Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part I of II) - Decrees - Article 1/11

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MANUAL SINGLE NATIONAL DISABILITY

(PART I OF II) 

DECREES I - Article 1/11

ACT 917 OF 1999

(From May 28, 1999)

Official Journal No. 43601 of June 9, 1999

PRESIDENCY OF THE REPUBLIC

 Which is modified by Decree 692 of 1995.

THE PRESIDENT OF THE REPUBLIC OF COLOMBIA

To the best of their constitutional and legal powers, especially those conferred by Article 189, paragraph 11 of the Constitution, Article 41 of Law 100 of 1993 and article 5. Act 361 of 1997,

DECREES:

Article 1. SCOPE. 

Unique Handbook for the disability rating contained in this decree applies to all inhabitants of the country, workers from the public, official, semiofficial, 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.

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.

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.

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.

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.

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.

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.

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

Disabilities 20

Handicap 30

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%.

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 patient in each of the categories of scale assigned to each of the Disabilities. In each of them has the highest value (mutually exclusive) and then added each of them. The result of this sum corresponds to the final of the handicap to be registered.

d) In determining the integral: For the final integral rating of the degree of loss of earning capacity of the person, in accordance with the specifications of this manual and tables, are added arithmetically those percentages for the values ​​of the deficiency, disability and handicap, the legal assessor assigned to each of them.

ARTICLE 10. INSTRUCTIONS FOR MEDICAL INTERCONSULTORES.

To determine the loss of earning capacity, qualifiers must have the technical background on the objective medical conditions studied. These records are provided by physicians or interconsultores of the IPS to which the patient is affiliated. For purposes of complying with this requirement, qualifiers interconsultores should require the appropriate medical and technical concept, fulfilling the following requirements:

1. Interconsultor the treating physician or expert advice that keeps your specialty (recognition and determination of diagnosis and clinical status of a particular disease that presents an affiliate), must consider that his report will be used by the assessor to determine the loss in earning capacity that has that individual.

2. Therefore, you should consider the expertise is requested in order to determine exclusively the professional consultant and as accurately as possible, the extent and the commitment of the pathology presented by the patient. Record should avoid personal opinions or ideas on the degree of disability of individuals studied, because such an assessment is a matter that belongs only to those who can legally determine.

3. The doctor should interconsultor decision solely on the diagnosis of a member, using language similar to the Manual.

4. In the presence of situations difficult to assess, you should inform the assessor about the examinations or tests of additional diagnostic aid should be made to give an accurate report. In no case can be taken into account reviews provided by patients or persons concerned.

5. There must be consistency between the history told by the worker, provided legal review and the doctor's conclusions interconsultor. Any inconsistencies should be reviewed and clarification, and inform the assessor and the competent authority.

6. The doctor interconsultor shall act exclusively in relation to their specialty, on the points requested by the qualifier, among which may contain at least the following: Date of care, diagnosis, treatment received or implied, concept and prognosis.

ARTICLE 11. INTERPRETATION OF THE RULES OF THE MANUAL.

To understand this Manual shall apply the following rules of interpretation:

1. The words used in their natural and obvious meaning, or has the meaning in the dictionary of the Real Academia de la Lengua.

2. The terms of technical content for use with the meaning in their fields.

3. The definitions and concepts set out in the manual, be construed in context and with their own meaning in it.

4. When a disease or diagnosis does not appear in the text of this Manual, or can not be approved at the same, be referred to the interpretation of similar instruments from other countries or international bodies such as the Committee of Experts of the ILO, Manual of Consequences of Disease and the WHO Manual on Disabilities American Medical Association AMA.

ARTICLE 12. BOOK ONE-OF DEFICIENCIES.