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Steven D. Feinberg

) substantial medical evidence; (2) causation; and (3) apportionment, all of which directly affect benefit delivery to injured workers. This article discusses the special aspects of addressing and defining substantial medical evidence, causation, and apportionment in the California Workers' Compensation system, and it applies these definitions to examples of cases. In addition, it also includes case scenarios that highlight how evidence-based medicine (EBM), genetics, and age differences could affect these three components (substantial medical evidence, causation, and

in AMA Guides® Newsletter
Les Kertay
,
Marjorie Eskay-Auerbach
,
Mark H. Hyman
,
David Torrey
, and
WC Judge

reach a level of substantial medical evidence. This is problematic when competing interests and money are involved, as they integrally are in disability systems.” The authors conclude, “in the absence of demonstrable clinical findings, clinical judgment regarding tolerance is an insufficient basis on which to base activity restrictions or functional limitations. ” Third, the authors essentially recommend what might be called a “tough love” strategy, counseling, “Call it like it is.” That is, the HCP simply explains that, without objective findings, he or she

in AMA Guides® Newsletter
Steven Feinberg
,
Kenneth Kingdon
, and
Robert Rassp

apportioned between the injury and nonoccupational factors. California law allows a treating physician and an evaluating physician, a qualified medical evaluator, or an agreed medical evaluator to write maximum medical improvement reports, also termed “permanent and stationary reports” in California. Trial judges have to determine which physician's conclusions about causation of injury, causation of disability, and apportionment constitute substantial medical evidence that can serve as the basis of an award of permanent disability. Physicians are required to individually

in AMA Guides® Newsletter
Stephen L. Demeter
,
Christopher Brigham
,
James B. Talmage
,
J. Mark Melhorn
, and
Steven D. Feinberg

the underlying causative factor. There is no apportionment to risk factors (eg, diabetes, obesity) unless there is substantial medical evidence that they contribute to the cause of the disability. Labor Code §4664 has the following 3 critical provisions: “the employer shall only be liable for the percentage of permanent disability directly caused by the injury arousing out of and occur ring in the course of employment.” If the applicant has received a prior award of permanent disability, it shall be conclusively presumed that the prior permanent disability

in AMA Guides® Newsletter
Daniel C. Schainholz

meridians, as if the visual field were constricting while the Goldmann visual fields were being tested, is conclusive substantial evidence of non-physiologic causation. For the purpose of the evaluator, the Goldmann visual field plots are substantial medical evidence of visual system injury, or the absence thereof along this dimension. The method for establishing the FFS is well described (5th ed, 288-295). The meridian method is the recommended approach to determining the FFS. The meridian method (or alternative methods for automated fields) is used to derive the right

in AMA Guides® Newsletter