Workers' Compensation

California Noteworthy Cases Interpreting the AMA Guides to the Evaluation of Permanent Impairment - Fifth Edition

In this Emerging Issues Analysis, Thomas A. Robinson analyzes noteworthy cases from California that interpret the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition. Robinson initially explains that California adopted the AMA Guides as follows: “Cal. Lab. Code § 4660(b)(1), as amended by SB 899, effective April 19, 2004, provides: "For purposes of this section, the 'nature of the physical injury or disfigurement' shall incorporate the descriptions and measurements of physical impairments and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition)." Pursuant to Cal. Lab. Code § 4660(b)(2), the Administrative Director of the Division of Workers' Compensation was required to "formulate the adjusted rating schedule based on empirical data and findings from the Evaluation of California's Permanent Disability Rating Schedule, Interim Report (December 2003), prepared by the RAND Institute for Civil Justice, and upon data from additional empirical studies." According to Cal. Lab. Code § 4660(e), the Administrative Director was required to perform this task by January 1, 2005, which she did, in the form of the 2005 Permanent Disability Rating Schedule, applicable to all claims arising on or after January 1, 2005. Additionally, Cal. Lab. Code § 4660(d) provides: "For compensable claims arising before January 1, 2005," the 2005 Permanent Disability Rating Schedule ‘shall apply to the determination of permanent disabilities when there has been either no comprehensive medical-legal report or no report by a treating physician indicating the existence of permanent disability, or when the employer is not required to provide the notice required by [Labor Code] Section 4061 to the injured worker.’”
 
He examines in detail cases dealing with the following:
  • Cases on Validity of 2005 Permanent Disability Rating Schedule; Rebuttal Evidence.
  • Cases on Rebutting AMA Guides.
  • Case Involving Injury to Ankle.
  • Case Involving Injury to Arm.
  • Cases Involving Injury to Back or Spine.
  • Case Involving Injury to Knee and Wrist.
  • Case Involving Injury to Wrist.
  • Case Involving Injury to Hand.
  • Case Involving Injury to Heart.
  • Case Involving Injury to Hip.
  • Case Involving Injury to Leg.
  • Cases Involving Injury to Multiple Body Parts.
 
(Article length: approx. 43 pages)
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 This article is excerpted from the new AMA Guides volume of Occupational Injuries and Illnesses (Matthew Bender) (published October 2009). This volume on the AMA Guides is intended to help attorneys, claims adjusters, and other personnel apply the AMA Guides to individual cases. Because most insurance law and workers’ compensation law is statutorily-derived and cases are adjudicated at the state level, it is important to be familiar with the impairment rating system used in each practitioner’s state. States have different philosophies, public policies, and laws regarding the use and application of the AMA Guides to individual claims administered in that state. To that end, this Volume attempts to capture court cases that have addressed the use of the AMA Guides methodology and impairment rating system, specific to each state. 
  • This is a great overview of the complex impairment rating system from an attorney perspective. Several attorneys believe the FCE is one way to find the true impairment. But the AMA differs from the California WCAB decisions and the true impairment continues to broaden in range. A better solution is to utilize the California Functional Capacity Evaluations by Safety Works Medical Inc. This is the only company i know that adopts their findings of impairment to current writ decisions More info can be found at www.safetyworks.org