BY LUIS PEREZ-CORDERO — The importance of the AMA Guides in determining impairment in Workers’ Compensation cases is fundamental to achieving reliable outcomes and reducing abuse of the system. I’d like to briefly cover a few areas of interest:
· First, it must be established that all impairment must have an objective foundation. It goes without saying that abuses in the system can and often do stem from the lack of objective medical evaluations. The lack of objectivity may not be intentional, but may be prompted instead by a lack of training in the proper use of the AMA Guides combined with the conflicting information reported in Almarez-Guzman-1 (AG1) and Almarez Guzman-2 (AG2), both released in 2009 and just seven months apart.
· Second, misquoting the AMA Guides or the criteria necessary to support any given impairment is not an objective foundation for impairment. Most commonly, the quoting of the exact language for a DRE Category II, rather than the relevant objectives at MMI. Here is where proper training comes in. If every claims administrator possessed a working copy of the AMA Guides at their desk and received training that emphasized objectivity and standardization we would likely see an improvement in the quality of impairment determinations submitted by physicians.
· Finally, subjective complaints without a clinical foundation cannot serve as the sole criterion upon which decisions about impairment are made. Here again, the emphasis needs to be on standardization and cohesiveness. The AMA Guides are an excellent resource and effective tool for combating the problems associated with reliance on subjective rating criteria that have become common practice in the industry.
For more on this topic, please read my column in WorkCompCentral on Thursday, March 4th. In addition, I look forward to discussing these topics with you at the conference. Before the conference, consider the following:
- Does every claims administrator in your organization have a working copy of the AMA Guides at their desk?
- Who does their training?
- Are your trainers balanced or one-sided?”
Let me know your answers here by writing them in the blog.