• Definitions for Work Load Classifications in a Return to Work Note

    31 October 2012 / California Workers Compensation, How To / Comments Off on Definitions for Work Load Classifications in a Return to Work Note

    The definitions below are classifications of work load that are used administratively to communicate the terms of “sedentary”, “light”, “medium” and “heavy” and “very heavy” work.

    These terms in and by themselves are not to be used to as standalone work functional instructions, but rather to provide a common reference when reading the literature, or communicating what is accepted as industry standards of the terminology.

    Sedentary Work:

    Occasional (0%-33% of the Work Day) 10 lbs. Exerting up to 10 lb. of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

     

    Light Work:

    Occasional (0%-33% of the Work Day) 20 lbs. Frequent (34%-66% of the Work Day) 10 lbs and/or walk/stand, push/pull, or arm/leg controls. Constant (67%-100% of the Work Day) Push/pull or arm/leg controls while seated. Exerting up to 20 lbs of force occasionally, and/or up to 10 lbs of force frequently, and/or a negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for sedentary work.

    Even though the weight lifted may be only negligible, a job should be rated light work: (1) when it requires walking or standing to a significant degree, or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible.

    NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, is physically exhausting.

     

    Medium Work:

    Occasional (0%-33% of the Work Day) 50 lbs. Frequent (34%-66% of the Work Day) 20 lbs. Constant (67%-100% of the Work Day) 10 lbs. Exerting 20-50# of force occasionally, and/or 10 to 25 lbs of force frequently, and/or greater than negligible up to 10 lbs of force constantly to move objects. Physical demand requirements are in excess of those for light work.

     

    Heavy Work:

    Occasional (0%-33% of the Work Day) 100 lbs. Frequent (34%-66% of the Work Day) 50 lbs. Constant (67%-100% of the Work Day) 20 lbs. Exerting 50 to 100 lbs of force occasionally, and/or 25 to 50 lb of force frequently, and/or 10 to 20 lb of force constantly to move objects. Physical demand requirements are in excess of those for medium work.

     

    Very Heavy Work:

    Occasional (0%-33% of the Work Day) over 100 lbs. Frequent (34%-66% of the Work Day) over 50 lbs. Constant (67%-100% of the Work Day) over 20 lbs. Exerting in excess of 100 lbs of force occasionally, and/or in excess of 50 lb of force frequently, and/or in excess of 20 lb of force constantly to move objects. Physical demand requirements are in excess of those for heavy work.

  • Recommendations for Chart Reviews

    19 October 2012 / Chart Reviews, How To / Comments Off on Recommendations for Chart Reviews

    • Purchase Writing and Defending Your IME Report, The Comprehensive Guide by Steven Babitsky, Esq, James J. Mangraviti, Jr., Esq, and J. Mark Melhorn, MD. SEAK, Inc.
    • Become an Adobe “Jedi Knight Master” if you work with electronic medical records.
    • Look for themes and trends in specific notes. Are they consistent?
    • What is missing in the chart if you were managing the case?
    • What is or is not present to confirm the working diagnosis of the report?
    • Be judicious with what you present in your chart review. Be easy on the reader’s eyes, and obvious with what is valuable.

    Fear no chart!

  • A Witnessed Injury and Taking the Medical Impairment History

    15 October 2012 / How To, Medical History / Comments Off on A Witnessed Injury and Taking the Medical Impairment History

    Was this a witnessed injury?

    • Who was at the injury?
    • What was their name and job title?
    • What was the interaction with this person?
    • Did this person help them initially at the injury?
  • In Summary: A Well Prepared Chart Review

    11 October 2012 / Chart Reviews, How To / Comments Off on In Summary: A Well Prepared Chart Review

    A well prepared chart review will separate your report from all those before it.

    The reader will welcome a comprehensive, yet economical review of the documents, be they five, 50, or 5,000 pages.

    Your role is to organize and weigh value to the contents, while searching all documents you have been provided.

    These documents include the longest consultant note down to the incidental photo copied post it note. Look for subjective and objective trends that support your conclusion.

    Finally, a link needs to be made that will bring together your first hand information and check it with the experience of other examiners.

    Chart review is a practiced skill. Develop a repeated method when approaching the chart and you will be less likely to miss valuable information. Your report will be stronger.

  • Who Was Hurt and The Medical Impairment History

    08 October 2012 / How To, Medical History / Comments Off on Who Was Hurt and The Medical Impairment History

    Questions to ask when taking the medical impairment history:

    Who was hurt?

