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Shaw Chiropractic THE AMA GUIDES FOR IMPAIRMENT In 1991 it was determined that 40 of 53 jurisdictions use the AMA Guides to the Evaluation of Permanent Impairment for workers' compensation cases. The growing emphasis on litigation cases makes the Guides an objective method of rating an injured individual. It should be important for attorneys to determine what source and reference the treating and independent medical reviewers are using when they are assessing percentages of impairment. If one is reasonably familiar with the Guides, inappropriate percentage numbers can be challenged. If two physicians examine a patient and use methods established in the Guides, their results should be similar. The Guides can also resolve differences. The Guides state that,"disability may be defined as an alteration of an individual's capacity to meet personal, social, or occupation demands, or statutory or regulatory requirements." Disability refers to an activity that an individual would like to perform, but cannot. All aspects of an individual's life need to be surveyed. An impaired individual is not necessarily disabled in all activities. For example, an accountant who loses his legs is certainly impaired, but may not be disabled from being an accountant. But, a factory worker who loses his legs may be totally disabled from the functions of his job, as well as, impaired. Furthermore, the Guides clearly state, "Employability is critically related to an individual's capacity to travel to and from work, be at work, and perform assigned tasks and duties for which the employer is willing to pay wages. If the individual has that capacity, even in the presence of impairment, he or she is not disabled for those tasks." The first step for a doctor to evaluate a case for impairment is to obtain a complete medical history, including all previous injuries, impairments, tests, prior systemic diseases, and so on. Chronic causally related pain may be considered also. In some cases, a prosthesis or supportive care may be needed to keep a patient functional. In fact, the patient may be relatively non-disabled with supportive care, but without this care the patient may be disabled from activities. A patient may decline treatment of an impairment with a surgical procedure, drug therapy, or other therapeutic approach. The Guides do not increase or decrease the percentage of impairment due to this. Apportionment is determined by the degree to which each of various occupational or non-occupational factors may have caused or contributed to a particular impairment. Two criteria must be met: the alleged factor could have caused or contributed to the impairment and in the case in question, the factor did cause or contribute to the impairment. WHAT IS THE PROGNOSIS? Physical findings during the first month of care after an injury are not helpful in predicting if symptoms will persist or if degenerative changes will occur. However, there will probably be osteoarthritis of the facetal joints with osteophytic productions or spondylosis of the bodies of the vertebrae and osteophytic productions from the spinal joints of Luschka (uncinate joints). The primary consideration, however, seems to be time, which allows the soft tissues lesions to heal. The patient may be symptomatic for 2 or 3 days, months, or years. Healing by first intention occurs with minor injuries essentially produces little to no residuals. Healing by second intention may take longer and there will be a loss of normalcy forever. Soft tissues will be less elastic and less functional. Other aspects affecting prognosis include the severity, time sequence of care, type of care, adherence to care protocol, age, work habits, leisure habits, general health, existence of pre-existing degenerative changes, etc. Questions??? Call us !!!
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