Search Results

You are looking at 1 - 4 of 4 items for

  • Author or Editor: LuAnn Haley x
  • Refine by Access: All content x
Clear All Modify Search
Luann Haley

Abstract

The method for rating impairments for lumbar spine injuries has evolved over time and has changed with each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The AMA Guides, Sixth Edition, uses a diagnosis-based impairment rating system as the template for evaluating impairment ratings for spinal conditions. A majority of US states use the AMA Guides to determine an impairment rating for injured workers and use this impairment rating to determine financial compensation, but no state system is the same as another's, and each state has a unique statutory scheme. Some cases warrant the finding of a permanent impairment when the injured worker has significant residual pain complaints and limitations that have been verified by the evaluator as being consistently present from the injury date. The AMA Guides, Sixth Edition, allows an assignment of permanent impairment, at the discretion of the evaluator, in cases of chronic lumbar sprains/strains. Evaluators should carefully consider whether it is appropriate to assign an award of permanent impairment for spinal conditions without verifiable objective findings. An evaluator's decision of no impairment vs class 1 impairment is a significant determination in compensation claims and will continue to include subjective factors until advances in medical science permit a more accurate assessment of complaints of non-specific back pain.

in AMA Guides® Newsletter
LuAnn Haley
and
Marjorie Eskay-Auerbach

Abstract

Pennsylvania adopted the impairment rating provisions described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in 1996 as an exposure cap for employers seeking predictability and cost control in workers’ compensation 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. The decision eliminates the impairment-rating evaluation (IRE) mechanism under which claimants were assigned an impairment rating under the most recent edition of the AMA Guides. The AMA Guides periodically are revised to include the most recent scientific evidence regarding impairment ratings, and the AMA Guides, Sixth Edition, acknowledges that impairment is a complex concept that is not yet defined in a way that readily permits an evidence-based definition of assessment. The AMA Guides should not be considered standards frozen in time simply to withstand future scrutiny by the courts; instead, workers’ compensation acts could state that when a new edition of the AMA Guides is published, the legislature shall review and consider adopting the new edition. It appears unlikely that the Protz decision will be followed in other jurisdictions: Challenges to using the AMA Guides in assessing workers’ compensation claims have been attempted in three states, and all attempts failed.

in AMA Guides® Newsletter
J. Mark Melhorn
,
LuAnn Haley
, and
Charles N. Brooks

Abstract

Repetitive illness sometimes is wrongly called repetitive injury or cumulative trauma, but the latter are misnomers because the employee cannot identify a specific injury as a cause of the symptoms. In workers’ compensation, such gradual illness claims may be compensable if the condition arises during the course of employment, which requires that it be caused by occupational duties, exposures, or equipment used on the employer's premises. Expert impairment evaluators face three requirements: they must know the best scientific evidence currently available regarding causation of the condition(s) in question, ie, generic causation; the facts of the individual case, ie, specific causation; and the legal threshold in the applicable jurisdiction for acceptance of a condition as work related. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an excellent resource and provides the physician a blueprint for the assessment of causation in occupational injury and illness claims. The book adopts the methodology developed by the National Institute for Occupational Safety and Health and the American College of Occupational and Environmental Medicine. When asked to render opinions regarding causation, a physician is wise to consider this methodology in determining the work relatedness of the condition. Medical opinions based on an accepted methodology and the best scientific evidence will result in better patient outcomes.

in AMA Guides® Newsletter
Lorne Direnfeld
,
David B. Torrey
,
Jim Black
,
LuAnn Haley
, and
Christopher R. Brigham

Abstract

When an individual falls due to a nonwork-related episode of dizziness, hits their head and sustains injury, do workers’ compensation laws consider such injuries to be compensable? Bearing in mind that each state makes its own laws, the answer depends on what caused the loss of consciousness, and the second asks specifically what happened in the fall that caused the injury? The first question speaks to medical causation, which applies scientific analysis to determine the cause of the problem. The second question addresses legal causation: Under what factual circumstances are injuries of this type potentially covered under the law? Much nuance attends this analysis. The authors discuss idiopathic falls, which in this context means “unique to the individual” as opposed to “of unknown cause,” which is the familiar medical terminology. The article presents three detailed case studies that describe falls that had their genesis in episodes of loss of consciousness, followed by analyses by lawyer or judge authors who address the issue of compensability, including three scenarios from Arizona, California, and Pennsylvania. A medical (scientific) analysis must be thorough and must determine the facts regarding the fall and what occurred: Was the fall due to a fit (eg, a seizure with loss of consciousness attributable to anormal brain electrical activity) or a faint (eg, loss of consciousness attributable to a decrease in blood flow to the brain? The evaluator should be able to fully explain the basis for the conclusions, including references to current science.

in AMA Guides® Newsletter