    • Was this person with or without pain at the time of the reported injury?
    • What was their baseline pain and medication usage?
    • Did their baseline pain change?
    • Did medication need change as a result of the injury?
  • Summarize or Plagiarize a Medical Chart Review?

    05 October 2012 / Chart Reviews, How To / Comments Off on Summarize or Plagiarize a Medical Chart Review?

    This is an interesting question.

    Some reviewers will summarize chart notes. It will generalize the nature of the visit, the contents of the findings, in the opinions of the doctors. I personally prefer taking the actual excerpts of the chart document notes and including them in the review section.

    I do this for the following reasons. First, I do not want my “opinion” to replace the chart information. I like the reader to read exactly what I have read, so there's no misunderstanding on what is presented in the chart.

    Second, I like to use quotation. Quotation is valuable to make a highlighted comment on a specific opinion are finding in the medical chart review.

    When using quotations, it is important however, not to take them out of context. Using quotations incorrectly may result in your report as being viewed as “biased” for one side or the other. If the employee or doctor makes a statement, that is critical or contradictory, I may consider that section of the chart as a quotation.

    Finally, when selecting direct text into the chart review, the use must be judicious. Remember, writing and editing is an active, if not aerobic, process. It requires thinking and editing.

    Read what you have selected. Does it add to the value of the report? Keep clear in your mind what is subjective and what is objective in the review being created.

  • Injuries and The Medical Impairment History

    02 October 2012 / Medical History / Comments Off on Injuries and The Medical Impairment History

    When was the injury?

    Date, time, location and circumstances. Auto accidents include visibility and driving conditions. Any amount for damages, monetary settlement?

    Consider lighting and also were they in an unfamiliar environment i.e. working off site or at a client’s location?

  • Ancillary Medical Chart Notes

    27 September 2012 / Chart Reviews / Comments Off on Ancillary Medical Chart Notes

    Valuable information is often found in the “ancillary” chart.

    The ancillary chart are those notes generated by the medical assistants, the front desk, or a hand written note the employee may have dropped at the front desk.

    Physical therapy notes may be a “gold mine” of information, as the therapist often has longer periods of time for evaluation, and this can be reflected in review of the notes. Everything in the chart must be considered.

  • How to Take the Medical Impairment History

    24 September 2012 / Medical History / Comments Off on How to Take the Medical Impairment History

    Let the first sentence put a picture in the mind of the reader: name, age, handedness, employer and number of days, months or years with the employer.

    Let the worker tell you what they do, remember, details make your history memorable and fun to read. Listen to the first task they list and try to get a sense of the working conditions, the hours and tools they use.

    • Include both the physical and administrative functions of the workers.
    • What do they offer as their first and primary function on the job? What tools or objects do they use during the shift? Who do they report to, who do they supervise?
    • Work attendance history and disciplines/promotions.
    • How much work has the employee missed, not just for this injury, but also in the past? Have they been promoted? Demoted or placed on a performance improvement program at any time?
  • Tendons and Impairment Ratings

    20 September 2012 / Impairment Physical Exam / Comments Off on Tendons and Impairment Ratings

    The tendon is a tough, fibrous tissue structure that connects muscle to bone. A tendon differs from a ligament, which connects bone to bone.

    Injury occurs when a tendon becomes stretched, partially torn, or completely disrupted. Disastrous results can occur when a tendon is completely torn in the knee, heel cord (Achilles tendon), distal bicep, and rotator cuff. Tendon injuries may be diagnosed through a palpable (visible) defect and/or MRI.

    Timely diagnosis is essential to prevent shortening of the muscle and optimize surgical outcome. Significant disability and impairment can result if diagnosis is delayed. Concern over a complete tendon rupture should prompt urgent consultation with an orthopedist.

     

    • Tendon injuries may range from minor strains to complete disruption.
    • Delay in diagnosis may result in significant disability and impairment, especially in the knee, heel, spinal cord, distal bicep, or rotator cuff.
    • Prompt referral for imaging and consultation with an orthopedist is necessary to determine extent of injury and to prevent further damage.

    Rating Comment: The AMA Guides to the Evaluation of Permanent Impairment Fifth Edition provides impairment rating for tendon injuries with regards to weakness and range of motion impairment. AMA Guides do not allow impairment rating for weakness in the presence of a painful condition.

    The AMA Guides 5th Edition instruct on page 531 section 17.2e, “Individuals whose performance is inhibited by pain or fear of pain are not good candidates for manual muscle testing, and other evaluation methods should be considered for them.”

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