Limit "Double Dipping" to Ice Cream

Limit "Double Dipping" to Ice Cream
by Don Barthel, Esq.

Bradford & Barthel believes "double dipping" should be limited to visits to Baskin-Robbins!

Unfortunately many QMEs, PTPs, and even AMEs are attempting to get applicants "a little something extra" when applying the DRE method to the spine!

3+4=5: A Rating Example

3+4=5: A Rating Example
by Mark Fletcher, Esq.

Did you know that 3 + 4 = 5 when applying the DRE (Diagnosis Related Estimate) method to the lumbar and thoracic spine? It's strange, but true.

If an applicant qualifies for a DRE Category III ("significant signs of radiculopathy"), but also qualifies for Category IV ("alteration of motion segment integrity"), this qualifies the individual for Category V (25% to 28%). (See Table 15-3, page 384, for the lumbar spine; see page 389, Table 15-4, for the thoracic spine).

Medical Provider Network Let the Games Begin...

Medical Provider Network Let the Games Begin...
by Sherri Dozier

Change is the name of the game in 2005. It appears that the legislative intent was much more than putting California on a "diet" to reduce its ever growing workers' compensation waistline. The intent was to create a "life-style change." Like any "life-style change" it's usually met with skepticism and resistance.

We knew the MPN was coming, yet many of our employers and carriers are still struggling to implement this valuable program. The advantages are clear. Keeping medical control for the life of a claim. Sounds great, but is it really that simple? Probably not. The advantages, however, may far outweigh the disadvantages. Keep in mind, every new program goes through years of trial, errors, and interpretations. This was evident with the Health Care Organization (HCO). The HCO was a part of the 1993-1994 reform. It was not really utilized or understood until the late 1990s.

How can we assure success through the MPN?

The Pain Game: 3+0=0?!?!

The Pain Game: 3+0=0?!?! by Don Barthel, Esq. Per the AMA Guides, a 0% whole person impairment rating (WPI) "is assigned... if the impairment has no significant organ or body system functional consequences and does not limit the performance of... activities of daily living." (AMA Guides, p. 5) Of course, a 0% WPI will rate out to 0% permanent disability (PD). This does not mean the injured worker was not injured; it simply means he or she has suffered no permanent impairment in his or her performance of ADLs. The AMA Guides permit the evaluating physician to rate pain-related impairment. After doing a pain-related impairment rating, the physician may increase the body or organ impairment (such as for an arm or the back), by up to 3% WPI. What if the body/organ impairment rating is 0% (such as a back injury that is assigned a DRE Category I impairment)? Can the physician nonetheless increase the spine impairment (0%) by up to 3% WPI to account for pain?

When Do I Really Need to Know This Stuff?

When Do I Really Need to Know This Stuff?
by Mark Fletcher, Esq.

There is a great deal of information (and misinformation) about when the AMA Guides and new PDRS are to be applied. Given that the application of the "new" rating system can easily result in a rating that will save the defense thousands, and even tens of thousands, of dollars, knowing when to apply the AMA Guides and new PDRS is essential.

Some preliminary information: First, the AMA Guides and new PDRS go hand-in-hand. Thus, if you are using one, you will be using the other. If your case is under the old system, neither the new PDRS nor the AMA Guides will apply.

PDRS Issues: The Dangerous Table B

PDRS Issues: The Dangerous Table B
by Don Barthel, Esq.

A subject of great debate and much criticism, the new Permanent Disability Rating Schedule used RAND study results "to establish the ratio of average California standard ratings to proportional wage losses for each of 22 injury categories" (page 1-6, California Schedule for Rating Permanent Disability).

We now know this means that we no longer rate an impairment by adjusting up or down for age and occupation. While these adjustments for age and occupation are still part of the rating process, the WPI is first adjusted by giving "consideration to an employee's diminished future earning capacity" (FEC). [See Labor Code Section 4660(a).] This language replaces LC Section 4660's earlier instruction that we give "consideration... to the diminished ability... to compete in an open labor market."