Impairment and disability ratings are often a major source of confusion for people injured, claims adjusters, attorneys and even doctors.
There are three main text that we follow when doing a rating:
American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, American Medical Association 2001
American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. Chicago, AMA, 2008
American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003. Edit
Definitions to understand concerning impairment:
A loss, loss of use, or derangement of any body part, organ system or organ function. American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, American Medical Association 2001
A significant deviation, loss or loss of use of any body structure or function in an individual with a health condition, disorder or disease. American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. Chicago, AMA, 2008
An anatomical, physiological, or psychological abnormality that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Social Security Administration (1995) Edit
Definitions to understand concerning disability:
It is an alteration of an individual's capacity to meet personal, social, and / or occupational demands or statutory or regulatory requirements because of an impairment. American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, AMA 2001
Activity Limitations and/or participation restrictions in an individual with a health condition, disorder, or disease. American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. AMA, 2008
Disability is the inability to complete a specific task successfully that the individual was previously capable of completing or one that most members of a society are capable of completing owing to a medical or psychological deviation from prior health status or from the status expected of most members of society. American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003. Edit
Definitions to understand concerning causation:
An identifiable factor (accident) that results in a medically identifiable condition ( injury or illness).
Causal opinions in reports and testimony must be given in terms of reasonable medical probability or certainty. (more probably than not)
Probability, simply means that something is more likely than not (51% or greater). If the confidence is equal to or less than 50% it is merely a possibility.
A causal relationship is biologically plausible when:
The relationship between the medical condition and the injury can be explained anatomically or physiologically.
The duration, intensity, or mechanism of exposure or injury was sufficient to cause the illness or injury in questions.
There is evidence suggesting that the exposure is consistently or reliably associated with the process under investigation in the population under investigation or in peer-reviewed literature.
Cause and effect are contiguous.
There is literature providing biologic or statistical evidence indicating that the symptoms or disorder could develop as a result of the exposure (coherence).
There is specificity of the association for the injury (i.e., the absence of other factors)
Definitions to understand concerning apportionment:
Once causation is determined and there is probable cause related to the event, then apportionment is evaluated. If there is no causal relationship then apportionment is not necessary.
The extent to which each of 2 or more probable causes are found responsible for an effect (injury, disease, impairment, etc..)
A distribution of causation among multiple factors that caused or significantly contributed to the injury and resulting impairment.
Precipitation - Injury or exposure causes a latent or potential disease process to become manifested.
Acceleration - Injury or exposure hastens the clinical appearance of an underlying disease process.
Aggravation - A permanent worsening of a prior condition by a particular event or exposure.
Exacerbation - A temporary worsening of a prior condition by an exposure / injury.
Recurrence - Signs and symptoms attributable to a prior illness or injury occur in the absence of a new provocative event.
American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003, page 99 -100.
The phrase "pre-existing condition" often causes confusion for medical-legal-insurance providers.
There are only two types of pre-existing conditions. The first is known as an "inactive" or "dormant" pre-existing condition. The second is known as an "active" or "symptomatic" pre-existing condition.
The difference between an active vs. inactive pre-existing conditions is "like night and day."
This may require a detailed review of past and present medical records.
The "proximate cause" of the present symptoms is the recent trauma, even though the symptoms may be worse or healing may take longer because of a pre-existing condition. Edit
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