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MEDICAL ADVISOR MUST CLARIFY RATING

posted Friday Mar 30, 2018 01:10 PM

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Steve Barszcz Esq.


About Steve Barszcz Esq.

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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

AMA Guides.

 

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

claimant appealed.

 

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



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