Assuring Accurate Impairment Ratings: Dealing with the Flawed Almaraz and Guzman Decision

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Assuring Accurate Impairment Ratings:
Dealing with the Flawed Almaraz and Guzman Decision

Teleconference Calls: March 4, 2009 and April 1, 2009

The State of California Workers' Compensation Appeals Board (WCAB) February 3, 2009 decision in the consolidated cases of Almaraz v. SCIF et al. and Guzman v. Milpitas Unified School District (Almaraz/Guzman) opined that an impairment rating based on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is rebuttable. This unfortunate and seriously flawed decision will result in significant challenges for California, including more confusion, litigation and costs, both financial and human. You can minimize the impact of this decision if you understand the decisions, the issues and how to manage them.

In the March 4, 2009 teleconference call, Christopher R. Brigham, MD, Chairman of Impairment Resources, LLC, who is regarded as the nation's leading expert on the Guides, was interviewed on the following topics:

*	a summary of the current situation in the California,
*	a medical and impairment expert analysis of the Almaraz/Guzman decision,
*	perspective on the consequences of this decision,
*	insight into the physician role in impairment assessment and the use of the Guides, and
*	specific suggestions in managing impairment ratings.

Attendees learned how the decision:

*	inappropriately intermixes the concepts of "work impairment" and "disability",
*	selectively included quotes from the Guides out of context,
*	failed to include other content from the Guides that would provide insight to the issues of impairment and disability assessment,
*	did not fully recognize the significant differences in California versus other jurisdictions (with the use of the California Permanent Disability Rating Schedule (PDRS) to translate impairment into disability), and
*	included references to case law not relevant.

Read the March 4 Call Transcript

In the April 1, 2009 teleconference call, W. Frederick Uehlein, Esquire, Director, Impairment Resources, LLC was interviewed. Mr. Uehlein is a nationally recognized attorney and expert on impairment issues. California legal expert and retired WCAB Judge, Susan England, Esquire and Christopher R. Brigham, MD participated in a live panel. Mr. Uehlein and Dr. Brigham are co-authors of the article "Impairment Rating in California: Analysis of the Almaraz and Guzman Decision and Impact on the Use of the AMA Guides, Fifth Edition" which is the feature article in the March - April 2009 issue of the Guides Newsletter.

The dialogue provided attendees with:

*	An update of the current situation in the California,
*	A legal expert analysis of the Almaraz/Guzman decision
*	Perspective on the consequences of this decision, and
*	Specific suggestions in managing impairment ratings.

Despite this flawed decision, it is impossible for a physician's personal opinion to rebut the AMA Guides. It is more important than ever to carefully assess impairment ratings to assure that they are accurate and consistent with the AMA Guides.