• A Different Workers' Comp Attorney -- Phil Walker, Esquire

    07 February 2012 / Impairment Rating Specialists / Comments Off on A Different Workers' Comp Attorney -- Phil Walker, Esquire

    How Dr. Alchemy, MD first met Phil Walker, Esq, a Different Workers' Comp Attorney.

  • Legal Question on Chapter 18 Pain (AMA Guides to the Evaluation of Permanent Impairment 5th Edition)

    30 January 2012 / Impairment Physical Exam / Comments Off on Legal Question on Chapter 18 Pain (AMA Guides to the Evaluation of Permanent Impairment 5th Edition)

    Pain Chapter 18 Question Sent in by a Guest:

    Dear Phil Walker, Esq: My employee has bilateral knee injury from patellofemoral industrial condition-lifted a box. It results in functional limitations. No knee problems prior. On exam she has 12 degrees of ratable valgus deformity 5% WPI (each knee). The valgus deformity is entirely genetic in it's design and has now resulted in a painful patellofemoral syndrome (old term would have been "lit up"). There are no ratable knee findings other than the non industrial condition. So could chapter 18 Pain add on be considered in this situation? Can the add on be given when there is only non industrial impairment?

    Sincerely, Confused in Chapter 18 Pain (AMA Guides to the Evaluation of Permanent Impairment 5th Edition).

    **

    Dear Confused in Chapter 18 Pain (AMA Guides to the Evaluation of Permanent Impairment 5th Edition),

    Here is what you need to know:

    1.  There cannot be an add-on when the underlying rating for the industrial condition is 0% WPI.

    2.  The add-on for pain is given in less than 1% of all cases, nationally.  That is because the AMA Guides indicate that all normal pain is included in the underlying ratings.  Chapter 18 indicates that an add-on for pain is ONLY to be given when the pain is greater than expected, that the Applicant is credible, and that the pain significantly impacts the Activities of Daily Living.  Because of those restrictions in the Guides, doctors nationally give the Add-on for pain in less than 1% of all cases.

    3.  However, we are different in California.  No surprise there!

    a.  Interestingly, when the Applicant attorneys first learned that the Guides permit an add-on of 3% for pain, they requested that the DEU simply increase all ratings by 3%.  Amazing.

    b.  The DEU declined.

    c.  While the AMA Guides, as applied by doctors nationally, make the add-on for pain very limited; California doctors and the DEU have taken a different approach.  The DEU takes the position that there can be an add-on for pain of up to 3% WPI anytime that there is a minimal rating of 1% WPI or greater for the industrial condition.

    d.  The DEU also takes the position that there can be no add-on for pain if the underlying rating for the industrial condition is 0% WPI.

    The position taken by the DEU to permit an add-on for pain anytime there is an industrial rating of 1% or greater is not consistent with the position of the AMA Guides that all normal pain is included in the underlying rating.  The AMA Guides were made the law of California by our Labor Code.  

    The DEU's position raises the question of whether or not the DEU has the power to make law versus the Legislature.  None of the members of the DEU are elected, as the Legislature is.  

    I am not aware of the issue's having been addressed legally, and I anticipate that that is because of the cost of a legal challenge versus the value of 3% WPI.

    So, from an economic standpoint, I recommend that people accept the add-on of up to 3% WPI if there is an underlying rating of 1% WPI or greater.  When people get angry over that, I remind them of how, under the Old System, pain add-ons were 20% PD, 30% PD, or higher, and a very large number of our workers' compensation cases were "subjective only, i.e., pain, with no objective findings."

    Hope that will help.

    Phil Walker, Esq.Phil Walker, Esquire
    Legal Director, Impairment Rating Specialists

    Phil Neal Walker Law Corporation
    "Workers' Compensation for the World"
    250 King Street, Suite 414
    San Francisco, California 94107

  • Are Your Impairment Reports Objective?

    24 January 2012 / Impairment Rating Specialists / Comments Off on Are Your Impairment Reports Objective?

    John Alchemy, MD & Phil Walker, Esq. explain how the treating doctor may not give the best objective impairment report.

