Case Example: Spinal Impairment: California Case

Abstract Accurate, unbiased impairment ratings must follow the procedures and processes defined in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This Case Example from California in 2010 illustrates some problems that result from rating a lumbar injury as if it were an inguinal hernia. At critical issue in this case is whether sufficient clinical findings were available to support a rating for lumbar radiculopathy; the evaluating (and also, treating) physician gave the patient the benefit of doubt with a rating of “nonverifiable radicular (nerve root) pain” but did not address the patient's ability to perform activities of daily living (ADLs). The State of California Workers’ Compensation Appeals Board (WCAB) affirmed on August 20, 2010, that the State relies on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, to determine impairment. WCAB noted that “medical opinion that departs unreasonably from a strict application of the [AMA] Guides can be challenged, and it would not be acceptable as substantial evidence.” In the present case, the rating provided by the evaluating physician was based on an obviously inapplicable section of the AMA Guides and is not appropriate. Evaluators must use the procedures defined in the AMA Guides, perform evaluations according to the standards in the AMA Guides, and do so without bias.