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Almaraz/Guzman Rating Will Not Apply If Physician Does Not Explain How Or Why AMA Guides Rating Is Not Accurate


(2015) 2015 Cal. Wrk. Comp. P.D. Lexis 583


Applicant, a correctional Sergeant, alleged injuries to numerous body parts including right hand and wrist as a result of an altercation with an inmate. The parties utilized an Agreed Medical Examiner in orthopedics to assess the hand and wrist injuries.

On April 17, 2013, the doctor reported that the applicant had reached maximum medical improvement, but he could not provide an impairment rating because he could not “get a credible examination” due to applicant’s failure to participate/cooperate. In a subsequent report (following a re-evaluation) the doctor noted that a strict AMA Guides rating would result in 0% Whole Person Impairment. However, he felt a more accurate rating would be 12% Whole Person Impairment based on the applicant’s loss of capacity to push, pull, lift and grip with the right hand. The report did not explain how the 12% Whole Person Impairment was calculated.

Based on the AME report, the applicant received an award which included permanent disability based on the 12% Whole Person Impairment. Defendant filed a Petition for Reconsideration.

The WCAB granted the petition and ordered that the award be amended to reflect a 0% permanent disability for the hand and wrist. The panel noted that the AME failed to meaningfully explain how or why he concluded that the applicant’s subjective complaints warrant a 12% Whole Person Impairment when the objective rating under the AMA Guides was 0%. The doctor also failed to explain why he relied on the subjective complaints when he previously noted the applicant’s lack of credibility and effort in testing.

Absent an explanation of how or why an alternative rating is more accurate, the doctor’s opinion was not based on substantial evidence. Consequently, it was insufficient to support an award of permanent disability.