     

  • The Impairment Physical Exam

    20 January 2012 / Impairment Physical Exam / Comments Off on The Impairment Physical Exam

    The physical examination begins immediately when you greet the employee and introduce yourself. Watch how the employee exits the waiting room chair, and if they use their arms to assist standing. Is there a grimace with the initiation of motion? What is the character of the gait?

     

    I try to find specifics in other parts of the exam other than the body part of the claim to demonstrate that indeed a full and complete exam was performed. For example, I comment on the condition of the teeth, scars on the neck, chest, torso and abdomen etc. This also makes it clear to the reader of the report that the other sections of your exam are not a default block template, but rather, an accurate and complete survey of the employee.

     

    You will find that an employee examined with this degree of detail and care will often thank you for “the best” or “most complete” exam they have ever received. I also make a point to narrate the exam to the employee so they understand what I am seeing, and confirm it to be accurate and correct. Example: “This area appears to be tender on the uninjured side. Is this finding correct, or did I misunderstand something in the history we discussed?”

  • John Alchemy, MD, Medical Director for Impairment Ratings Specialists

    13 January 2012 / Impairment Rating Specialists / Comments Off on John Alchemy, MD, Medical Director for Impairment Ratings Specialists

    Dr. Alchemy describes how writing a correct report requires a thorough and complete understanding of the AMA guides and how the chapters and the philosophies interact.

     

  • Workers Compensation Cases by Impairment Rating Specialists

    06 January 2012 / Impairment Rating Specialists / Comments Off on Workers Compensation Cases by Impairment Rating Specialists

    Phil Neal Walker, Esquire, is the Director of Legal Review for Impairment Rating Specialists. Mr. Walker is founder and CEO of Phil Neal Walker Law Corporation and Walker World Wide, the first International Workers' Compensation law company.

  • The Doctor's Perspective

    21 December 2011 / Impairment Rating Specialists / Comments Off on The Doctor's Perspective

    Doing medicine in the California workers' compensation system is unlike any other medical specialty or experience.

    When I began my family medicine training in 1994, I really enjoyed the opportunity to rotate through all the specialty fields. I found the practice of general medicine to offer a new and different challenge every day in my residency training. Every two months I would suddenly find myself in a new rotation, learning new kinds of medicine, terminology and subcultures.

    Every field of medicine had its perspective on disease, diagnosis, treatment and even the approach to learning. Just when I was beginning to get an understanding of the rotation and the hierarchy of the department politics, it was off to the next chapter in training. This was my life for three years.

  • Henry DeGroot, MD - New Program Director of Dermatologic Disease and Surgery

    16 December 2011 / Impairment Rating Specialists / Comments Off on Henry DeGroot, MD - New Program Director of Dermatologic Disease and Surgery

    Dr. Henry DeGroot our Program Director of Dermatologic Disease and Surgery. Dr. DeGroot began practicing Dermatology in 1998, and is a Diplomate of the American Board of Dermatology.

    He has experience as an Occupational Medicine Dermatology consultant, and currently is the CEO and Medical Director of NorCal Skin Disease and Surgery. He has clinics in Santa Rosa and Ukiah in Northern California.

    After high school he served in the United States Marine Corps both in the States and abroad. He finished his military service in Hawaii and stayed there for his initial undergraduate work at the University of Hawaii. Dr. DeGroot received his Medical Degree with Distinction at Indiana University, where he received numerous awards and scholarships.

    After completing his Residency at UC San Diego, where he also served as Chief Resident, Dr. DeGroot worked at Kaiser Permanente for 10 years before pursuing private practice. Dr. DeGroot has remained active in teaching and holds academic appointments with both UC Davis and UC San Francisco.

    Dr. DeGroot has experience in Occupational Dermatology and serves as both as a consultant and secondary treating physician. Visit Dr. DeGroot at our website to learn more about his practice.

