GENERAL ADVICE – November 2020

Subspecialty Crossover

I recently consulted with a patient who had sustained a combination of injuries involving an upper limb. There was an element of crushing, along with electrical burns. The management team included a trauma surgeon, an upper limb surgeon and a plastic surgeon.

The outcome was as good as could be expected but clearly, the female plaintiff was severely disabled and exhibited a large impairment.

Reports had been solicited from all three expert subgroups. The difficulty arose because not all experts are as familiar with the AMA 5 Guides as would be desirable. Plastic surgeons in particular sometimes struggle with the intricacies of the cross-referencing of tables and figures to arrive at a final permanent impairment rating. Tables 16-10 (page 482) and 16-11 (page 484) deal with the sensory and motor losses consequent upon a peripheral nerve injury respectively. Those Tables in turn must be cross-referenced with Table 16-15 on page 492. Unless the text is read carefully and the fine print is noted specifically, errors in interpretation can occur.

As the disparity between the final impairment that is quantified increases between experts, so does the likelihood of the litigation being protracted.

The solution lies in proper education of all experts who are using the AMA 5 Guides to assist the Court with its interpretation of the Injury Scale Value (ISV).