Many of our clients have requested that we develop a checklist of the needed knowledge, skills, certifications and resources to achieve success. Physicians provide a valuable service by performing quality, reliable impairment evaluations and preparing excellent, supportable reports.

Click Here to view this checklist with hyperlinks to the resources you need.

by Christopher Brigham, MD

Opinions of causation and apportionment are often based on individual professional opinions, often without due consideration of the facts and science. Many physicians have not been trained in causation analysis nor are familiar with the most recent studies in terms of cause and effect. Current studies are resulting in dramatic changes in our understanding of the origin of common problems such as back pain, degenerative disk disease, osteoarthritis and carpal tunnel syndrome. In upcoming issues we will share with you evidence-based resources that will assist you in assessing causation and apportionment. It is important to determine both an accurate impairment rating and to determine the cause(s) of impairment.

The premise of causation is that a given cause (A) and a given effect (B) are associated within a reasonable degree of medical probability. If the practitioner promotes the premise that, "within a reasonable degree of medical probability (A) & (B) are causally related," all three of the following separate notions are assumed to be correct (medically probable):

• 1. (A) The cause is medically probable, (A) is more likely than not the cause and/or aggravator of the problem.
  
• 2. (B) The effect is medically probable, (B) is more likely than not the correct diagnosis or condition.
  
• 3. (A) and (B) are related in a medically probable manner. If either (A) or (B) or both are considered to be possible, but not probable, the causal association cannot be upheld as being medically probable. Further, no number of possible causes can be taken together and viewed as a probable cause.
  

We are knowledgeable of the science of causation and apportionment; these factors are often intertwined with impairment assessment. In making an online referral, consider whether "causation" is an issue to be addressed in our review. In "Special Instructions" you can also identify specific questions that need to be answered.

Brigham and Associates & Insurance Education Association (IEA) Presents the AMA Guides 101 Webinar Series

The Fundamentals is an overview on the use of the AMA Guides, with a focus on principles of impairment evaluation, and assessment of spine, upper extremity, lower extremity, neurological, and pain impairments.

The Webinar is offered in four convenient two hour sessions, totaling eight hours of superb training. This seminar is designed for physicians, attorneys, and claims staff with minimal or no experience in the use of the Guides. It is also an excellent review for individuals who may have attended an introductory course and desire further review and clarification. Most individuals require two to three learning experiences to grasp the complexities of impairment evaluation.

At the conclusion of these Guides Webinars you will be able to:

• Demonstrate the appropriate use of the AMA Guides to the Evaluation of Permanent Impairment in assessing musculoskeletal, neurological and pain impairment.
  
  
• Explain how to review an impairment evaluation report to determine if the rating is accurate or not.
  
  
• Describe specific claims and legal strategies to manage erroneous ratings.

• Tuesday, September 25th
  2:00-4:00 p.m. PST:
  Overview, Lower Extremity
  
  
• Tuesday, October 2nd
  2:00-4:00 p.m. PST:
  Upper Extremity
  
  
• Tuesday, October 16th
  2:00-4:00 p.m. PST:
  Spine
  
  
• Wednesday, October 31
  2:00-4:00 p.m. PST:
  Other Chapters & Strategies
  
  

by Ken Subin, MD, MPH, CIME, CIR

The dual-inclinometer technique used for measuring lumbar spine range of motion is discussed in Section 15.9 ROM: Lumbar Spine of the Guides beginning on page 405. In order to obtain accurate measurements, it is important to correctly identify the T12 spinous process and S1 level of the sacrum where the inclinometers are to be positioned. This can be accomplished by utilizing the iliac crests as your primary landmark. While placing your fingers on the tops of the iliac crests and thumbs in the midline of the back in the same horizontal plane, you should be able to identify the interspace between the L4 and L5 spinous processes. Once you have identified these landmarks, you can then palpate above and below and count towards T12 and S1. It is helpful to mark these landmarks for easy identification during the course of your examination.

Now you have a second chance to register and attend our seminars on advanced issues involving the AMA Guides. Don't miss out on this great opportunity.

We are offering two different seminars in late November, specific dates to be determined.

Practical Application of the AMA Guides, 5th Edition

Attendees will be reviewing medical reports to determine accuracy of impairment. A step-by-step approach will be taught for reviewing medical reports and how to handle erroneous impairment ratings.

This seminar is oriented to claims managers, adjusters, case managers, defense attorneys, applicant attorneys, raters, judges, and physicians who have had prior training on the Guides, 5th Edition.

Clinical Assessment of Impairment

A hands-on approach to learning with live demonstrations of physical examination.

This course is oriented to physicians (orthopedic, neurosurgery, neurology, occupational medicine, physical medicine and rehabilitation and pain medicine), chiropractors, and other health professionals who have had prior training on the AMA Guides, 5th Edition.

• Reserve your spot today by emailing Mindy Brigham and get on our early registration list.
• Dates to be announced soon!