  • Permanent Impairment Ratings

    14 December 2011 / Impairment Rating Specialists / Comments Off on Permanent Impairment Ratings

    Under the AMA Guides, p. 19, permanent impairment ratings are only done when the Applicant is at maximum medical improvement (mmi).

    P. 601 of the Guides indicates that a patient is at mmi when his medical condition is unlikely to improve during the next year, with or without medical treatment.

    What does this mean?  If a patient is not at mmi, he CANNOT receive a whole person impairment rating under the AMA Guides.

    Examples:

    1.  Doctor says the patient needs surgery to improve his condition.  He is not at mmi.

    2.  Psychiatrist says the patient needs to undergo psychiatric treatment (including antidepressants and psychotherapy) to improve his condition.  The patient is not at mmi.

    3.  Patient allegedly has gi symptoms from taking non-steroidal anti-inflammatories.  The patient is not at mmi if the physician has not removed him from the non-steroidal anti-inflammatories as his condition would likely improve if he were taking off the offending medications.

    4.  Patient has a sleep disorder contributed to by his obesity/weight.  If the patient has not been put on weight reduction, then he is not at mmi as his condition would likely improve if the obesity/high weight were eliminated.  (Sleep apnea has a tendency to go away when the patient loses weight.)

    5.  Patient has hight blood pressure and is not on medication.  The patient is not at mmi because placing him on high blood pressure medication would likely improve his blood pressure and improve his condition.

    So, the first question to ask in any situation is, has the patient reached mmi as defined by the Guides.

    Frequently, doctors claim a patient is at mmi when one of the following has occurred:  TTD is ending; the doctor does not want to see the patient again; or the doctor just feels like giving the patient a rating despite the fact that the patient has not undergone treatment to improve his condition.

    Remember, the reason doctors are supposed to treat patients is to get them better.

    So, make sure the patient is at mmi under the Guides before you accept any permanent impairment rating for an Applicant.  Remember, permanent means permanent.  That means that the condition is not likely to go away, with or without further medical treatment.

  • Dr. John Alchemy - Founder & CEO of Impairment Rating Specialists

    07 December 2011 / Impairment Rating Specialists / Comments Off on Dr. John Alchemy - Founder & CEO of Impairment Rating Specialists

    Dr. John AlchemyDr. John Alchemy is founder and CEO of Impairment Rating Specialists, a California Medical Corporation that performs clinical AMA impairment exams, and has written over 1,500 reports since opening in 2009.

    He was first drawn to the world of workers compensation in 1997 recognizing that the discipline, solution-based problem solving and case variety fit well with his skill set. In his career he has performed and reviewed over 10,000 cases, gaining a wide breadth of expertise and deep understanding of the industry.

    He possesses that unique dedication needed to manage the mechanical and technical aspects of report writing to produce highly effective results. He has a passion for managing projects, developing efficient report writing techniques, and developing relationships that move parties smoothly through what can otherwise be a confusing claim process.

    Dr. Alchemy brings his years of experience as a staff physician, utilization review physician and clinic director to offer the industry's best, comprehensive reports and impairment rating formatting services.

    Dr. John Alchemy has been practicing Occupational and Family Medicine since 1997, and is a Diplomate of the American Board of Family Practice. Dr. Alchemy has certificates of education from the American Board of Independent Medical Examiners (ABIME), the American Association of Medical Review Officers (AAMRO) and is also a California Qualified Medical Examiner (QME).

    He has directed occupational medicine clinics, has been a staff utilization review doctor. Dr. Alchemy brings his many years of experience as a staff physician, utilization review (PDF) physician and clinic director to offer the industry's best, comprehensive reports and impairment rating formatting services.

    He performs expert permanent rating exams the California workers comp system it also serves as an independent medical evaluator. Clients include UPS, Fed Ex, US Postal Service, California Highway Patrol, and Pacific Gas and Electric.

    He enjoys speaking and educating while sharing ideas and offering solutions for cutting-edge impairment rating design and work flow for physicians.

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