Ankle and foot injuries, rated the same way

A page that publishes an “average workers’ comp settlement for ankle surgery” is publishing a number nobody can stand behind. A California settlement is built from the impairment rating, apportionmentApportionment Dividing permanent disability between industrial and non-industrial causes. It is to disability, not to findings on an image., your occupation and age, your earnings, and future medical care. Two workers with the same fracture and the same surgery can end up with very different ratings. The useful question is whether yours was rated correctly, and you can check that on paper. What the number is built from.

Permanent impairment of the leg is measured under Chapter 17 of the AMA Guides, 5th Edition. Chapter 17 offers thirteen ways to evaluate a lower extremity: diagnosis-based estimates, range of motion, arthritis measured by cartilage interval, muscle atrophy, strength, gait derangement, and others. The result is stated in lower extremity percent and then converted: 100% lower extremity is 40% whole person.

The state’s rating schedule gives every method its own impairment number. For the ankle and foot, the list looks like this:

Summarized from the impairment number list in the 2005 Permanent DisabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week. Rating Schedule. The first two digits are the AMA Guides chapter. The list names methods, not values.

Notice what is not on it. There is no entry named for an Achilles tendon rupture, for plantar fasciitis, or for a sprain. Like a rotator cuff tear at the shoulder, those conditions are rated by what they left behind: motion, strength, stability, the joint surface, the way you walk. If your motion comes back and nothing else measures, the strict rating can be very small. That is the method working as written.

The methods cannot simply be added together. The Guides include a table specifically to prevent double-counting, and its rules are strict:

• Arthritis stands apart. It cannot be combined with range of motion, atrophy, strength, or gait.
• Atrophy, strength, and gait derangement are mutually exclusive with each other.
• Gait derangement is a last resort. It stands alone and is used only when nothing else applies. In the schedule it is coded for the whole leg, at 17.01.07.00, not at the ankle.
• Where more than one method applies, the Guides direct that the method producing the higher rating be adopted. That is the chapter’s own instruction, not an argument.

So the evaluator has to choose, and the choice is checkable:

An evaluator who computes two methods and reports the lower one has misapplied the chapter. The knee page describes the same error. Separate impairments, such as an ankle and a tibia, or a foot and the toes, are combined through the Combined Values Chart, which produces less than simple addition. Vigil v. County of Kern (2024, WCABWCAB Workers’ Compensation Appeals Board. The court system that decides these cases. 23 district offices statewide. en banc) held that the chart is rebuttable.

For injuries on or after January 1, 2013, the Division of Workers’ Compensation’s rating unit puts the formula this way: “The WP impairment will be multiplied by the 1.4 modifier, rounded to the nearest whole number, and then adjusted for occupation and age.” That is § 4660.1(b).

Occupation is assigned by what you actually did all day, not by your job title, and the variant is specific to the injured body part. If you spent your shifts on your feet and the group on your string describes a desk job, say so. Age is your age at the date of injuryDate of injury For a cumulative or occupational disease claim, the law sets it as when you first suffered disability and knew or should have known it was work-related — not when the wear began. Almost every deadline runs off this.: older workers rate higher, younger lower, and the neutral bracket is 37 to 41. How the adjustments work.

Before 2013, injuries were rated with an earning-capacity rank instead of the 1.4. In the schedule, the ankle and foot carry rank 2, the same low rank as the knee.

Read the string. An ankle rated on range of motion produces a string beginning 17.07.04.00: Chapter 17, region 07 (ankle), method 04 (range of motion). An instability rating begins 17.07.10.01, and gait derangement begins 17.01.07.00. If the code does not describe what is actually wrong with your ankle, that is visible on the face of the document. Decode yours.

Where every strict method still misses, Almaraz/GuzmanAlmaraz/Guzman The doctrine permitting a physician to depart from the strict AMA rating where it does not accurately reflect the impairment, using another method inside the “four corners” of the Guides. II (2009, WCAB en banc) lets a physician give the strict rating, explain why it fails, and use a more accurate method inside the four corners of the Guides. It is an argument, not an entitlement, and it has to be planned before the examination. What it requires.

Surgery is requested through utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out.. A decision to approve, modify or deny is due within five business days of receipt of the complete request. Only a physician may modify or deny. Most surgery denials are documentation problems. Guideline pathways almost always require a documented trial and failure of conservative care, with dates.

The guideline changed on August 1, 2026. Since then, the treatment schedule has incorporated the Ankle and Foot Disorders Guideline (ACOEM, January 29, 2026), at 8 CCR § 9792.23.7. If you get a denial, check which version it relies on.

