Senate Bill 899 (SB 899) has taken the California workers compensation industry by storm, revolutionizing the way permanent disability is determined along with changes in apportionment of disability. Now that the 5th Edition of the AMA Guides to the Evaluation of Permanent Impairment is the gold standard as the first step to determine permanent disability in California, the claims, legal, and judicial participants in the workers compensation system need their own guidance on the use of the AMA Guides in these cases. The Lawyer's Guide to the AMA Guides and California Workers' Compensation, 2008 Edition, by Robert G. Rassp, is the only practical guide to help you calculate and understand permanent disability ratings under SB 899 and the AMA Guides.
Workers' compensation claims involving the AMA Guides will emerge that hinge on the proper use, misuse, or under-use of the Guides and on the causation of permanent disability under the apportionment statutes and developing case law. The Lawyer's Guide to the AMA Guides and California Workers' Compensation will assist you in the proper use of the AMA Guides and thus enable you to determine whether a medical report constitutes substantial evidence. In addition, there are some observations about the AMA Guides that are intended to assist you in learning and understanding them and to help you formulate questions to doctors about them.
The Lawyer's Guide to the AMA Guides and California Workers' Compensation is organized as follows:
Ch. 1 How to Use This Guidebook
1.01 Purpose and Organization of This Guidebook
1.02 AMA GuidesFrequently Used Terms
1.03 AMA GuidesCommon Acronyms
1.04 AMA GuidesCommon Medical Conditions by AMA Guide Chapter
Ch. 2 Permanent Disability Ratings Under SB 899
2.01 The Effects of SB 899 Reform Legislation
2.02 Overview of 2005 Permanent Disability Rating Schedule
[1] Organization of 2005 PDRS
[2] Comparison to 1997 Rating Schedule
[3] Basic Components of 2005 PDRS
[4] Multiple-Step Process for Determining Permanent Disability
2.03 Application of AMA Guides to California Workers Compensation Cases
2.04 Compliance of Medical Reports With Requirements of AMA Guides
2.05 Pain Adjustments
2.06 Psychiatric Injuries
[1] Generally
[2] Ratings
[3] Apportionment
[4] Informal Ratings and Formal Rating Instructions in a AMA Guides Cases
2.07 Model Joint AME and Panel QME Letters
[1] Introduction
[2] Advocacy Letters
[3] Joint AME Letters
[4] Joint PQME Letters
[5] Required Elements in a AMA Compliant Medical Report
[6] Templates for Letters
Ch. 3 AMA Guides: Chapter-by-Chapter Analysis
3.01 Introduction
3.02 AMA Guides Chapter 1: Philosophy, Purpose, and Appropriate Use of the Guides
3.03 AMA Guides Chapter 2: Practical Application of the Guides
3.04 AMA Guides Chapter 3: The Cardiovascular System: Heart and Aorta; Chapter 4: The Cardiovascular System: Systemic and Pulmonary Arteries
3.05 AMA Guides Chapter 5: The Respiratory System
3.06 AMA GuidesChapter 6: The Digestive System
3.07 AMA Guides Chapter 7: The Urinary and Reproductive Systems
3.08 AMA Guides Chapter 8: The Skin
3.09 AMA Guides Chapter 9: The Hematopoietic System
3.10 AMA Guides Chapter 10: The Endocrine System
3.11 AMA Guides Chapter 11: Ear, Nose, Throat, and Related Structures
3.12 AMA Guides Chapter 12: The Visual System
3.13 AMA Guides Chapter 13: The Central and Peripheral Nervous System
3.14 AMA Guides Chapter 14: Mental and Behavioral Disorders
3.15 AMA Guides Chapter 15: The Spine
[1] Discussion and Analysis
[2] Checklist for Compliance of Medical Report on Spinal Injuries
3.16 AMA Guides Chapter 16: The Upper Extremities
[1] Overview
[2] ROM Measurements
[3] Peripheral Nerve Disorders
[4] Digital and Hand Impairments
[5] Carpal Tunnel Syndrome
[6] Complex Regional Pain Syndrome
[7] Vascular Disorders
[8] Other Disorders
[9] Checklist for Evaluating Upper Extremity Impairments
[10] FEC Adjustments
3.17 AMA Guides Chapter 17: The Lower Extremities
[1] Overview
[2] 13 Methods of Evaluation
[3] Gait Derangement
[4] Atrophy
[5] ROM Testing
[6] Multiple Lower Extremity Impairments
[7] Arthritic Conditions
[8] Amputations
[9] Diagnosis Based Estimates
[10] Peripheral Nerve Injuries
[11] Complex Regional Pain Syndrome
[12] Peripheral Vascular Disease
[13] FEC Adjustment
3.18 AMA Guides Chapter 18: Pain
Ch. 4 Substantial Medical Evidence in a AMA Guides Case
4.01 Model Sequential Step Analysis
4.02 Substantial Evidence Defined
4.03 AMA Compliant Reports
[1] Defined
[2] Required Elements
4.04 The Good, the Bad, and the Ugly: Examples of AMA Compliant and Non-AMA Compliant Medical Reports
[1] In General
[2] Example #1: Lumbar Spine Impairment Rating
[3] Example #2: Upper Extremity (Left Wrist) Impairment Rating
[4] Example #3: Multiple Orthopedic Impairment Ratings
[5] Example #4: Upper Extremity (Shoulders, Wrists, Elbow) Impairment Rating
[6] Example #5: Lumbar Spine, Thoracic Spine, and Hip Impairment Ratings
[7] Example #6: Lower Extremity (Patella Fracture) Impairment Rating
[8] Example #7: Head Injury Impairment Rating
Ch. 5 Developing the Record to Establish Accurate Ratings Under the AMA Guides
5.01 Introduction
5.02 Justification for Use of the Guides in Workers' Compensation Cases
5.03 Development of the Record Using AMA Guides Chapters 1 and 2
5.04 Population Averages
5.05 Age or Gender Related Impairments
5.06 Apportionment, Duplication, and Overlap
5.07 Risk Factors and Causation of Permanent Disability
5.08 Use of Clinical Judgment
5.09 Practical Applications of the Guides
5.10 Measurements Must Be Reliable
5.11 Assistive Devices
5.12 Side Effects of Medication
5.13 Spinal Injury Cases--DRE vs. ROM Methods
5.14 Muscle Strength Deficits
5.15 Complex Regional Pain Syndrome
5.16 Chronic Pain Syndromes
5.17 Failed Lumbar Syndrome
5.18 Multiple System Impairments
5.19 Sleep Disorders
[1] Introduction and Background
[2] Is Sleep Disorder Ratable?
