Erroneous Rating Study Part V

Saturday, April 22, 2006 | 0

In the last issue we examined how erroneous clinical assessment will result in an erroneous rating. In this installment we will explore problems with inaccurate causation assessment.

In assessing impairment it is necessary to distinguish what impairment is related to the alleged injury as opposed to impairment that may be due to other injury, degenerative disease, or illness. 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):

(A) The cause is medically probable - (A) is more likely than not the cause and/or aggravator of the problem.
(B) The effect is medically probable - (B) is more likely than not the correct diagnosis or condition.
(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.

Causation analysis is the critical first step to apportionment analysis. Impairment may be related to multiple causes. Section 2.5h Changes in Impairment from Prior Ratings on page 21 provides a discussion of the Guides approach to apportionment. The Guides state: "if a prior impairment evaluation was not performed, but sufficient historical information is available to currently estimate the prior impairment, the assessment would be performed based on the most recent Guides criteria. For example, in apportioning a spine impairment, first the current spine impairment rating is calculated, and then an impairment rating from any preexisting spine problem is calculated. The value for the preexisting impairment rating can be subtracted from the present impairment rating to account for the effects of the intervening injury or disease."

In reviewing a case it is imperative to assure that clinical and causation assessments were accurate, that the rating was performed when at maximal medical improvement, that examination findings were consistent, and what was normal for the individual was determined. An unreliable examination will result in an erroneous rating, and nearly always this erroneous rating will be higher than is appropriate.

In the next article of this series we will examine some of the common errors in the rating process itself, i.e. the use of Guides criteria.

Please contact Mindy Brigham for further information on training and resources. Call 619-299-7377 or mbrigham@brighamassociates.com.

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