Flexible QME Reappointment Program: Choose Your Emphasis

 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 but then, strangely, it was vetoed by Governor Newsome.  Now, the burden for eliminating bias to prohibit Apportionment to race, religious creed, color, national origin, gender, marital status, sex, sexual identity, or sexual orientation falls squarely on the shoulders of the DWC.  In Todays Live Video, we review the good intentions of SB 788 as well as two 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?'"

Transcript

 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. 

 Join us as we delve into the nuances of pain impairment assessment and its relationship with functionality. Contrary to popular belief, if pain does not significantly interfere with an individual's ability to carry out common activities of daily living, it may not qualify for a 1%, 2%, or 3% increase in whole person impairment - according to Chapter 18 of the AMA Guides.  Learn how to resolve the dilemmas surrounding pain-related impairment evaluation. Our live video session is designed to empower Qualified Medical Evaluators with the knowledge and tools needed to make accurate and fair assessments.  Join us now for this insightful session. 

 The current Permanent Disability Rating Schedule is based - by law - on the AMA Guides 5th Edition.  By law, the Impairment ratings provided for by the AMA Guides are presumed to be correct and accurate, unless they can be proven incorrect.  And, the AMA Guides relies on use of the Combined Values Chart (CVC) when summing multiple Impairments.  However, there is great opportunity to rebut the AMA Guides through the use of simple addition of multiple Impairments, versus using the compressive and reductive CVC.  In this video, we review how to step outside the CVC to provide your examinee with the most accurate Impairment rating. 

 In this session of the program we review what the law, what the 2016 Physician's Guide, and what the AMA Guides have to say about what topics, items, and issues need to be included and discussed in today's QME Report and, we create a hybrid Template that includes all of the required elements specific to California Workers Compensation. 

 In this brief session we review the Administrative Director's Disability Evaluation Guidelines as described in CCR 43-46 and, we begin our Introduction to 1) the AMA Guides to the Evaluation of Permanent Impairment - 5th Edition and 2) the QME Regulations CCR 1 - 159.  These are important sections of the law for all QMEs to be familiar with, and to review regularly. 

This session begins a 3 parts series entitled "The Language of Reports."  In these next 3 session we begin to develop the new vocabulary you will be using and mastering in the completion of your QME Reports.  In this session, we trace the flow of the QME Report through the workers compensation system, all the way to a successful resolution of the claim/case.

Transcript

 This is the second video in the 3 part series "The Language of Reports."  In this session, we review the 4 laws that govern your "Review of Records", we review how to compose the "Occupational History section of your Report, and we review the AMA Guides and the many diagnostic tests and studies that are required in the evaluation of Permanent Impairments.