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Alan Colledge

Abstract

Workers’ compensation systems provided $25.3 billion of compensation benefits in 1999, and nearly $19 billion of this was compensation for permanent injury. Under workers’ compensation, when injured worker have missed a predetermined amount of work time, they are eligible for wage indemnification (the amount is determined by the jurisdiction). Benefits continue until the disabling condition either permits a return to work or reaches a plateau at which healing ends and no significant improvement is likely (maximum medical improvement or a permanent and stationary condition). How the award is calculated differs from jurisdiction to jurisdiction: In some jurisdictions, permanent injury benefits are awarded only on the direct physical loss; other jurisdictions compensate to some degree for expected wage loss, loss of employment options, expenses for accommodating the disability, and, perhaps, 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 basis (eg, some statutes limit or disallow awards for conditions such as tinnitus or certain psychological conditions). Evaluators must be aware of statutes, administrative rules, and case law that apply to the evaluation.

in AMA Guides® Newsletter
Alan Colledge
and
Greg Krohm

Abstract

The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) specifies that impairment evaluation may be conducted by a treating or nontreating physician. A treating physician who is knowledgeable about the use of the AMA Guides may be the appropriate professional to evaluate impairment, but in cases that involve pain, disability, and medicolegal (forensic) issues, a truly independent medical examiner typically is most appropriate. All specialties share the same elevated risk of iatrogenesis when treating and evaluating/forensic roles are mixed because mixing compromises the quality of care and threatens the viability of the therapeutic relationship. Further, all treating specialties share the same bias toward offering treatment for most complaints—rather than engaging in the type of cautious skepticism that is required for competent impairment evaluation and other forensic duties. Finally, no treating clinician, regardless of specialty, can offer allegiance to judicial and administrative decision-makers. Treating clinicians often find themselves in a position in which they would be cutting off a source of their own income if they were to offer opinions that the clinical presentation is not valid, work related, or injury related, nor is the patient in need of further treatment. Such a financial conflict of interest can be eliminated only by referral to independent examiners and restricting treating clinicians from becoming involved in such decisions.

in AMA Guides® Newsletter
Alan L. Colledge
,
Roger Pack
,
Christopher R. Brigham
, and
Charles N. Brooks

Abstract

Whiplash-associated disorder (WAD) refers to complaints attributed to a shear-hyperextension then hyperflexion cervical injury, typically following a rear-end motor vehicle collision. Research suggests that chronic whiplash symptoms should be the exception rather than the rule, and the surge of chronic whiplash symptoms probably reflects the focus on biological treatment of WAD, ignoring the cultural, psychological, and sociological influences. The physician evaluating and/or treating a whiplash patient needs to have a solid understanding of the complexities and controversies associated with this disorder. Evaluation should be prompt and thorough, but, unless indicated, evaluators should avoid sophisticated diagnostic studies (eg, magnetic resonance imaging studies correlate poorly with whiplash symptoms). Treatment generally should be simple and consists primarily of reassurance and home exercise. Disability, both occupational and avocational, should be avoided or minimized. As with other impairment evaluations, the clinical assessment (history, physical examination, and review of diagnostic studies) must be thorough. If there are ratable findings, examiners must determine their reliability and whether the examinee has achieved maximal medical improvement. Most cases of WAD do not result in permanent impairment, but when there is ratable impairment it usually falls in DRE Cervical Category II, with a rating of 5% to 8% whole person permanent impairment. Managing patients’ beliefs and expectations following motor vehicle injury can help guide them to continue or promptly return to normal activities. {223}

in AMA Guides® Newsletter