biological, psychological, and social factors forms the basis of disability evaluation.
| Criterion | Maximum Percentage (%) |
|---|---|
| Deficiency | 50 |
| Disability | 20 |
| Handicap | 30 |
| Total | 100 |
ARTICLE 8. PERCENTAGE DISTRIBUTION OF THE CRITERIA FOR THE TOTAL OF THE DISABILITY RATING. To perform the integral rating of disability, is given a score to each of the criteria described in the previous article, whose sum equals 100% of the total loss of earning capacity, within the following maximum ranges of scores:
STANDARD RATE (%)
50 Deficiency
20 Disabilities
30 Handicap
Total 100
PARAGRAPH 1. Where there is no deficiency or its value is zero (0) no disability may be described or disability. Therefore, the loss of earning capacity resulting report with a value of zero (0).
PARAGRAPH 2. In accordance with paragraph 1 of article 34 Decree-Law 1295 of 1994, for qualifying in the case of work accidents and occupational diseases, the existence of previous conditions is not caused to increase the degree of disability or the benefits payable to the worker. Similarly, when there are deficiencies of congenital or acquired before complying with legal minimum ages for work and the individual has been approved occupational and socially, these deficiencies are not taken into account for the classification of the loss of working capacity occupational origin, unless they have been aggravated or have thrown up.
PARAGRAPH 3. Given that a patient suffering from a deficiency improves functional status to receive a prosthesis, reduce a defined proportion of the overall deficit of the segment that receives, as follows:
a) For aesthetic prosthesis subtract 10% of the value of global deficiency found;
b) For functional prosthesis 20% of the overall deficit found, and
c) For cosmetic and functional prostheses 30% of the overall deficit found.
Example : Enucleation of left eye with normal right eye: 15% deficiency. In this case, it is an aesthetic prosthesis and therefore subtracted 10% from 15%. Ie, 1.5%, to a final value of overall deficit of 13.5%.
Paragraph 2 of Article 8 is particularly important as it addresses pre-existing conditions and their impact on disability qualification for work accidents and occupational diseases. It clarifies that prior conditions do not automatically increase the degree of disability or benefits unless they have been aggravated. This prevents individuals from claiming benefits for conditions unrelated to their occupational activities. The paragraph also considers congenital or acquired deficiencies before working age, stating they are not considered for occupational disability unless worsened.
Furthermore, Paragraph 3 introduces a provision for prostheses, recognizing their role in improving functional status. It stipulates specific percentage reductions in the overall deficiency value based on the type of prosthesis (aesthetic, functional, or both), illustrating a practical application with an example of an eye enucleation. This demonstrates the decree's attention to detail in accounting for rehabilitative measures.
General Instructions for Qualifiers (Article 9)
Article 9 provides overarching instructions for qualifiers, emphasizing the uniform and compulsory nature of the manual. It dictates that the rating of loss of work capacity should occur once a definitive diagnosis is made, treatment is completed, and the comprehensive rehabilitation process concludes, or when there is an unfavorable medical prognosis for recovery. This ensures that assessments are based on stable and definitive conditions.
The manual is structured into three main books:
- Book 1: Deficiencies. Comprises fourteen chapters evaluating damage or absence in different organ systems, with specific criteria and tables for percentage functional loss.
- Book 2: Disabilities. Divided into seven categories, addressing additional levels of severity.
- Book 3: Handicap. Defines seven categories of handicap.
A key instruction for calculating deficiencies involves combining values when multiple organs or systems are affected. The decree provides a specific formula for this:
Formula for combining deficiencies: 1 A + (50-A) B / 100, where A is the highest value and B is the lowest. If limb deficiencies are combined, a different formula is used: 1 A + (100-A) B / 100. This mathematical approach ensures a standardized calculation of overall deficit.
ARTICLE 9. GENERAL INSTRUCTIONS FOR QUALIFIERS. The "Manual single disability rating of" established based on criteria and components defined in the previous articles, a uniform method compulsory for the legal determination of the loss of working capacity that provides an individual at the time of evaluation. The rating of the loss of working capacity of the individual must be made known once the definitive diagnosis of the disease, treatment is completed and on completion of comprehensive rehabilitation process, or even without finishing the same, there is an unfavorable medical concept recovery or improvement. The Manual consists of three books, namely:
1. The first deals with deficiencies. Consists of fourteen (14) chapters that correspond to the evaluation of damage or partial or total absence of different organ systems. Contains a number of criteria and special tables of values to describe the damage;
2. The second deals with Disabilities, broken down into seven (7) categories, which include the additional level of seriousness, and
3. The Third, defines seven (7) categories of disability.
To determine the values of impairments, disabilities and handicaps should follow the following instructions:
a) For the deficiencies: The degree of deficiency referred to the First Book which relates to organic systems, are expressed as percentage of functional loss (global failure). To facilitate the exercise of the assessor or the Qualifying Board, contains a series of tables of values for organs or systems, which can escape the values for this component. However, in cases that are affected two or more organs or systems, partial values of the respective global deficiencies must be combined using the following formula:
1 A + (50-A) B
100
Where A and B correspond to the different deficiencies. A being the highest value and B the lowest value. This will combine the values for A and B. This is called ® combined sum. If there are more than two values, they must be pre-ordered from highest to lowest value, to proceed to combine on the formula.
Example : A = 20% B = 10% Combined sum = 20 + (50 -20) X10 = 23% 100
Given that the value of the limb deficiency may reach 100%, you should use the following formula when they combined limb deficiencies:
1A + (100-A) B
100
It must calculate the overall deficit for each chapter and only then will a combination of global impairment values between chapters to find the final overall deficit. Who legally can or should determine the loss of working capacity of a person, take into account that the deficiency must be demonstrable anatomically, physiologically and psychologically, or in combination. Such abnormalities may be determined by testing a diagnostic aid affiliate, regarding the signs and symptoms. The pathologies that manifest themselves only symptoms, not easily possible to define who qualifies. Thus, decisions on the rates of disability must be supported with the patient's medical history and diagnostic testing aid, complementing clinical criteria. The results obtained with additional diagnostic tests should match the anatomic, physiological and / or mental detectable by such tests, and confirm the signs found during the medical examination. The patient's statements which only consider the description of their discomfort without the support of signs or additional examinations have no value to establish a deficiency. Where applicable, it should support the opinion with the concept of Occupational Health to determine the source of the injury.
There are other cases in which, following the specific instructions for each lesion, may be added or limb deficiencies in the evaluation of damage to the brain is selected from the different degrees of deficiency the most value to the overall deficit as final.
b) Disability: the case of determining the value of disability, we proceed to perform an arithmetic sum of all disabilities with which characterize the lesion. The result of this sum corresponds to the final value of disability to be registered.
c) In the Disabilities: for determining the value of disability should assess the...
The decree emphasizes that deficiencies must be anatomically, physiologically, or psychologically demonstrable, supported by diagnostic tests and medical history. Subjective patient statements without objective signs or additional examinations are not sufficient to establish a deficiency. This rigorous requirement ensures that disability ratings are based on verifiable medical evidence, maintaining the integrity and scientific basis of the assessment process.
In conclusion, Decree 917 of 1999 provides a robust and detailed framework for disability rating in Colombia. Its comprehensive nature, from defining key terms to outlining specific procedures and mathematical formulas for assessment, reflects a commitment to fairness and consistency. Understanding the intricacies of this decree is essential for anyone involved in the social security and healthcare landscape of Colombia, ensuring that individuals with reduced earning capacity receive the appropriate recognition and support.
Fuente: Contenido híbrido asistido por IAs y supervisión editorial humana.
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