Impairment Questions and Answers

1997 ◽  
Vol 2 (2) ◽  
pp. 4-5
Keyword(s):  
Insurance Industry ◽  
Organized Labor ◽  
Injured Workers ◽  
Disability Benefits ◽  
Uniform System ◽  
Questions And Answers

Abstract Controversy attends use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in defining injured workers’ permanent partial disability benefits: States desire an efficient, nonsubjective way to determine benefits for nonscheduled injuries and are using the AMA Guides to define the extent of disability. Organized labor is concerned that use of the AMA Guides, particularly with modifications, does not yield a fair analysis of an injured worker's disability. From its first issue, The Guides Newsletter emphatically emphasized and clearly stated that impairment percentages derived according to AMA Guides criteria should not be used to make direct financial awards or direct estimates of disability. The insurance industry and organized labor differ about the use of the AMA Guides in defining permanent partial disability (PPD). Insurers support use of the AMA Guides because they seek a uniform system that minimizes subjectivity in determining benefits. Organized labor is particularly concerned about the lack of fairness of directly equating impairment and disability, and if the rating plays a role in defining disability, additional issues also must be considered. More states are likely to use the AMA Guides with incorporation of additional features such as an index to PPD.

scholarly journals O2C.2 Does region of residence matter for return-to-work after work-related injury? A comparative analysis of six canadian workers’ compensation jurisdictions

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A16.1-A16
Author(s):  
Robert Macpherson ◽  
Hui Shen ◽  
Mieke Koehoorn ◽  
Benjamin Amick ◽  
Alex Collie ◽  
...  
Keyword(s):  
Return To Work ◽  
Rural Areas ◽  
Urban Areas ◽  
Work Disability ◽  
Injured Workers ◽  
Workers Compensation ◽  
Disability Benefits ◽  
Work Related ◽  
Work Related Injury ◽  
Urban Rural

ObjectivesTo investigate regional differences in return-to-work following work-related injury and whether these differences persist after adjusting for individual characteristics.MethodsWorkers’ compensation claims from six Canadian provinces were used to create comparable cohorts of workers aged 15–80 with a work-related injury resulting in at least one disability day from 2011 to 2015. Workers’ residential postal codes were mapped to Census standard geographic units to categorize workers into six regions representing decreasing urban density and metropolitan influence (ranging from large urban areas of 100,000+people to rural areas of <10 000 people with no metropolitan influence). Cox regression models were used to estimate the effect of urban-rural residence on the likelihood of injured workers transitioning off work disability benefits within one-year post-injury, adjusting for confounders, including provincial compensation jurisdiction. Models were stratified by industry sectors.ResultsThe cohort included 7 46 029 work disability claims, of which the majority resided in large urban areas (69%). Unadjusted models showed that workers residing in smaller urban and rural areas had a lower likelihood of transitioning off work disability benefits compared to those in large urban areas. Urban-rural differences persisted in adjusted models (e.g. HR=0.91 95% CI 0.89, 0.94 for workers in rural areas with no metropolitan influence). Industry-stratified models showed that greater differences existed between urban and rural places of residence for workers in the transportation and construction sectors, and smaller differences for workers in the health care and manufacturing sectors.ConclusionsThe main finding suggests that injured workers in more rural areas face barriers in returning to work and that workers’ compensation resources may need to be allocated to address these regional disparities. Future research will incorporate both individual and regional-level variables in a multilevel model framework to identify the characteristics that are the most important in explaining variability in work disability duration.

The AMA Guides in Pennsylvania “Post-Protz”: Act 111 and Case Law Update

2020 ◽  
Vol 25 (3) ◽  
pp. 12-19
Author(s):  
Justin D. Beck ◽  
Judge David B. Torrey
Keyword(s):  
Case Law ◽  
General Assembly ◽  
Disability Benefits ◽  
Permanent Disability ◽  
Sixth Edition ◽  
Legal Questions ◽  
The Supreme Court ◽  
Recent Edition ◽  
Impairment Ratings

