Georgia code 34-9-263
(d) Impairment ratings. In all cases arising under this chapter, any percentage of disability or bodily loss ratings shall be based upon Guides to the Evaluation of Permanent Impairment, fifth edition, published by the American Medical Association. (Nowhere does it say an impairment rating has to be performed by a medical doctor. “shall be based upon Guides to the Evaluation of Permanent Impairment, fifth edition, published by the American Medical Association.”)

On page 17 of the AMA Guides to the Evaluation of Permanent Impairment, fifth edition, it says that “if the clinical findings are fully described, any knowledgeable observer may check the findings with the Guides criteria.” The “AMA Guides” are basically a set standards or a cookbook for any doctor or other knowledgeable observer to evaulate impairment. Moreover, “any other observer or physician following the methods in the Guides to evaluate the same patient should report similar findings.”

The term any knowledgeable observer leads us to:

Daubert
In 1993, the US Supreme Court directed federal judges to examine the method or reasoning underlying the admission of expert evidence and to admit only evidence that was reliable and relevant ( Daubert v. Merrell Dow Pharmaceuticals, Inc.). Georgia uses Daubert to qualify evidence. Daubert set forth a non-exclusive checklist for courts to use in assessing the reliability of scientific expert testimony. The effect of this decision was that judges presiding over technically complicated cases have assumed a new gate keeping function, screening expert evidence to ensure that what was admitted was both relevant and reliable. In Kumho Tire Co. v. Carmichael (97-1709, 1999), the U. S. Supreme Court ruled that expert testimony need not be based on scientific knowledge or methods, but may rely on the training, experience, education, and other qualifications of the witness.

AMA Guides to the Evaluation of Permanent Impairment is the only method acceptable using Daubert to evaluate for an impairment.“if the clinical findings are fully described, any knowledgeable observer may check the findings with the Guides criteria. ” Then, “any other observer or physician following the methods in the Guides to evaluate the same patient should report similar findings.”

Federal Rules of Evidence 702
Rule 702: Testimony by Experts
If scientific, technical, or other specialized knowledge will assist the court of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise, if (1) the testimony is based upon sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case.

(d) Chiropractors who have complied with this chapter shall have the right to sign health certificates, reporting to the proper health officers the same as other practitioners.

The International Classification of Functioning, Disability and Health (ICF), produced by the World Health Organization, distinguishes between body functions (physiological or psychological, e.g. vision) and body structures (anatomical parts, e.g. the eye and related structures). Impairment in bodily structure or function is defined as involving an anomaly, defect, loss or other significant deviation from certain generally accepted population standards, which may fluctuate over time. Activity is defined as the execution of a task or action. The ICF lists 9 broad domains of functioning which can be affected:

• Learning and applying knowledge
• General tasks and demands
• Communication
• Mobility
• Self-care
• Domestic life
• Interpersonal interactions and relationships
• Major life areas
• Community, social and civic life

(see also List of mental disorders)

The introduction to the ICF states that a variety of conceptual models has been proposed to understand and explain disability and functioning, which it seeks to integrate.

The medical modelMain article: Medical model of disabilityThe medical model is presented as viewing disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at "cure", or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming healthcare policy.

The social modelMain article: Social model of disabilityThe social model of disability sees the issue of "disability" mainly as a socially created problem, and basically as a matter of the full integration of individuals into society (see Inclusion (disability rights)). In this model disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, in this model, the management of the problem requires social action, and thus, it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The issue is both cultural and ideological, requiring individual, community, and large-scale social change. Viewed from this perspective equal access for people with impairment/disability is a human rights issue of major concern.

The National Safety Council reports "Each year, more than 5,000 workers lose their lives and nearly four million suffer disabling injuries on the job in America." 
*The National Safety Council, Press Release, National Safety Council Honors Workers on Workers Memorial Day, April 24, 2003
The National Safety Council reports "Every 1.5 seconds someone in the U.S is disabled in an injury." *
*The National Safety Council, Injury Facts, 2001

The National Institute on Disability and Rehabilitation Research states that "Computer technology and the Internet have a tremendous potential to broaden the lives and increase the independence of people with disabilities.  These new technologies hold great promise, but as this report makes abundantly clear, the computer revolution has left the vast majority of people with disabilities behind. Only one-quarter of people with disabilities own computers, and only one-tenth ever make use of the Internet." *

*The United States Department of Education, National Institute on Disability and Rehabilitation Research, NIDRR, 
Report 13, March 1, 2000
The National Institute on Disability and Rehabilitation Research states that "two most common causes of disability are Back Problems and Heart Disease." *
*The United States Department of Education, National Institute on Disability and Rehabilitation Research, NIDRR, Pub. No. 16. September, 1996.
The United States Department of Health and Human Services has documented that "for persons under the age of 45, low back problems are the most common cause of disability." *
*Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Quick Reference Guide Number, 14, Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR, Pub. No. 95-0643. December, 1994.

