How to Read Your Report

The medical-legal report — the QME or AME report — is the document your entire permanent disability is built from. It is long, it is technical, and almost nobody reads it carefully.

Here is what to check, in order.

1. Is every injured body part addressed?

Not mentioned in the history — addressed, with findings and an impairment determination.

A body part that appears in your treatment records but not in this report contributes nothing to your rating. And under § 5502(d)(3), discovery closes at the mandatory settlement conference — raising it afterward is generally too late. More.

2. Are the work restrictions specific?

Pounds. Hours. Positions. Frequencies. Surfaces.

"Light duty" is not a restriction, and a vague restriction is the root of most return-to-work disputes.

3. Is impairment stated as whole person impairment?

Extremity percent is not whole person percent. 100% upper extremity = 60% whole person. 100% lower extremity = 40%.

A shoulder report saying "20% upper extremity" is 12% whole person, not 20. This is the single most common source of confusion in a rating.

4. Is the method identified?

Which chapter, which table, which method. A report that gives a number without saying how it was derived cannot be checked — and cannot be challenged.

5. Does the apportionment paragraph explain itself?

This paragraph decides more of your case than any other, and it is usually four sentences long.

Under Escobedo, an apportionment opinion must explain how and why a non-industrial factor caused a specific percentage of the disability. A percentage attached to a named condition without reasoning is not substantial evidence.

Check what records were reviewed. A physician apportioning to a pre-existing condition who reviewed nothing from before the injury has no factual basis for the number. The report has to list what was reviewed — read that list.

And remember what apportionment is to.* Lindh is not on your side here — it permits apportionment to a condition that never disabled anyone. But it still demands substantial medical evidence tying that condition to *this disability. A history of injury is not, by itself, a history of disability. How to attack it.

6. Did the strict rating fail?

Some injuries rate poorly by design. A rotator cuff tear has no impairment value. Grip strength is excluded from carpal tunnel. The first 25 decibels of hearing loss are free.

Where the strict rating plainly does not capture the impairment, Almaraz/Guzman permits a different method inside the Guides — but the physician must give the strict rating, explain why it fails, identify the alternative, and explain why it is more accurate. A bare assertion will be rejected. What it requires.

7. Is future medical care described?

What you will need, and for how long.

This is the paragraph that determines whether a Compromise and Release makes sense — and in any case involving a device, a joint replacement, ongoing medication, or a progressive condition, it should be read before any settlement discussion. Why.

8. Is causation stated clearly?

For a physical injury, California requires only that the employment be a contributing cause — not the only one and not the predominant one. A report holding you to a higher standard is applying the wrong test. More.

9. Is the history right?

Read the history section as if it were a deposition transcript, because it will be used like one.

Dates, mechanism, prior injuries, prior symptoms, and what you said you can and cannot do. If it is wrong, that matters — and it is correctable through a supplemental report, before the settlement conference.

10. Does the rating string add up?

The final string is arithmetic and it must be self-consistent. In DWC's own published example — 15.03.01.00 – 8 – [1.4]11 – 340G – 13 – 15 — 8 × 1.4 = 11.2, which rounds to 11. If the impairment and the multiplier do not produce the adjusted figure, something is wrong. How to read the whole string.

If something is wrong

There are procedures for objecting, for supplemental reports, for deposing the evaluator, and for cross-examination — and they have deadlines.

What there is not, generally, is a way to fix it after the mandatory settlement conference. This is the moment in the case where a review is worth the most and costs the least.