Friday, January 3, 2014

Court of Appeal Protects Police Officers' Workers' Compensation Benefits

In City of Sacramento v. Workers Compensation Appeals Board (Cannon) (December 26, 2013, Court of Appeal Case No. C072944), the Court of Appeal ruled in favor of accuracy and fairness when rating workers’ compensation injuries.  The decision establishes the Almaraz/Guzman rule is not limited to “complex and extraordinary" workers’ compensation claims.

When a client suffers a permanent impairment, an evaluator rates the injury using the American Medical Association’s Guide to the Evaluation of Permanent Impairment (“AMA Guides”). Almaraz/Guzman, allows the evaluator to give a fair and accurate rating of the client’s disability using any page from the AMA Guides. This is particularly useful when a strict rating under AMA Guides rating is unfairly low. The use of Almaraz/Guzman often results in a higher disability rating for the client.

In this case, the City of Sacramento challenged the rating for a police officer injured on the job. The City's first argued an evaluator may not rate solely on the basis of subjective complaints of pain. The AMA Guides does not allow a strict rating solely based on pain. Thus, defendant argued no rating should be given. But the Court of Appeal quoted the Almaraz/Guzman decision, and reaffirmed the evaluator is not limited to either strict compliance or mechanical application of the AMA Guides. Where a condition is entirely subjective, the evaluator is entitled to use his/her best judgment in assigning a disability rating.

Next, the City of Sacramento dissected four words from the Almaraz/Guzman opinion and asserted it can only be used in “complex and extraordinary cases." The Court of Appeal flatly rejected the claim. The City of Sacramento misinterpreted Almaraz/Guzman. The words “complex and extraordinary cases” referred to syndromes not fully understood or those manifested solely by subjective complaints.  Officer Cannon’s injury, plantar fasciitis, is mentioned nowhere in the AMA guides. Thus, it was clearly within the realm of cases contemplated by Almaraz/Guzman.

This case was not the first time the defense bar has claimed Almaraz/Guzman was limited to “complex and extraordinary cases."  Hopefully, it will be the last. We hope this decision makes it clear accuracy and fairness is the key to rating workers’ compensation injuries.  In those cases where the strict interpretation of the AMA Guides does not accurately reflect a client’s impairment, the evaluator should cite Almaraz/Guzman and provide a more accurate rating.  Mastagni attorney Eric D. Ledger argued the case for Sacramento police officer Arthur Cannon before the Court of Appeal.