PLEASE READ
We have just
learned (6/8/09) that OWCP has started using the AMA Guides 6th Edition.
Until we can update all of our resources please understand that wherever
the AMA Guides 5th Edition is written here, just know that the AMA Guides
6th Edition is now required. PENIt has been brought to our attention that your OWCP claim for a schedule
award may contain RED FLAGS that may be
viewed by a claims examiner as an indicator that your claim may, in their
opinion, contain incomplete, inconsistent, inaccurate, or other type
information indicating to them that they may want to challenge your claim.
OWCP may consider items listed below as Red Flags to Erroneous
Impairment Ratings:
-
Your impairment rating was performed by your regular
physician or your treating physician.
It seems that claims examiners have greater confidence in your claim
if your rating has been provided by someone other than the physician who
treated you for your injury - or the injury for which your claim
addresses.
-
Your rating fails to point out specific figures, tables,
and/or page numbers that can be found in the AMA Guides to the
Evaluation of Permanent Impairment, Fifth Edition.
Your ratings physician should make a point to reference specific
figures, tables, or page numbers from the AMA Guides 5th Edition.
-
MMI or Maximal medical improvement has not been properly
defined in your claim or your impairment rating was performed prior to
one year from date of injury.
Obviously, it seems that claims examiners give less credit to your
claim if your physician states that you have reached MMI and one year
has not lapsed since your injury occurred. A scheduled award
cannot be filed until you have reached MMI or maximum medical
improvement. Your claim must address when you reached MMI.
-
The AMA reference book titled “AMA Guides to the
Evaluation of Permanent Impairment, Fifth Edition” has not been
indicated in your claim by your ratings physician.
The vast majority, if not all, impairments ratings - best known as
PPI ratings - must come directly from the AMA Guides to the Evaluation
of Permanent Impairment, Fifth Edition. If your physician has not
indicated in your claim that he/she derived their ratings from this AMA
reference book please make certain to have this corrected before filing.
-
Your ratings physician references the term "disability"
when he/she should be referencing "impairment".
-
Your ratings physician fails to document an adequate
clinical evaluation and analysis as specified in the AMA Guides
to the Evaluation of Permanent Impairment, Fifth Edition.
The items above are but a few of the RED FLAGS
that claims examiners look for in your claim for a scheduled award. We're
certain others exist - if you know of any please
Contact
PEN.
Back To On The
Job Injury Section | PEN Home
|
