Core QME Reappointment Compliance Program

According to the AMA Guides, 5th Edition, providing an accurate a spinal impairment rating involves utilizing one of two rating methods: the Range of Motion (ROM) method or the Diagnosis-Related Estimates (DRE) method. Although these methods appear to be straight-forward to use, we must remember and be aware of many important facts and issues before rating an Applicant for spinal impairment. In this presentation, we will take an in-depth look at the DRE method as we explore the rationale for its use and many examples as they apply when providing a correct spinal impairment rating.

     Providing   an accurate spinal impairment rating using the Diagnosis-Related Estimate   Method can involve more than just throwing an Applicant into a DRE category   and calling it a day. There is much more to it than that… Together, we   explore the DRE categories to understand their similarities and differences   between the spinal regions. We also cover several examples of accurate   placement of the individual into the appropriate category for spinal   impairment rating purposes.    

 It's time to break free from the shackles of the strict application of the AMA Guides.  By thinking outside the box of the standard definitions of impairments provided in the charts and tables of the AMA Guides, QMEs can more accurately and thoroughly describe their examinee's actual impairment.  Today's Live Video explains the use of 1) the ranges of values provided in most of the charts and tables, and 2) using analogies of your examinee's condition or impairment, to other conditions or impairments that are listed in the AMA Guides.  Open up your thinking, and let your creative juices flow! 

     Chapter   18 of the AMA Guides provides for additional "discretionary"   impairment when "pain" increases the burden of illness. Part 1 of   this 2 video series discusses the proper use of Chapter 18 in assessing   whether, or whether NOT your examinee qualifies for additional Impairment due   to "pain." Hint: MOST examinees will NOT fit the criteria described   in Chapter 18 and therefore, their Permanent Impairment rating will be   adequately described by the "conventional impairment rating." Part   2 (on another video) discusses "how" to properly perform the   "Pain Related Impairment Assessment" so that a Permanent Impairment   conclusion either "for" or "against" additional Pain   Related Impairment qualifies as "substantial medical evidence."    

     Bias,   stereotyping, and discrimination in the medical legal evaluation has the   unintended consequence of opinions and conclusions by the QME that are NOT   accurate. In other words, the opinions and conclusions of the QME - when   influenced by implicit and unconscious bias - are INACCURATE. Because   ACCURACY in workers compensation is King, the DWC has a plan to eliminate the   pernicious impact of bias on the QME's opinions and conclusions.    

     The   first domino falls in the war against bias in the medical legal evaluation   with the recent passage of SB 788. Now, Labor Code 4663 - the Apportionment   Law - is rewritten to prohibit the consideration of race, religious creed,   color, national origin, gender, marital status, sex, sexual identity, or   sexual orientation in the development of an apportionment declaration. In   todays Live Video, we review SB 788 as well as two other actual cases that   involved 1) gender discrimination, and 2) national origin discrimination.    

     In   Today's Live Video we review several actual cases that involve unique   situations and scenarios involving difficult and disputed AOE determinations.   In most of the cases, the injury itself was not disputed but rather,   industrial causation (AOE) for the injury was the dispute that brought the   case to the Judge, the WCAB, or even the Court of Appeals.    

     "When   the WCAB issues an en banc decision, it is a big deal. This signals a   significant and controversial legal decision that is now binding on all   workers compensation judges, and all Appeals Board Panels. In Nunes vs. The   Department of Motor Vehicles, the controversial issue revolved around - guess   what - Apportionment, and its application to the vocational evidence   supporting a 100% loss of future earning capacity for Ms. Nunes. This raises   the question, ""What is the difference between 'medical   apportionment"", and ""vocational apportionment?