AMA Guides and Utah Impairment Guides Control Impairment, not Causation in CRPS situation

Petitioner injured his right hand after turning on a hose while the hand was in front of the nozzle. The petitioner was eventually diagnosed with complex regional pain syndrome (CRPS) by three different doctors. However, a fourth doctor, relying on the AMA 5th Edition which is used in Utah Workers Compensation claims, concluded that the petitioner did not have CRPS, as Petitioner only exhibited three of the eleven specific objective symptoms. The AMA Guides state that an individual can be clinically diagnosed with CRPS only if he or she exhibits at least eight of the eleven symptoms.

The claim went to a medical panel which determined that Petitioner did have CRPS. However, the medical panel did not use the AMA 5th Edition or Utah’s 2006 Impairment Guides. Instead they used the more recent “Budapest Criteria” established by the International Association for the Study of Pain, which the ALJ found were “the most widely accepted diagnostic criteria among pain specialists.”

The issue was whether the Commission correctly determine that the Panel’s report was admissible, or should it have been excluded because the Panel did not use the diagnostic criteria found in the AMA Guides 5th Ed. or the 2006 Utah Guides, which the employer maintained was required by a state regulatory provision contained in R612-300-9(A).

R612-300-9(A) specifically governs Permanent Impairment Ratings. The Rule by its express terms is limited in its application to proceedings in which the establishment of an impairment rating is sought. “Nothing in the Rule indicates any application to proceedings not involving the establishment of an impairment rating, and we are reluctant to read such language into the Rule, not only because such a reading would be contrary to plain language principles of interpretation.” In the current case, an impairment rating was not at issue and so it was not error for the ALJ to accept the medical panel report even if it utilized outdated diagnostic standards when establishing a diagnosis.

The Utah Court of Appeals disagreed with Respondents’ argument that the Impairment Rating Guides or the AMA Guides should be followed in this case. The Court of Appeals determined that the Impairment Rating Guides and AMA Guides were applicable when an impairment rating was at issue. In this case, a diagnosis of CRPS, not an impairment rating was at issue and the Court was reluctant to expand the Rules and statute for impairment ratings to apply to an establishment of a diagnosis. Therefore, the medical panel was free to utilize whatever criteria they deemed reasonable in determining the diagnosis of CRPS of the injured worker.

Clean Harbors Environmental Services v. Labor Commission, — P.3d —-, 2019 UT App 52, 2019 WL 1474887

Would you like to know more? Contact Christin Bechmann at cbechmann@pollartmiller.com or 877-259-5693.

2019-05-31T15:15:53+00:00