Impairment Guide Considerations: Below in Table 15 is an approach to gathering information in evaluating a patient for an opinion and using the AMA Impaiment Guide Spine Injury Model if such an opinion is requested.
Table 15: Administrative Examination Directions
The patient should not be punished for being threatened - for not trusting you in a system where someone has to lose. Be objective about what you record, make judgment calls based upon the objective data rather than hearsay, and use knowledge about the natural history of recovery relative to age, daily physical requirements, and options to using the body as a crane until retirement age. Don't become an executioner just because a claimant doesn't treat you, as do your regular patients, because in this arena you are the enemy until you prove you cannot be bought.
Sometimes much of this contest's displeasure can be averted by concentrating upon specific medical findings that are used in the 4th edition of the AMA guide to Impairment Rating. The original transcript for this system is based upon a medical evaluation of injury that could be used by any administrator if the medical data is evaluated. Providing the insurance system with information used as differentiators (table differentiators) is a means of allowing determinations to be carried out in a timely fashion. Let the administrative system fight over what is truth. Interpret EMG
findings of radiculopathy (see EMG
under Physiologic Evidence) or lateral hyper-flexion to hyperextension x-rays for loss of structural integrity (segmental instability- Fig. 13 & 14
) whenever present. Evaluate for a residual severe neurological loss in the extremities or bowel and bladder dysfunction and in some instances structural residuals that will allow the patient to be classified for administrative purposes (AMA Guide Categories
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