If you’re an applicant attorney or an injured worker, and you want to get an adequate resolution for your workers’ compensation case, there are some tools available that could help you get a much higher award. There are also some recent cases to consider, that could give you a lot of insight about what to do and what not to do when you’re seeking that award. The more you understand about the rules and regulations of workers’ comp cases, the more you can work within those rules for a successful outcome.
If you’re injured in California, the prima facie evidence of your disability is based on the AMA Guides. This is a book that breaks down all the objective factors such as diagnostics, MRIs, and other details. Then it correlates those diagnostics with the complaints you have for pain, reduced range of movement, and other issues. Your doctor can use the correlation to see where you fall on a range of whole-person impairment. Then that’s rated, and that rating becomes your worker’s compensation disability.
The AMA Guides can be conservative when it comes to rating disabilities, and there are times when a worker with a serious issue isn’t being rated in a way that accurately captures the extent of their injuries. There’s a lot of litigation on this issue, and a consolidation of cases under a binding holding referred to as Almaraz Guzman. While the AMA is still the default, Almaraz Guzman indicated that there are issues that go beyond that rating scale, and these issues have to be considered for disability, as well.
The Maria Estella case that recently came out is showcasing how the Almaraz Guzman issue works, and how it’s used to show that the standard AMA is not always accurate. It’s important to note that it’s not just about whether a particular doctor thinks that the AMA doesn’t go far enough, or that Almaraz Guzman should apply. Backing up the “why” of all that is vitally important, in order for the injured worker to meet their burden of proof for their impairment.
Even though the Maria Estella case had a doctor providing an impairment under the AMA Guides, and another impairment under Almaraz Guzman, the injured party didn’t receive both awards. Why? Because there wasn’t any specific explanation of the reasons behind those impairment ratings. The “how” and “why” wasn’t established, and those are both required for impairment ratings. Without that tie-in being established, workers miss out on proper impairment ratings and the injury awards they deserve.
The “how” and “why” is extremely important in a workers’ compensation claim. Conclusory statements aren’t enough, and they won’t be upheld. If you have questions or concerns, and want to go over the specific facts of your case, we’re here to help. Reach out to us at Michael Burgis & Associates today, and let us help you address the details of your worker’s compensation case.