| |
| |
Upper Extremities: Giving Credit Where Credit is Due
by Donald R. Barthel, Esq.
Every week B&B's Rating and Consultation Services is requested to review and
analyze MMI reports purporting to determine impairment for upper extremity injuries. Inasmuch as range of motion (ROM) is the primary AMA-based method used for upper extremities (see AMA Guides, p. 450-479), we see this methodology misapplied time and again. Invariably, the doctor has overestimated the true level of impairment.
Where do the doctors go wrong? Most physicians simply identify the injured joint, measure that joint's remaining ROM, and apply the applicable AMA chart(s) to obtain their final Whole Person Impairment (WPI) percentage. For example, in the case of an injured right shoulder, if the doctor measures 160° of shoulder flexion, he/she uses Figure 16-40 (page 476) to award 1% UE (which converts to 1% WPI).
Although the foregoing analysis is accurate, it is wholly incomplete. The
doctor has failed to "give credit where credit is due." In particular, the
doctor has failed to consider the ROM in the uninjured left shoulder. This failure can, and often does, result in your overpaying permanent disability.
How does it work? "Both extremities should be compared" (AMA Guides, page 451). Why? "If a contralateral 'normal' joint has less than average mobility,
the impairment value(s) corresponding to the uninvolved joint can serve as a baseline and are subtracted from the calculated impairment for the involved joint." (AMA Guides, p. 453).
The reason behind this step of the analysis is simple. Normal is a "range or zone [that] represents healthy functioning and varies with age, gender, and other factors..." (AMA Guides, page 608). Thus, for many impairment methods, including upper extremity ROM, it is appropriate for the physician to consider "the condition of the unaffected side as 'normal' for the individual..."
How does the foregoing apply to our shoulder example? If the doctor measured the ROM for the left, uninvolved shoulder and found it at 170° of flexion, this too would be valued at 1% UE, which converts to 1% WPI (see Figure 16-40, p. 476). Thus, without information to the contrary, the doctor would be required to assume that immediately prior to the injury the injured right shoulder's ROM reflected that of the uninjured shoulder. Thus, per the AMA Guides, 1% UE (the "impairment" of the uninjured shoulder) would be subtracted from 1% UE (the "impairment" of the injured side). In short, there would be no impairment (and no permanent disability).
Be sure to always "get credit where credit is due." Insist that the examining physician provide you with the contralateral uninjured joint's measurements.
Donald Barthel, Esq., is a Founding Partner of Bradford & Barthel, LLP, and B&B's Rating & Consultation Services.
|
|
|
Upper Extremities: Giving Credit Where Credit is Due
The Audit Unit Is Made Up of People Too
The 4062.2 Dance Requires Fast Steps. Can You Keep Up?
Copyright © 2006 Bradford & Barthel, LLP. All rights reserved.
Legal Disclaimer:
This web site seeks to provide accurate, informative updates pertaining to items of interest to Bradford & Barthel, LLP's clients and friends. It is not intended to render legal advice. If legal advice or expert analysis is needed, seek an attorney's assistance. All opinions expressed in this newsletter are those of the authors and not necessarily endorsed by Bradford & Barthel, LLP, its partners, attorneys, employees or agents.
|
