...Christopher R. Brigham, MD; William T. Grant, MD; Waqas Ahmad, MBBS, MHA, BSc Jurisdictions use impairment ratings differently, and physicians must understand the specific requirements in each jurisdiction. This article discusses a case of severe spinal cord injury for a jurisdiction that only...

..., methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions...

..., an implicit award for psychological loss and pain. Some jurisdictions require all impairments to be combined as a single whole person impairment, but others use individual impairments expressed as a regional impairment. In some jurisdictions, the permanent benefit is statutory and has no medical or clinical...

... edition in the current jurisdiction is used to recalculate the rating for the first injury. Regarding which edition of the AMA Guides to use, evaluators should be aware of the jurisdictional requirements and also the timing to ensure that the individual is at maximum medical improvement. If the issue...

... be familiar with jurisdictional requirements that effectively supplant AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) methodology. © 2020 American Medical Association. All Rights Reserved. 2020 American Medical Association Analysis of the Findings AMA Guides Methodology...

... person rating. Jurisdictional requirements vary, but rating physicians commonly are asked to provide a single impairment percentage for the limb or whole person; when two or more impairments are involved, the rater must add or combine the percentages, carefully following the specific instructions...

... in the relevant jurisdiction before confirming any opinion regarding work relatedness. Many jurisdictions require the physician to establish causation of the condition “with a reasonable degree of probability”. The AMA causation book also has a useful chart of causation thresholds in each jurisdiction...

... for lost work time, except for medical expenses related to an injury. The percentage of medical-only claims in a jurisdiction is a function of the quality and speed of medical care, the length of lost time required before an injury qualifies for indemnity benefits, and how scrupulously employers report...

... in a state or other jurisdiction, an injured worker may receive an award for the current impairment or permanent partial disability, but the responsibility for payment of that award is allocated between the fund and the current employer/insurer. Some states’ Second Injury Funds require the permanent...

.... The qualifications required of an IME examiner vary by arena, jurisdiction, and issues. Medical evaluators should be board certified and can obtain a special credential from, eg, the American Board of Independent Medical Examiners or the International Association of Independent Medical Evaluators. In addition...

... for medical records, including those from IMEs, depends on the jurisdiction and any corresponding regulations imposed by local, state, or federal authorities; medical boards; and other overseeing bodies. Physicians are generally expected to retain medical records for a specific period, often several years...

... causes; and assessing impairment is based on the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ). These three are separate activities, but sometimes all three must be addressed in a single evaluation and may be required for a specified jurisdiction (eg, California). Evaluators thus...

... include other practitioners, eg, psychologists and chiropractors. Depending on the referral request, the IME typically discusses disability (the definition depends on the local jurisdiction) based on deficits in the person's activities of daily living. In the IME, the evaluator may be asked to consider...

... may be appropriate in an older individual, depending on jurisdiction. Clinical judgment on the part of the rater is required with a full explanation in the report that also reflects an understanding of jurisdictional approaches. Cranial nerve 5–the trigeminal nerve . The Fifth and Sixth Editions...

... claims. In 2017, the Supreme Court of Pennsylvania handed down the Protz decision, which held that requiring physicians to apply the methodology set forth in the most recent edition of the AMA Guides reflected an unconstitutional delegation of legislative power to the American Medical Association...

..., whereas in other states, it must be a major contributing factor. Therefore, it is important to understand the standards of the specific jurisdiction. The following 3 cases illustrate evidence-based causation analysis. A 58-year-old male systems analyst (a sedentary job that requires continuous...

...Charles N. Brooks, MD; Christopher R. Brigham, MD Most acute injuries and illnesses resolve, ie, reach maximum medical improvement (MMI), within days or weeks and without permanent impairment. Fractures, more severe soft tissue injuries and illness, and conditions that require surgery take longer...

... to a number of problems. Some jurisdictions require a patient be at maximum medical improvement (MMI) before rating, which prevented use of the DRE Model, at least early in a claim. In addition, all patients with radiculopathy were rated the same despite some true differences in outcomes. For all...

... information collected during an IME. Typically, requests for a copy of the IME report should be made to the retaining party. However, in some jurisdictions there is a requirement for the IME report to be furnished directly to the examinee as well. Again, it is incumbent on the examiner to be familiar...

... Effective May 1, 1997, all physicians and chiropractors who rate workers’ compensation permanent partial disabilities (PPD) are required to become members of the Nevada Division of Industrial Relations panel of rating physicians and chiropractors. The State of Nevada previously used the AMA Guides...