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E. Randolph Soo Hoo

Abstract

Two disability programs are administered by the US Social Security Administration (SSA): Disability under Title II of the Social Security Act is referred to as SDI, which is funded via contributions made by the individual worker, and disability under Title XVI of the Act commonly is referred to as SSI, which is funded through general funds from the US Treasury. Both SDI and SSI disability adjudication use the same five-step sequential evaluation process to determine if a claimant fulfills SSA's disability definition. The foundation for determining disability under SSA is medical evidence that establishes a medically determinable impairment based on defined evidentiary criteria. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. Unlike SSA, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not determine (or rate) disability. The AMA Guides, Sixth Edition, emphasizes the use of evidence-based diagnosis for determining whole person impairments and contrasts with SSA disability for which a diagnosis is not a requirement and the focus is placed on determining «impairment» based on symptoms, clinical signs, and laboratory/diagnostic findings. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. An impairment rating using the AMA Guides should not be equated to an SSA disability determination.

in AMA Guides® Newsletter
Stephen L. Demeter
and
E. Randolph Soo Hoo

Abstract

Apportionment sometimes is necessary when a person had a prior injury that affected the same organ system or when there was evidence of a pre-existing disorder that was similar to the injury that will be rated. The past three editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) include subtle differences in the way that apportionment is defined. In addition to the information provided in the appropriate edition, certain philosophical and mechanistic considerations should be assessed before any apportionment and then should be used consistently in any subsequent cases that require apportionment. The first step in apportionment is a scientifically based causation analysis. Evaluators must avoid arbitrary, opinion-based unscientific apportionment estimates that are little more than speculations. In a situation that involves multiple injuries, if the impairment assessment has reached a defensible position with respect to causation then the rating for the first injury is determined using the edition of the AMA Guides that was used to rate the second injury. For example, if the rating for a second injury will be determined using the sixth edition, then the data for the first injury should be reworked using the sixth edition rules, irrespective of the rating for the first injury and the edition that was used.

in AMA Guides® Newsletter
E. Randolph Soo Hoo
and
Stephen L. Demeter

Abstract

Referring agents may ask independent medical evaluators if the examinee can return to work in either a normal or a restricted capacity; similarly, employers may ask external parties to conduct this type of assessment before a hire or after an injury. Functional capacity evaluations (FCEs) are used to measure agility and strength, but they have limitations and use technical jargon or concepts that can be confusing. This article clarifies key terms and concepts related to FCEs. The basic approach to a job analysis is to collect information about the job using a variety of methods, analyze the data, and summarize the data to determine specific factors required for the job. No single, optimal job analysis or validation method is applicable to every work situation or company, but the Equal Employment Opportunity Commission offers technical standards for each type of validity study. FCEs are a systematic method of measuring an individual's ability to perform various activities, and results are matched to descriptions of specific work-related tasks. Results of physical abilities/agilities tests are reported as “matching” or “not matching” job demands or “pass” or “fail” meeting job criteria. Individuals who fail an employment physical agility test often challenge the results on the basis that the test was poorly conducted, that the test protocol was not reflective of the job, or that levels for successful completion were inappropriate.

in AMA Guides® Newsletter