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CALIFORNIA COMPENSATION CASES
Vol. 88, No. 9 September 2023
A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions...
MYTH #6: The Vast Majority of All Medical Reports Using the AMA Guides Are Inaccurate
This assertion has been repeatedly made any time a version of the AMA Guides has first been adopted in a state that mandates its use in a state’s workers’ compensation system. California adopted the 5th Edition of the AMA Guides in April 2004. Within a year, a cottage industry of “expert” reviewers developed in which the recurring mantra was that the vast majority of medical reports written by treating or evaluating physicians were not “accurate.”
The fact of the matter is that the authors of the AMA Guides were careful in stating that the Guides is intended for reference by physicians as a guideline only, and each physician should use his or her own clinical judgment in determining an accurate permanent impairment rating. On page 1 of the 5th Edition, the authors state:
“The purpose of this fifth edition of the Guides is to update the diagnostic criteria and evaluation process used in impairment assessment, incorporating available scientific evidence and prevailing medical opinion. Chapter authors were encouraged to use the latest scientific evidence from their specialty and, where evidence was lacking, develop a consensus view.”
First of all, this directive is misleading. The WPI ratings in all versions of the AMA Guides are not based on any scientific research, epidemiological studies, clinical trials or any other objective analysis. They are “consensus derived”, which means that someone voted on adopting WPI ratings based on some undisclosed criteria and without even discussing minority views of physicians. In real medical science, “prevailing medical opinion” can be totally wrong.
Second, there is no correlation between a given WPI rating and loss of function or effects of impairment on activities of daily living. Even the definition of “ADLs” has changed between the different versions of the Guides, with different WPI ratings for the same medical conditions between different versions of the Guides.
Third, the diagnostic criteria for ratable impairments have changed since the 5th Edition of the AMA Guides was published in 2000. Current diagnostic criteria for hypertension and complex regional pain syndrome are examples where those listed in the 5th Edition are completely obsolete.
The point is that even the individual authors, editors, contributors and followers of the AMA Guides, regardless of version, cannot profess to be any more qualified to write an “accurate” report than any other physician. Each version of the Guides states that the determination of whether an injury or illness results in a permanent impairment requires a medical assessment by a physician. See 5th Edition, section 1.2a, page 2. How can any so-called “expert” reviewer say that the vast majority of medical reports that use the AMA Guides are inaccurate when the reviewer has not performed an assessment of the patient?
In California, reports written by these “experts” who review and critique medical reports are not admissible at the WCAB, and cause significant consternation among reputable treating and evaluating physicians who have a deep understanding of the AMA Guides and case law that mandates certain interpretations and applications of the language in the Guides. Hopefully, other states like Illinois will develop similar case law.
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