AMA Guides® Newsletter - Issue Archive

Articles

1. State-by-State Use of AMA Guides

   Pages 3–7, 16

   DOI: 10.1001/amaguidesnewsletters.2019.SepOct01

   Abstract

   This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.
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2. Comorbid Conditions in Workers' Compensation

   Marcos Iglesias

   Pages 8–13

   DOI: 10.1001/amaguidesnewsletters.2019.SepOct02

   Abstract

   A comorbidity is a concomitant but unrelated pathological or disease process, and comorbid conditions are coexisting medical conditions that are not necessarily compensable in a work-related injury but may affect the individual's treatment and recovery. Many comorbid conditions also are chronic health conditions that may interact with the sequelae of a compensable injury or illness and/or may affect the individual's health and abilities. In addition to the normal physiological changes of age, advancing age increases the number and severity of comorbid conditions, and this article examines three: obesity, diabetes, and heart disease. Obesity is associated with increasing workers’ compensation claims, medical and indemnity claim costs, and lost workdays; it is also a risk factor for type 2 diabetes, cancer, heart disease, and numerous other chronic and serious diseases. Hypoglycemia associated with diabetes can lead to falls and accidents, and diabetes may delay healing, predispose to infection, and cause peripheral neuropathies. Uncontrolled hypertension may be present in half of people with hypertension, leading to increased cardiac risk, especially if procedures or operations are needed. Claimants with comorbid conditions should be identified early in the claims process so claim handlers can use available comorbidity calculators to better plan for higher costs, longer disability, and more complex medical management. Nurse case managers can help the injured worker navigate the health system and act as a liaison between claims staff and medial providers.
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3. Nonspecific Chronic Back Pain: Sixth Edition Approaches

   Jay Blaisdell, James B. Talmage

   Pages 14–15

   DOI: 10.1001/amaguidesnewsletters.2019.SepOct03

   Abstract

   Ratings for “non-specific chronic, or chronic reoccurring, back pain” are based on the diagnosis-based impairment method whereby an impairment class, usually representing a range of impairment values within a cell of a grid, is selected by diagnosis and “specific criteria” (key factors). Within the impairment class, the default impairment value then can be modified using non-key factors or “grade modifiers” such as functional history, physical examination, and clinical studies using the net adjustment formula. The diagnosis of “nonspecific chronic, or chronic reoccurring, back pain” can be rated in class 0 and 1; the former has a default value of 0%, and the latter has a default value of 2% before any modifications. The key concept here is that the physician believes that the patient is experiencing pain, yet there are no related objective findings, most notably radiculopathy as distinguished from “nonverifiable radicular complaints.” If the individual is found not to have radiculopathy and the medical record shows that the patient has never had clinically verifiable radiculopathy, then the diagnosis of “intervertebral disk herniation and/or AOMSI [alteration of motion segment integrity] cannot be used.” If the patient is asymptomatic at maximum medical improvement, then impairment Class 0 should be chosen, not Class 1; a final whole person impairment rating of 1% indicates incorrect use of the methodology.
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