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Permanent impairment claim – combining components of impairments of limbs

We have noticed a reasonably regular error made by doctors in assessing permanent impairment of limbs when there are several components to the impairment of that limb. It involves ignoring chapter 2.8 of the SIRA Impairment Guides in respect of upper extremity assessments and chapter 3.6 in respect of lower extremity impairments.
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Can total permanent impairment exist immediately before death?

After suffering an horrific accident at work, a person survives for three minutes with debilitating injuries, then dies.

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