AMA Guides & Permanent Impairment
5/15/2009 12:14:58 PM EST
Jesse N. Rosen on AMA Guides, Spinal Impairment, and First Reported Calif. Workers' Compensation Cases
Attorney at Law, Los Angeles, CA
Ch. 15 of the AMA Guides, 5th Edition, details the methods of assessing Whole Person Impairment (WPI) for spinal injury. It sets forth detailed instructions and methods of determining spinal WPI. Two methods of evaluating spinal WPI are provided: DRE (Diagnosis Related Estimate) and ROM (Range of Motion). The instructions regarding which method to use are vague and sometimes contradictory. The instructions for rating within the respective methods can also be less than clear.
There are now four reported California workers' compensation cases that apply Ch. 15 to spinal impairment issues. This article analyzes these first efforts to apply the AMA Guides to spinal injury and WPI issues in California. These cases address the question of whether DRE or ROM should be used, as well as proper application of DRE categories. While each of these cases addresses other issues besides spinal WPI, this article focuses on the spinal impairment issues only.
The other three decisions that are examined in this article contain issues of multiple level involvement. Multiple level involvement is set forth in the AMA Guides as one of several situations in which ROM may be used to assess WPI for spinal injury, although the phrase is not defined in the Guides. Two of these decisions touch on the question as to whether disc bulging is a sign of multiple level involvement allowing use of the ROM method.
The issues of how different DRE categories are assigned, and how multiple spinal region impairments are assigned, are contained in the fourth decision that is reviewed in this article. Hernandez v. Lonestar Trucking, 2007 Cal. Wrk. Comp. P.D. LEXIS 143, involves spinal injuries in all three spinal regions. The case summary explains whether the workers' compensation administrative law judge found the WPI assigned for each region to be justified, based on the findings of the physician.
These four California decisions that attempt to apply Ch. 15 of the AMA Guides have yielded uneven results, as is noted in the comments on each decision in this article. The author states that, “This is understandable, since the Guides are complex, the instructions are subject to interpretation, and the text itself is not clear at points. It is up to parties to scrutinize medical reports and compare the findings to the requirements of Ch. 15 to see if the method for reporting spinal WPI is correct and if the category and level of WPI are correct.”
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