A. DRE Impairment for Nonverifiable vs. Verifiable Radicular Complaints - Uploaded on 01-13-2015

Before estimating the extent of any impairment, the AMA Guides requires that physicians establish an accurate diagnosis.  The primary requirement is the confirmation of the presence or absence of specific pathology and/or loss of organ function.

Increasingly, we have encountered evaluations providing Cervical and Lumbar DRE II Impairment based on insufficient findings, without reporting any clinical elements (muscle spasm,  guarding, nonverifiable radicular pain) or medical history (prior history of verifiable radiculopathy) in support of the rated impairment. This trend is contrary to Sections 1.5, 15.1b, 15.3, 15.4 and 15.6 guidelines of the AMA Guides 5th Edition.

The attached Spine Impairment Appendix addresses the issue of non-verifiable vs. verifiable radicular complaints.  This Appendix will help you decide if the evaluation you are reviewing meets the minimal requirements for Substantial Medical Evidence in the use of a DRE Category II or a DRE Category III.

Spine Impairment Appendix


AA. Back to Basics 2005 thru 2013: Rating California Case Using the AMA Guides 5th Edition - Uploaded 12-24-2012 


B. Consistency of AMA Impairment Evaluation & Reporting - Updated June 14, 2012

Chapter 16 Upper Extremity Impairment Evaluation: Upper Extremities Appendix

Chapter 16 Grip Stength Impairment Evaluation: Grip Strength Appendix

Chapter 16 Brachial Plexus/Thoracic Outlet Syndrome Updated:
Brachial Plexus Appendix

Chapter 16  Brachial Plexus, Etiology, Symptoms, Evaluation (Revised):
Brachial Plexus Appendix II

Chapter 16  Brachial Plexus P&S Report Checklist (Revised): 
Brachial Plexus Appendix III

Chapter 15 Checklist for Impairment Evaluation Consistency re: Spine

Chapter 16 Checklist for Impairment Evaluation Consistency re: Upper Extremities

Chapter 16 Neurological Examination & Testing - PND Impairments:
Peripheral Neuropathy (UE PND)

Chapter 16  PND Impairments Medical Report Checklist (Revised 10-07-16):
PND MMI Report Checklist

Chapter 17 Checklist for Impairment Evaluation Consistency re: Lower Extremities


B. Valdez, Ogilvie III & Guzman III: A Perfect Trifecta from the Courts of Appeal - Updated June 21, 2012

With Guzman-III and Ogilvie-III, what impact will Valdez have on Claim’s Administration, Litigation and Resolution? This is the 2nd time the Dissenting Opinion of Commissioner Caplane has become the Opinion of the Appeals Court. Rising medical and benefits costs have the potential to accelerate given this latest decision. Ogilvie & Guzman increased medical and legal costs measurably greater than the aggregated benefits an injured worker has received from those decisions. As a community, we once had a multitude of professional opinions on issues.  Now we get the same ‘feed-line’ via blogs, newsletters, classes and seminars, carefully dancing around the real issues -the true impact of these decisions on the cost to both employers & employees (legal disputes rarely benefit employees).  As members of the workers compensation community, we should openly discuss the risks of issues that concern us and ask challenging questions of the potential impact of our court decisions and the DWC decisions by the AD.

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C. Occupational Group Number Characteristics - Updated April 5, 2012

In Section III of the Schedule for Rating Permanent Disabilities, pg. 3-1, "Occupations & Group Numbers" you will find an alphabetical listing of occupations and their related three-digit group numbers with a corresponding industrial designation to distinguish it from other occupations having the same title but whose functions and activities differ. The Schedule divides the labor market into 45 numbered occupational groups. Each group is assigned a three-digit code called an occupational group number. The first digit of the code refers to the arduousness of the duties, ranking jobs from 1 to 5 in ascending order of physical arduousness. The second digit separates occupations into broad categories sharing common characteristics. The third digit differentiates between occupations within these groups." 05PDRS, page 1-8.

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