If it is denied, you have 30 days from service to request Independent Medical ReviewIMR Independent Medical Review. The appeal from a UR denial. 30 days (10 if the dispute is only over drugs on the MTUS Drug List)., or 10 days if the dispute is only about a drug on the MTUSMTUS Medical Treatment Utilization Schedule. California’s treatment guidelines. Four of them — shoulder, elbow, hand/wrist/forearm and traumatic brain injury — were replaced January 2, 2026. Drug List. If the IMR form and an addressed envelope were not enclosed, the clock never started. A late utilization review decision is invalid, and under Dubon II (WCAB en banc, 2014) a judge then decides the treatment. How to check a denial.

A successful operation can lower a rating. That is not a reason to decline surgery you need, only a reason not to be surprised. Before surgery.

If the surgery made it worse, through a nonunion, failed hardware, infection, nerve injury or CRPS, that disability belongs to the claim. Hikida v. WCAB (2017) treats disability caused by industrial medical treatment as industrial. But County of Santa Clara v. WCAB (Justice) (2020) 49 Cal.App.5th 605 holds that Hikida “precludes apportionment only where the industrial medical treatment is the sole cause of the permanent disability.” The surgery made it worse.

An ankle injury changes the way you walk, and the joints above it absorb that. The other leg carries the load. And if your ankle gives way and you fall, what you break in the fall belongs to the original claim. These are compensable consequences. My other side started hurting.

None of them is added on its own. The claim form lists the ankle, the doctor treats the ankle, and the evaluator is asked about the ankle. The knee, the other foot and the back contribute nothing to the rating unless someone puts them in the record. Discovery closes at the mandatory settlement conferenceMSC Mandatory Settlement Conference. Where most cases end — and where discovery closes. and undisclosed evidence is generally inadmissible.

Tell your treating doctor and make sure the note says why: “right knee pain since altered gait from the left ankle injury.” Tell the claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer. in writing, and make sure the evaluator is asked about it before the examination. How to add a body part.

Expect three arguments: arthritis, body weight, and an old sprain. The physician must state what percentage of the permanent disability the injury caused and what percentage other factors caused. Under EscobedoEscobedo The en banc decision requiring an apportionment opinion to explain how and why. A percentage without reasoning is not substantial evidence. v. Marshalls (WCAB en banc), the opinion has to explain how and why. A report that names a condition and attaches a number is not substantial evidenceSubstantial evidence The standard a medical opinion must meet to support a finding..

We will be straight about the other side: under City of Petaluma v. WCAB (Lindh) (2018) 29 Cal.App.5th 1175, a pre-existing condition that never disabled you can still support apportionment, if it caused part of this disability. And an old injury is not an old award. § 4664(b)’s conclusive presumption needs an actual prior award.

• Were you doing your full job the day before? — Full duty without restriction is evidence of what the old condition was costing you.
• Did the evaluator review your pre-injury records? — An opinion built without them is built on assumption.
• What supports 40% rather than 15%? — The percentage has to be explained, not asserted.

How apportionment works. · They say it’s arthritis.

The voucher. If the injury caused permanent partial disability and your employer does not offer regular, modified or alternative work within 60 days after the claims administrator receives the physician’s Return to Work & Voucher Report, you are entitled to a Supplemental Job Displacement Benefit: a $6,000 voucher for injuries on or after January 1, 2013. The offered work must last at least 12 months and fit your restrictions. If you lost no time from work, or returned to the same job for the same employer, you are deemed to have been offered and accepted regular work.

The supplement. A voucher also opens the Return-to-Work Supplement Program, a one-time $5,000 payment. The application must be received within one year from the date the voucher was served on you. The voucher and the supplement.

Your job itself is a different body of law. FEHA requires employers with five or more employees to reasonably accommodate a known disability and to engage in a timely, good-faith interactive process. Ask in writing, and use the word “accommodation.” Return to work.

Feet and ankles wear out where the work is standing, walking and stepping down: warehouse shifts of ten to twelve hours on concrete; security foot patrol in issued boots; hotel housekeepers on hard floors, and the slips on wet bathroom floors; line cooks standing ten to twelve hours; truck drivers and refuse crews stepping down from the cab and the truck all shift; transit operators and garment workers on pedals; and ladder falls, where the heel takes the landing.

If your feet or ankles wore out over years rather than in one moment, that is a cumulative traumaCT — Cumulative trauma Injury from repeated exposure over time. The largest injury category in California and the least claimed. claim. The date of injury is when you first suffered disability and knew, or should have known, it was work-related — not when the wear began. Cumulative trauma.