[3] AMA Guides Discussion of Sleep Disorder
[4] Checklist for Sleep Disorder Claims
5.20 Obstructive Sleep Apnea
5.21 Fibromyalgia
[1] Introduction and Background
[2] Inconsistency in AMA Guides Regarding Fibromyalgia
[3] Is Fibromyalgia Ratable?
5.22 Pain Add-Ons
5.23 Zero Percent Impairment Ratings
Ch. 6 Application of AMA Guides and 2005 PDRS
6.01 Example 1: More Than One Body Part Injured in One Injury
6.02 Example 2: Upper Extremity Injury and Its Sub-Regions
6.03 Example 3: More Than One Body Part Injured in More Than One Injury
6.04 Example 4: Failed Back Case With Psychiatric and Pain Sequelae
6.05 Example 5: Voice/Speech Impairment
6.06 Example 6: Recurrent Disc Herniation
6.07 Example 7: Multiple Upper Extremity Injuries
Ch. 7 Case Summaries With Commentary
7.01 Introduction
7.02 Permanent Disability, Apportionment, and PDRS
7.03 Applicability of 2005 PDRS to Injuries Prior to 1/1/2005
Ch. 8 Medical and Vocational Evidence
8.01 Direct and Cross Examination of Applicants
[1] Introduction
[2] Applicants Deposition
[3] Other Deposition and Trial Considerations
8.02 Direct and Cross Examination of Physicians
[1] Introduction
[2] Checklist of Questions in a AMA Guides Case
8.03 Medical Questions on Pathology
8.04 Bibliography of LexisNexis® Medical and Vocational Products
[1] Medical Products
[2] Vocational Products
8.05 Medical and Vocational Hypothetical
[1] Extrinsic Evidence in a AMA GuidesCase
[2] Hypothetical
Appendix A 2005 Permanent Disability Rating Schedule
Appendix B Permanent Disability Rates
Index
Rassp, Robert G.
Robert G. Rassp is a graduate of Loyola Law School class of 1981. He previously earned two undergraduate degrees from the University of California at Irvine in 1978 at age 20.
Mr. Rassp has practiced workers' compensation and Social Security disability law since 1981 and is the principal of his own law firm since 1983. In addition to his law practice, Mr. Rassp was the Chair of Friends Research Institute's West Coast Institutional Review Board for fifteen years. The IRB is a committee consisting of eleven members that conducts the oversight of human subject medical research under the auspices of the Food and Drug Act, 21 CFR 50, 21 CFR 56, and 45 CFR 46. In 2005, Mr. Rassp was appointed as a member of the Friends Research Institute's Board of Directors and remains a member of the FRI East Coast IRB.
In addition to his duties as an attorney and medical ethicist, Mr. Rassp was appointed as a member of the State Bar Workers' Compensation Law Section Executive Committee in April 1998 and became its Chair in 2000-2001. Mr. Rassp was reappointed as a member of the Workers' Compensation Law Section Executive Committee in May 2003 and is currently an advisor to the Committee.
Mr. Rassp has conducted workers' compensation judge's training seminars at the request of the Division of Workers' Compensation. Topics presented include substantial evidence in AMA Guides cases and the integration of workers' compensation settlements, Social Security disability, and Medicare issues. Since the enactment of SB 899 in April 2004, Mr. Rassp has conducted over 30 seminars for the workers' compensation community, including for the Division of Workers' Compensation, California Applicants' Attorneys Association, California Workers' Compensation Defense Attorneys Association, Workers' Compensation Claims Association, and the San Fernando Valley Bar Association. In 2005, Mr. Rassp was a contributing author for Chapters 29 (Social Security and Medicare) and 32 (Permanent Disability Rating Schedules) in Hanna, California Law of Employee Injuries and Workers' Compensation (LexisNexis Matthew Bender), and Chapter 7 (Permanent Disability Rating Schedule) in Herlick, California Workers' Compensation Law (LexisNexis Matthew Bender).
Mr. Rassp is also a member of the LexisNexis California Workers' Compensation Editorial Board and is a member of the sub-committee for WCAB Noteworthy Panel Decisions.