Medical Treatment

Medical Treatment

Substantial Medical Evidence

Tags: , , , Medical Treatment, Proceedings

In Blackledge v Bank of America (2010) 75 CCC 613, the court addressed what constitutes substantial medical evidence of whole person impairment under the AMA Guides and Almarez/Guzman II
Under the AMA Guides, a physician performs an evaluation to determine the WPI for the injured employee’s medical condition(s) expressed as a percentage. (AMA Guides, Section 2.1, at p. 18). The impairment evaluation includes a discussion of the employee’s history and symptoms, the results of the physician’s examination, the results of various tests and diagnostic procedures, the diagnosis, the anticipated clinical course, the need for further treatment, and the residual functional capacity and ability to perform activities of daily living. After considering all of these factors, the physician compares the medical findings for each condition with the impairment criteria listed within the Guides and then calculates the appropriate impairment ratings for the conditions. The physicians report should include a summary list of the impairments and impairment ratings by percentage, together with a calculation of the final WPI, and a statement of the rationale underlying the WPI opinion.
The opinion of a single physician may establish an injured employee’s WPI, provided that the opinion constitutes substantial evidence. Place v. WCAB (1970), 35 CCC 525, 529-530. Among other things, to constitute substantial evidence regarding WPI a physicians opinion must comport with the AMA Guides, including as applied and interpreted in published appellate opinions and en banc decisions of the Appeals Board. Hegglin v WCAB (1971) 36 CCC 93. Medical report and opinions are not substantial evidence … if they are based on incorrect legal theories. Zemke v WCAB (1968) 33 CCC 358, 360. An expert’s opinion which …assumes an incorrect legal theory cannot constitute substantial evidence.
Also, a physician’s opinion regarding WPI must set forth the physician’s reasoning, not merely his or her conclusions. Granado v. WCAB (1970) 33 CCC 647, 653
A physician’s mere conclusion not sufficient. Zemke p, 363. People v Bassett (1968) 70 Cal Rptr 193. The chief value of an expert’s testimony rests upon the material from which his or her opinion is fashioned and the reasoning by which he or she progresses from the material to the conclusion, and it does not lie in the mere expression of the conclusion; thus, the opinion of an expert is no better than the reasons upon which it is based.


Tags: Medical Treatment

AME means Agreed Medical Evaluator, a physician selected by agreement between the defendant and the applicant’s attorney to resolve disputed medical issues.

Synergistic Effect of Injury

Tags: , , Injuries, Medical Treatment No comments

In determining the degree of Permanent Disability the medical examiner may consider the synergistic effect of applicant’s injury, any surgeries, whether further surgery would be beneficial, the effects of pain medication and the conclusion of a vocational rehabilitation expert that the applicant is not feasible for vocational retraining and has no future earning capacity, and is thus, permanently totally disabled.

Medically Required Equipment

Tags: , , , California Workers Compensation System, Medical Treatment No comments

Medically Required Equipment.

In Green v. WCAB, 74 CCC 998, the Court held that an applicant was not required to relocate to another home at defendant’s request to avoid cost of installing medically required elevator and defendant was required to construct and install elevator in applicant’s home.

Multiple Injuries To The Same Body Part

Tags: , , , , , , Injuries, Medical Treatment No comments

Multiple Injuries To The Same Body Part.

Pursuant to SB 899, and the decisions in Brodie and Benson, successive injuries to the same body part that become permanent and stationary at the same time can no longer be rated as a single injury. Rather, successive injuries must be rated separately, except when physicians cannot parcel out the causation of disability. See Benson v. WCAB (2009) 74 CCC 113.

Medical Malpractice Statute

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Medical Malpractice Statute.

Code of Civil Procedure Section 340.5 provides that “In an action for injury or death against a health care provider based upon such person’s alleged professional negligence, the time for commencement of action shall be three years after the date of injury or one year after the plaintiff discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first.”

Ex Parte Communication With AME Or QME

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Ex Parte Communication With AME Or QME.

Labor Code Section 5701 precludes a party from communicating with an Agreed Medical Evaluator(AME) or Qualified Medical Evaluator(QME) on an ex parte basis. Communications must be joint until an applicant is examined by the doctor. There are strict rules about any communication with the doctor after the exam. Applicant’s should never contact the doctor. They should speak with their attorney. A d irect contact by the applicant with the AME or QME will allow the defense attorney to replace the doctor if they wish.

Untimely Medical Reports

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In Regards To Untimely Medical Reports

Labor Code Section 139.2(j)(1)(A) provides that reports from Agreed Medical Evaluator’s(AME) or Qualified Medical Evaluator’s(QME) must be submitted to the parties within 30 days. A party may object to a late report and the doctor will be removed as AME or QME as long as the objection occurs prior to the receipt of the report.