AMA Guides® Newsletter - Issue Archive

Articles

1. Longshore and Harbor Workers' Compensation Act: Use of AMA Guides

   Christopher R. Brigham

   Pages 1–12

   DOI: 10.1001/amaguidesnewsletters.2003.MarApr01

   Abstract

   The US Congress passed the Longshore and Harbor Workers’ Compensation Act (LHWCA) in 1927 to provide coverage to longshore laborers working on navigable waters of the United States when no state workers’ compensation law applied. After amendments that extended and standardized the Act, the Longshore Compensation Act provides more than $670 million in monetary, medical, and vocational rehabilitation benefits to more than 72,000 individuals annually. Under the LHWCA, ratings are performed for “scheduled injuries” (ie, a scheduled member of the body), including upper extremity injuries (excluding the shoulder), lower extremity injuries, and hearing loss. Impairment ratings typically are expressed in terms of whole person permanent impairment, but under the LHWCA impairment is expressed in the smallest applicable body part (eg, an injury of two digits is expressed as a hand rating). Definitions of terms such as injury, disability, and impairment are similar in the LHWCA and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Claims examiners are advised to require any physician selected to evaluate permanent medical impairment to use the AMA Guides, where applicable, to be detailed in their assessment report, and to rate and report permanent impairment according to the AMA Guides. Boxes in the article present portions of the LHWCA that address compensation for disability and the basic elements required to evaluate anatomical impairment.
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2. Legal Update: Cross-Examination: Fifth Edition Examples

   Christopher R. Brigham

   Pages 8–10

   DOI: 10.1001/amaguidesnewsletters.2003.MarApr02

   Abstract

   Physicians may need to defend their impairment evaluation opinions during cross-examination, and, in contrast to direct examination during which leading questions cannot be asked, during cross-examination the laws of evidence allow the questioning attorney to pose leading questions that are designed to elicit more information than a “yes” or “no” answer. A witness being cross-examined with leading questions typically may respond “yes,” “no,” or “I don't know,” but physicians should not volunteer information during examination because this may disclose inappropriate information. Similarly, physicians should avoid vague terms such as “I guess,” “I believe,” or “It's possible.” If the witness does not know the answer, the proper response is “I don't know,” or “I don't remember.” The expert's professional qualifications, expert opinion, and reasoning in forming that opinion are all subject to challenge, and the expert must be qualified to perform permanent impairment evaluations and prepare a report with supportable conclusions. The article includes examples of cross-examinations based on principles from the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Chapters 1 and 2. For example, evaluators may be criticized for erroneously using the terms guidelines instead of guides and disability instead of impairment; physicians who use impairment and disability interchangeably should expect close cross-examination. Evaluating physicians also may be challenged regarding their status as “independent and unbiased” examiners based on having seen the patient only once or, as a treating physician, on numerous occasions.
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3. Impairment Tutorial: Hearing Impairment

   Kathryn Mueller, Christopher R. Brigham

   Pages 11–11

   DOI: 10.1001/amaguidesnewsletters.2003.MarApr03

   Abstract

   A 1999 study of adults showed hearing loss was the fifth most common disability in the US population, and almost 50% of workers in carpentry, plumbing, and mining had hearing impairment. Determining hearing impairment according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 11.2a, Criteria for Rating Impairment Due to Hearing Loss, is straightforward, if limited. Examiners should be aware that hearing can be temporarily impaired by recent exposure to loud noise and should test only after an extended period without such exposure. Audiometers should be properly calibrated, and technicians must be appropriately trained to obtain accurate measurements. The evaluator should separately test both of the individual's ears at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz (the representative or test frequencies) and then identify the total worst ear decibel level using the AMA Guides Table 11-1 or 11-2. The evaluator can use Tale 11-3 to convert hearing impairment to whole person loss. Tinnitus also can be rated if a hearing loss in that ear affects speech discrimination; in such instances, the tinnitus rating is limited to a 5% loss. The article includes a Hearing Impairment Rating Sheet that can be used to record data from the hearing impairment evaluation.
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