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Jesse E. Bible
,
Dan M. Spengler
, and
Hassan R. Mir

perpetuity. In exchange for the employer paying for the injured worker's care regardless of the cause, the worker offers the employer exclusive tort immunity from legal suit in response to being injured. Under this no-fault system, workers with work-related injuries give up their right to sue employers at common law. Therefore, civil litigation remedies, such as actual wage, pain and suffering, and punitive damages, are not available. Exceptions exist in cases of deliberate intentional acts by workers or employers. Progression after work injury The first and most

in AMA Guides® Newsletter
Christopher R. Brigham

the Workers’ Compensation Board found Kotch eligible for 25% partial incapacity benefits for his 1994 work injury. American Protective sought to discontinue benefits in 1999, contending that Kotch's entitlement to benefits had expired pursuant to the 260-week limitation of section 213. Kotch filed a petition to determine the extent of his permanent impairment and to establish that his permanent whole body impairment exceeds 11.8%. The hearing officer found that, although Kotch suffers a 10% whole body impairment related to his work injury, Kotch's permanent whole

in AMA Guides® Newsletter
Marjorie Eskay Auerbach

chronic recurrent low back pain (also known as chronic sprain/strain, symptomatic degenerative disc disease, facet joint pain, SI joint dysfunction, etc.)”. The instructions on page 563, in the third paragraph under “General Considerations” indicate that for this condition (group of diagnoses) the only grade modifier used in impairment rating is the modifier for functional history, as there are no reliable physical exam or imaging findings for this condition (group of diagnoses). Since imaging has no role in impairment rating of this condition, having a work injury that

in AMA Guides® Newsletter
James B. Talmage

, it will likely be looked upon as a ratable complication of the injury. How is a physician to rate the impairment for an individual with no history of substance use disorder before a work injury, who is prescribed opioids for the work-related injury, and who subsequently develops OUD? What is the actual diagnosis, and has it been substantiated in the medical records? The AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), 7

in AMA Guides® Newsletter

Abstract

Most impairment ratings for conditions affecting the cervical spine are relatively straightforward and can be addressed using the first three categories of the Injury Model in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This real-life case study illustrates how higher impairment categories are applied, including combining categories; the importance of rating the patient's condition based on the injury (as opposed to treatment outcome); and how apportionment is handled in different jurisdictions. Mr Smith, a 64-year-old high school principal, presented with numbness and burning pain from the chest to the feet, unsteadiness of gait, and difficulty maintaining an erection. Symptoms reportedly began two years earlier when he tripped and fell down a flight of stairs at work, striking his face. An MRI scan revealed marked spinal stenosis and cervical cord compression at C3 due to a combination of posterior C3-4 disc protrusion and osteophyte formation. Via an anterior approach, the orthopedic surgeon performed a C4 corpectomy, C3-4 and C4-5 discectomies, and then inserted a tricortical iliac bone graft between C3 and C5. Mr Smith improved postoperatively but still complained of numbness from upper chest to feet, mild unsteadiness of gait, and difficulty maintaining an erection. Evaluators can use the Injury Model, recalling that surgery to treat an impairment does not modify the original impairment, and in the jurisdiction in which Mr Smith was rated, if a claimant was asymptomatic before a work injury, the entire impairment is attributed thereto.

in AMA Guides® Newsletter
Christopher R Brigham
,
James B. Talmage
,
Marjorie Eskay-Auerbach
, and
Lorne Direnfeld

opine that: The principle diagnosis line used in Table 15-7 had not changed. Range-of-motion was not documented before the work injury, and current motion cannot be compared to motion prior to his 2010 work injury, so range of motion loss cannot be attributed to the injury or either surgery. Since the medical records available suggest no persisting neurologic deficit after the first surgery and the current exam documents no persisting neurologic deficit now, there would be no impairment for neurologic deficit in the range-ofmotion method. The 2% WPI for the

in AMA Guides® Newsletter
David J. Bourne

turbulent relationships at work, and his belief that he was being persecuted by the employer and coworkers severely impacted his ability to return to work and to be rehabilitated. His psychological problems were due to his underlying personality disorder, exacerbated by both substance abuse and the work injury. In the particular jurisdiction in which he was evaluated, the worsening of his psychological condition due to his work injury was deemed compensable by the workers—compensation hearing officer. Case 2 A thirty-one year old woman was sexually harassed by a

in AMA Guides® Newsletter
Alan Colledge
and
Greg Krohm

approximate and highly inconsistent from jurisdiction to jurisdiction. It is worth noting that some jurisdictions do not compensate for objective permanent injury to the body, but will for permanent wage loss due to the injury or likely to ensue from the injury. Fortunately, claims for death benefits are relatively infrequent. In 1999, there were 6023 fatal work injuries out of 5.7 million Occupational Safety and Health Administration (OSHA) reportable injuries (.1%). As Table 1 shows, about one-fourth of claims in the United States involve permanent injury benefits

in AMA Guides® Newsletter
Steven D. Feinberg

years. The point is that each of us is very different and how an event or work injury affects us will depend on a variety of issues including, of course, the event itself, but also various risk factors'both physical and mental. The extent that we present with a disability post-injury will depend on many factors, not just the injury itself. Merely labeling an asymptomatic condition or particular pathology as a “risk factor” will not change the fundamental “how and why” analysis for purposes of determining apportionment. For example, an older individual who suffers

in AMA Guides® Newsletter