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Name of Requestor:
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Email Address:
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Carrier / Adjust. Agency:
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Direct Voice Number:
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Fax Number:
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Billing Email Address:
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Olgilvie Calculation Services
Basic Calculation BC
1 or 2 Impairments
($95-125)
Complex Calculation CC
3 or More Impairments
($175-225)
Optional Rush Services
Regular Turnaround RT
Same Day ($75) SD
1 Business Day ($50) 1
2 Business Days ($40) 2
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Required Service Level:
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Rush Service: SD, 1 or 2
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PDF of Word Format:
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Injured Worker Information:
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IW Name:
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Claim Number:
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SS # (Last 4 Numbers):
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Employer:
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Occupation:
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Date of Injury:
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Date of Birth:
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Injuries To:
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Impairment (WPI%)
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Total Earnings for Last 3
Years (Post Injury)
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1. Print a Copy of request for your records
2. Send Income Documentation for Last 3 Years (Post Injury)
3. Send Impairment / PD Determination Information and/or Medical Report
As a Fax to (415) 276-3741
Or as Email Attachment to pdrating@att.net
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Olgilvie DFEC Adjustment Factor Calculator:
1. IW Earnings for past 3 years Post Injury (IWE)
2. Income for similar Uninjured Worker for same 3 year period (UWE).
3. UWE minus IWE = Earnings Loss Estimate (ELE).
4. Divide ELE by UWE = Proportional Earnings Loss (PEL)
5. Divide WPI by PEL = Individualized Loss Ratio (ILR)
6. See Table A of 05PDRS:
7. If ILR falls within range of ratios, then no Rebuttal. If outside the range of ratios, ILR
is used as New DFEC Multiplier
8. Use Formula to calculate Individual DFEC Adjustment
([1.81/a] X .1) + 1 = DFEC Adjustment Factor where "a" = ILR
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Example where:
IW = Age 43 Carpenter (Occ# 380)
IWE = $25,000 for past 3 years or $75,000
UWE = $180,000
WPI% = 05% for Lumbar DRE II (.05)
ELE = 180,000 – 75,000 = 105,000
PEL = 105,000/180,000 = .5833
ILR = .05/.5833 = .0857
.0857 falls out of the range of ratios FEC Rank of 5 for Lumbar Spine (a range between 0.963
and 1.133) along with all Range of Ratios. The minimum of all Range of Ratios is 0.450 (FEC
Rank of 8)
Formula for calculating the maximum and minimum FEC Adjustment Factors:
([1.81/a] X .1) + 1
In this case:
([1.81/.0857 =21.1202] X .1 = 2.12) + 1 = 3.12
PD Formula:
15.03.00.00 – 05 – [3.12] – 16 – (380 – H) – 20 – 21%
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