If you are an insurance company, please call
(770) 469-7330 to schedule an IME, first look review, or records review. Dr. Connelly, DC does meet the Georgia Review Agent requirements.

When you have been injured or have a serious medical condition, it is often necessary to perform an impairment and disability rating. We will also address mechanism of injury and causation. You do not need to be a patient for us to do a work up. It usually takes just 1 visit, and no treatment is involved. Over the years, we have done evaluations for patients from all over Georgia, and even from out of state, though most of our patients hail from the Stone Mountain, Atlanta, Tucker, Swanee, Snellville, Conyers, Dekalb, Gwinnett, Fulton, Cobb, and Marietta areas. 

Our reports are based on the information below:

It is important that you bring or forward to us all your medical records and diagnostic tests. 

There are three main texts that we follow when doing a rating: 

American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, American Medical Association 2001 

American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. Chicago, AMA, 2008 

American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003.

Definitions to understand concerning impairment: 
A loss, loss of use, or derangement of any body part, organ system or organ function. American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, American Medical Association 2001 

A significant deviation, loss or loss of use of any body structure or function in an individual with a health condition, disorder or disease. American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. Chicago, AMA, 2008 

An anatomical, physiological, or psychological abnormality that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Social Security Administration (1995)

Definitions to understand concerning disability: 
It is an alteration of an individual's capacity to meet personal, social, and / or occupational demands or statutory or regulatory requirements because of an impairment. American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, AMA 2001 

Activity Limitations and/or participation restrictions in an individual with a health condition, disorder, or disease. American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. AMA, 2008 

Disability is the inability to complete a specific task successfully that the individual was previously capable of completing or one that most members of a society are capable of completing owing to a medical or psychological deviation from prior health status or from the status expected of most members of society. American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003.

Definitions to understand concerning causation: 
An identifiable factor (accident) that results in a medically identifiable condition ( injury or illness). 

Causal opinions in reports and testimony must be given in terms of reasonable medical probability or certainty. (more probably than not) 

Probability, simply means that something is more likely than not (51% or greater). If the confidence is equal to or less than 50% it is merely a possibility. 

A causal relationship is biologically plausible when: 

The relationship between the medical condition and the injury can be explained anatomically or physiologically. 

The duration, intensity, or mechanism of exposure or injury was sufficient to cause the illness or injury in questions. 

There is evidence suggesting that the exposure is consistently or reliably associated with the process under investigation in the population under investigation or in peer-reviewed literature. 

Cause and effect are contiguous. 

There is literature providing biologic or statistical evidence indicating that the symptoms or disorder could develop as a result of the exposure (coherence). 

There is specificity of the association for the injury (i.e., the absence of other factors) 

Definitions to understand concerning apportionment: 
Once causation is determined and there is probable cause related to the event, then apportionment is evaluated. If there is no causal relationship then apportionment is not necessary. 

The extent to which each of 2 or more probable causes are found responsible for an effect (injury, disease, impairment, etc..) 

A distribution of causation among multiple factors that caused or significantly contributed to the injury and resulting impairment. 

Precipitation - Injury or exposure causes a latent or potential disease process to become manifested. 

Acceleration - Injury or exposure hastens the clinical appearance of an underlying disease process. 

Aggravation - A permanent worsening of a prior condition by a particular event or exposure. 

Exacerbation - A temporary worsening of a prior condition by an exposure / injury.

Recurrence - Signs and symptoms attributable to a prior illness or injury occur in the absence of a new provocative event. 

American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003, page 99 -100. 

The phrase "pre-existing condition" often causes confusion for medical-legal-insurance providers. 

There are only two types of pre-existing conditions. The first is known as an "inactive" or "dormant" pre-existing condition. The second is known as an "active" or "symptomatic" pre-existing condition. 

The difference between an active vs. inactive pre-existing conditions is "like night and day." 

This may require a detailed review of past and present medical records. 

The "proximate cause" of the present symptoms is the recent trauma, even though the symptoms may be worse or healing may take longer because of a pre-existing condition.

Please call us to make an appointment or ask any questions, 770-469-7330. Common search terms Atlanta Impairment, Atlanta Disability, Disability Doctors, Auto Accident Reports Atlanta Georgia,  Atlanta Disability Chiropractors, IME's, Independent Examinations, Disability Reports, and Impairment Reports.