MEDICAL ADVISOR MUST CLARIFY RATINGposted by SteveBarszczEsq , Group AdministratorTuesday, January 4th 2011 @ 5:10 PM
The District Medical Advisor isn't always correct when he or she
provides an opinion regarding the rating of an injured worker for
schedule award purposes. In the following case, the finding
of 1% by the medical advisor was sent back by ECAB for not
sufficiently explained how the rating was determined.
In the case, an employee suffered a compensable injury to his
right wrist. He was diagnosed with tenosynovitis of his hand and
wrist and muscular calcification and ossification.
His orthopeadic surgeon ultimately determined that the patient
reached maximum medical improvement (MMI) and opined that he
had a 12% impairment of the upper extremity under the 5th edition
AMA Guides. (By that time they should have utilized the 6th edition
The opinion was submitted to the claims examiner who subsequently
sent the paperwork to the district medical advisor for review and
consideration. The medical advisor opined that the injured worker
had sustained a 1% impairment to the upper extremity and the
ECAB ultimately decided that the medical advisor did not support
his 1% rating with sufficient medical documentation required by the
6th edition AMA guidelines. The case was sent back for further
clarification to determine the appropriate rating with sufficient
medical documentation and findings to support the opinion.
The important point of the case is that just because the district
medical advisor issues a ruling does not necessarily mean that
the rating is correct. Contact us with your award letter or with
your physician's opinion even before it is submitted. We will be
happy to review the medical documentation to determine if it
meets the requirements set out by the law.
If you have questions please visit www.theOWCPattorney.com or email Steve@theOWCPattorney.com.
© Stephen V. Barszcz, P.A. 2012