Doctors Cannot Circumvent the AMA Guides

Moten v. City of Los Angeles 2015 Cal. Wrk. Comp. P.D. LEXIS 566: In this unanimous panel decision, the applicant was evaluated by an AME who diagnosed multiple ailments. On cross-examination, the AME changed his impairment rating for the lumbar spine from 2% WPI to 20% WPI apparently taking into account the applicant’s loss of function and utilizing Almaraz/Guzman.  At trial, the WCJ issued rating instructions and instructed the rater to ignore the 20% rating given by the AME to the lumbar spine. Applicant’s counsel filed a Petition for Reconsideration. The WCAB held that the AME did not correctly utilize Almaraz/Guzman. Just because one is an AME, does not mean they can circumvent the Guides. The WCAB reaffirmed its holding in Milpitas Unified School Dist. v. Workers’ Comp. Appeals Bd. (Almaraz-Guzman) (2010) 187 Cal.App.4th 808, 822 (757 Cal.Comp.Cases 837) that the overarching goal of rating impairment is to achieve accuracy. In order to do that, the doctor must provide a strict rating per the Guides, explain why the strict rating does not accurately reflect the disability, provide an alternative rating utilizing the four corners of the Guides, and explain why that alternative rating most accurately reflects the applicant’s level of disability.

Leave a Reply

Your email address will not be published. Required fields are marked *