Waiver of Premium Reviews
To qualify for “disability”, a claimant must have a “medically determinable” impairment. The impairment must have a demonstrable anatomic, physiologic, or psychological abnormality. To meet the definition of disability under Federal Law, the claimant’s impairment must be of such severity that they are not only unable to do the work done previously, but also can not perform any kind of substantial gainful employment.
An independent medical examination or medical record review from a qualified medical provider can address the issue of what a claimant can do despite their impairments.
Disability medical examinations and medical record reviews can be used to address:
- The diagnosis that is causing the disability
- Causal relationship of injury to the disability
- Causation is frequently a critical issue in workers’ compensation and liability cases
- Is injury a temporary or permanent condition?
- What is the Prognosis
- This gives the probability and predicted time of recovery. The recovery may be influenced by factors other than the diagnosis. Such factors include attitude, social environment, concurrent problems, and probable future risks.
- Has the claimant met Maximum Medical Improvement
- When further recovery and restoration of function can no longer be anticipated to a reasonable degree of medical certainty.
- Work Capability or Functional Capacity-
- Parameters contained in the U.S. Department of Labor’s Dictionary of Occupational Titles, which are primarily lifting requirements.
- Appropriateness of Care-
- Identifying Issues such as missing records and need for additional diagnostic studies or consultations
- Impairment Rating-
- Impairment is not synonymous with disability
- Impairment is a measurable decrement in health status evaluated by medical means. AMA Guidelines are most often the criteria used.
- Disability is assessed by the consideration of non-medical issues such as the person’s educational and vocational skills, experience and age
- Recommendation-
- include unnecessary and/or omitted diagnostic evaluation and inappropriate, excessive, and/or omitted treatment.