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Law offices of Stephen Barszcz Disability Lawyer

Medical advisor must clarify rating

Doctor consulting male patient, working on diagnostic examination on men's health disease or mental illness, while writing on prescription record information document in clinic or hospital office

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 orthopedic 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.

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© Stephen V. Barszcz, P.A. 2012

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