Kentucky IME May Use Clinical Skill and Judgment in Construing AMA Guides

Where an independent medical evaluator concluded that the active range of motion (ROM) measurements she obtained from an injured worker were implausible, indicative of poor effort, and insufficient to verify that an impairment of a certain magnitude existed, the physician could utilize passive ROM measurements as a part of her overall assessment of the impairment to the worker’s right shoulder [Cunningham v. Quad/Graphics, Inc., 2017 Ky. App. LEXIS 268 (June 16, 2017)].

The Court observed that an ALJ may not give credence to a physician’s impairment rating if the rating is not based on the AMA Guides (5th Ed.) and that the AMA Guides required the evaluation of the worker’s shoulder to be based upon “active” ROM measurements. The Court stressed, however, that the AMA Guides themselves acknowledged that the effectiveness and accuracy of these kinds of tests were subject to the conscious or subconscious processes of the individual being evaluated. Where, as here, the IME believed, in light of other medical evidence and in the exercise of her entire range of clinical skill and judgment, that the worker’s measurements were implausible, the physician was permitted to discount the active ROM measurements she obtained from the worker and modify his impairment rating.