DISABILITY IMPAIRMENT RATING

 California QMEs now have a new Continuing Education requirement that  includes instruction in "Disability Impairment Rating." This video  begins a 4-part "Disability Impairment Rating" series designed to help  physicians think clearly about accurate impairment rating under the AMA  Guides.  In Part 1, we focus on "Chapter 1 of the AMA Guides." Chapter 1 gives  the QME the language of impairment. It explains the difference between  impairment and disability. It defines impairment as a loss, loss of use,  or derangement of a body part, organ system, or organ function. It also  explains why whole person impairment focuses on activities of daily  living rather than direct work disability.  For QMEs, this foundation matters. A medical-legal impairment opinion  should explain what medical condition exists, whether that condition has  reached maximum medical improvement, what body function has changed,  and how that change affects ordinary human function.  The central teaching point is simple:  "Accurate impairment rating begins with understanding the language of  impairment."  This video is Part 1 in the Disability Impairment Rating series.  Sessions Include:  Part 1: AMA Guides Chapter 1 — The Language of Impairment Part 2: AMA Guides Chapter 2 — The Method of Evaluation Part 3: AMA Guides Chapter 18 — Pain and Impairment Part 4: Substantial Medical Evidence — Defending Your Impairment Opinion  This course series is designed for California QMEs, AMEs, and primary  treating physicians (PTPs) who want to better understand how the AMA  Guides support clear and accurate impairment opinions. 

 Disability Impairment Rating — Part 2: Chapter 2 of the AMA Guides  This is Part 2 in our 4-part series on "Disability Impairment Rating"  for California QMEs.  In Part 1, we reviewed Chapter 1 of the AMA Guides and focused on the  language of impairment. Chapter 1 teaches the QME how to distinguish  impairment from disability, how to think about whole person impairment,  and why activities of daily living matter.  In Part 2, we move to Chapter 2 of the AMA Guides and focus on the  method of evaluation.  Chapter 2 shows how the QME applies the language from Chapter 1 during  the actual evaluation. It explains how the QME gathers medical  information, evaluates the injured worker, determines maximum medical  improvement, selects the proper chapter and rating method, checks  consistency, combines impairments when appropriate, and prepares a clear  report.  For California QMEs, this chapter has special value. The impairment  opinion must do more than state a percentage. It must show how the QME  moved from the medical facts to the final rating. The report should  allow the reader to understand the history, examination, diagnostic  studies, MMI status, rating criteria, calculation, and rationale.  The central teaching point is:  Chapter 2 gives the QME a disciplined method for the evaluation of  permanent impairment.  This video is Part 2 in the Disability Impairment Rating series.  This  series includes:  Series Structure:  Part 1: Chapter 1 — The Language of Impairment Part 2: Chapter 2 — The Method of Evaluation Part 3: Chapter 18 — Pain and Impairment Part 4: Substantial Medical Evidence — How to Always Be Right  This course series is designed for California QMEs, AMEs, and Primary  Treating Physicians (PTPs) who want to better understand how to provide  clear and accurate opinions on Permanent Impairment based on the AMA  Guides. 

 Part 3: Chapter 18 of the AMA Guides — Pain and Pain-Related Impairment.   This portion of the course reviews Chapter 18 of the AMA Guides and  addresses the evaluation of pain in the context of permanent impairment.  The presentation explains how pain may already be included in a  standard body-system rating, when pain may require additional analysis,  and when pain may be unratable under the Guides. The course also  addresses activities of daily living, credibility, consistency,  behavioral factors, psychological factors, and careful discussion of  possible malingering. 

 Disability Impairment Rating - Part 4 "Substantial Medical Evidence —  Defensible Impairment Opinions"  This section explains how the QME supports their impairment opinions  with substantial medical evidence. It reviews the legal principles that  require accurate facts, adequate history, adequate examination,  reasonable medical probability, correct legal theory, and clear  reasoning. The section applies these principles to causation, permanent  impairment, apportionment, future medical care, work status, and  alternative impairment ratings under Almaraz/Guzman.