6-21-2011; A great question from a reader—do the 2011 Amendments to the Illinois Workers’ Compensation Act require physicians handling Illinois WC patients to be certified to report/refer to...

As you read this, please note the bill hasn’t been signed and isn’t yet law—everyone assumes that will happen, including me but these recommendations remain “open” until the bill becomes law by signature of the Governor.

To answer this complex inquiry below:

·         No to physician certification on the current AMA Guidelines—from our view, it isn’t required in the Amendments. All a licensed IL physician has to do is provide an impairment rating; they don’t have to be “certified” in any particular fashion to do so.

·         Similarly, no to reporting/reference—it isn’t required in the Amendments. It is basically up to the physician as to whether to “add it to their quiver” or learn how to provide AMA ratings from the current Guidelines. It will be up to the individual doctor to decide whether the demands of their medical practice will be best served to add this capability. We are pretty sure lots of doctors won’t have any need for it—for example, OB/GYN’s aren’t going to consider it. In contrast, orthopedic surgeons with lots of WC patients truly should consider it.

However, it is our impression/advice to all doctors with a few to a lot of IL WC patients to

·         Become familiar with and

·         Start to learn/implement and provide impairment ratings based on current AMA Guidelines and

·         Include an impairment rating as part of any report which documents a particular claimant who they are treating is at or about to reach MMI.

It will make the physician’s role in handling IL patients with WC claims much more “functional” or useful to the IL defense/claims industry. As a claimant reaches MMI, if a treating physician provides an AMA impairment rating, the claims adjuster could offer that rating to the claimant to seek to settle on either a formal pro se basis or on an informal “green sheet” to advance claim closure and avoid unnecessary litigation. If the impairment rating is a zero, Steve or his adjusters could tell claimant the rating is a zero and no monies will be offered.

If the treating physician is not familiar with AMA Guidelines and cannot provide an impairment rating, if claims handlers want to offer an impairment rating to claimant, they might have to send claimant to another doctor who would be familiar with the current AMA Guidelines to get a rating. In our view, that may make claims handlers want to start with treating doctors who are already familiar with the process and to the extent possible, avoid docs who aren’t. We also feel PPO networks are going to seek out doctors who are familiar with current AMA guidelines for similar reason.

Understanding the genius a typical physician or surgeon brings to the practice of medicine, we don’t consider the current AMA guidelines to be an “Everest-level” challenge to climb. One easy starting spot on the web is http://www.impairment.com/. If a physician clicks on their products link, you will find books, DVD’s and CD’s and other websites to get your fill of the current AMA guidelines and be rating impairment faster than you can imagine.

Please also note claimant is not required by Illinois law to take the impairment rating when offered but it is our impression the typical worker doesn’t understand the overall WC system like we do and may quietly accept a reasonable rating and avoid the delay and uncertainty of litigation. Folks who are shown a zero rating may view their claims to be at an end when they reach MMI, as happens in other states.

Finally, please note it is challenging for us to tell the industry this news because it isn’t good for defense lawyers but our overall goal at KC&A is to provide the best possible advice and counsel to everyone in this process. We appreciate your thoughts and comments.