Abstract Medical evaluators must understand the context for the impairment assessments they perform. This article exemplifies issues that arise based on the role of impairment ratings and what edition of the AMA Guides to the Impairment of Permanent Impairment (AMA Guides) is used. This discussion also raises interesting legal questions related to retroactivity, applicability of prior precedent, and delegation. On June 20, 2017, the Supreme Court of Pennsylvania handed down its decision, Protz v. WCAB (Derry Area Sch. Dist.), which disallows use of the “most recent edition” of the AMA Guides when determining partial disability entitlement under the Pennsylvania Workers’ Compensation Act. An attempted solution was passed by the Pennsylvania General Assembly and was signed into law Act 111 on October 24, 2018. Although it affirms that the AMA Guides, Sixth Edition, must be used for impairment ratings, the law reduces the threshold for total disability benefits from 50% to 35% impairment. This legislative adjustment benefited injured workers but sparked additional litigation about whether, when, and how the adjustment should be applied (excerpts from the laws and decisions discussed by the authors are included at the end of the article). In using impairment as a threshold for permanent disability benefits, evaluators must distinguish between impairment and disability and determine an appropriate threshold; they also must be aware of the compensation and adjudication process and of the jurisdictions in which they practice.

Questions and Answers: Rating Spinal Pain Using the Sixth Edition

2013 ◽  
Vol 18 (5) ◽  
pp. 11-12
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage ◽  
Marjorie Eskay-Auerbach ◽  
Charles N. Brooks
Keyword(s):  
Spinal Pain ◽  
Sixth Edition ◽  
Questions And Answers

Impairment Questions and Answers

1999 ◽  
Vol 4 (4) ◽  
pp. 4-4
Keyword(s):  
Symptom Validity ◽  
Validity Testing ◽  
Symptom Validity Testing ◽  
Negative Results ◽  
Tunnel Vision ◽  
Questions And Answers ◽  
Blurry Vision ◽  
Fatigue Evaluation ◽  
Choice Testing ◽  
Rule Out

Abstract Symptom validity testing, also known as forced-choice testing, is a way to assess the validity of sensory and memory deficits, including tactile anesthesias, paresthesias, blindness, color blindness, tunnel vision, blurry vision, and deafness—the common feature of which is a claimed inability to perceive or remember a sensory signal. Symptom validity testing comprises two elements: A specific ability is assessed by presenting a large number of items in a multiple-choice format, and then the examinee's performance is compared with the statistical likelihood of success based on chance alone. Scoring below a norm can be explained in many different ways (eg, fatigue, evaluation anxiety, limited intelligence, and so on), but scoring below the probabilities of chance alone most likely indicates deliberate deception. The positive predictive value of the symptom validity technique likely is quite high because there is no alternative explanation to deliberate distortion when performance is below the probability of chance. The sensitivity of this technique is not likely to be good because, as with a thermometer, positive findings indicate that a problem is present, but negative results do not rule out a problem. Although a compelling conclusion is that the examinee who scores below probabilities is deliberately motivated to perform poorly, malingering must be concluded from the total clinical context.

Questions and Answers

2000 ◽  
Vol 5 (2) ◽  
pp. 3-3
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Spinal Nerve ◽  
Sensory Loss ◽  
Residual Symptoms ◽  
Additional Information ◽  
Questions And Answers ◽  
Motor Nerves ◽  
Symptoms And Signs ◽  
Limited Motion

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes procedures for rating upper extremity neural deficits in Chapter 3, The Musculoskeletal System, section 3.1k; Chapter 4, The Nervous System, section 4.4 provides additional information and an example. The AMA Guides also divides PNS deficits into sensory and motor and includes pain within the former. The impairment estimates take into account typical manifestations such as limited motion, atrophy, and reflex, trophic, and vasomotor deficits. Lesions of the peripheral nervous system may result in diminished sensation (anesthesia or hypesthesia), abnormal sensation (dysesthesia or paresthesia), or increased sensation (hyperesthesia). Lesions of motor nerves can result in weakness or paralysis of the muscles innervated. Spinal nerve deficits are identified by sensory loss or pain in the dermatome or weakness in the myotome supplied. The steps in estimating brachial plexus impairment are similar to those for spinal and peripheral nerves. Evaluators should take care not to rate the same impairment twice, eg, rating weakness resulting from a peripheral nerve injury and the joss of joint motion due to that weakness.

Questions and Answers

2011 ◽  
Vol 16 (4) ◽  
pp. 13-15
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage ◽  
Craig Uejo
Keyword(s):  
Questions And Answers
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