Upon further review: 2nd thoughts on the AMA 2nd

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Back in October, I wrote a critical post about the American Medical Association Guide to Causation of Injuries, 2nd edition. (AMA 2nd for short) But as I revised that post to submit as a more formal article, I realized some of my criticisms of the AMA 2nd were misplaced.

I still believe the AMA 2nd will be used by the defense bar to informally heighten causation standards. Other bloggers have made similar observations about the use of the AMA 2nd.

I still believe the AMA 2nd will be used in lobbying efforts by the insurance industry.

But after reviewing the AMA 2nd in more detail, I think the danger of the AMA 2nd is in the misuse rather than the use of the AMA Guides.

I came to my conclusion after reviewing materials written about the AMA 2nd by J. Mark Melhorn, MD who is one of the primary authors of the AMA 2nd.

The AMA 2nd gives doctors guidance on how to determine causation for a work injury. How the AMA 2nd differs from a traditional differential diagnosis is that the Guides ask doctors to consider statistical studies concerning causation – or epidemiology – as to whether a condition is work-related. I think it is important to note that the AMA 2nd still requires a doctor to consider work duties and other factors specific to the injured worker in determining whether an injury is work-related or not. The authors of the AMA 2nd is clear about the limits of epidemiology. The authors of the AMA Causation Guides are also clear that medical causation and legal causation are different concepts.

Because of how the AMA Guides to Permanent Impairment, 6th edition (AMA 6th) for short, have hurt injured workers, I like most plaintiff’s lawyers have a visceral reaction to anything document that includes “AMA Guide” in the title. But if I am faced with a medical report or doctor stating that my client’s work duties could not have caused his or her injuries citing to the AMA 2nd, the AMA 2nd is likely being misinterpreted.

The term “evidence-based medicine” is another trigger for plaintiff’s attorneys. Evidence-based medicine is synonymous with the use of statistical research. While the defense bar seems to have marshalled the mystique of math to their advantage, a lot of time the numbers can work for employees. Plaintiffs can cite to favorable studies linking repetitive or overuse to musulo-skeletal conditions.

Epidemiology can also be helpful to workers in other ways. In cases litigated under the ADA employers will justify discrimination based on disability under the theory that a disability or medical condition can pose a direct threat to the safety or health of others. Epidemiology can help an employee prove their medical condition poses little or no risk to their safety or the safety of others. In my experience, this is particularly true if this research is shared with specialists who have treated the individual in the past.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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