1. Will the Board bar any Schedule Loss of Use (SLU) results that do not list range of motion (ROM) /or normal values?

   No, the report will not be barred, but an SLU report that fails to provide relevant ROM findings consistent with the Impairment Guidelines (Guidelines) may be considered to have little or no evidentiary value.

2. What will you do if a doctor does not provide the correct documentation to support his opinion?

   An opinion with respect to SLU percentage should be supported by objective findings consistent with the Guidelines. An opinion that is not supported by objective clinical findings consistent with the Guidelines may be considered to have little or no evidentiary value.

3. Will the doctor's calculations/documentation be reviewed for SLU accuracy?

   SLU percentage calculations by a physician should be accurate. The Board will evaluate whether an SLU percentage calculation was done accurately, consistent with the Guidelines, and if not, the SLU opinion may be considered to have little or no evidentiary value.

4. If an Independent Medical Examiner did not record the exam start time, exam end time and the amount of time it took for the IME to review medicals for any exams that took place already (from 5/16/18 to date), what should be done?

   The start and end times of IME examinations should be accurately noted in the examining doctor's IME-4 report. However, failure to note the start and end times will not, at present, result in the report being barred.

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1. With the new SLU guidelines, how can the Independent Medical Examiners apply apportionment (if any)?

   An examining physician should, to the extent possible, offer an opinion of the SLU that resulted from the relevant work-related injury, as opposed to other causes. This can be done by using a claimant's contralateral side as a baseline (e.g., if the left leg was injured, use the right leg as a baseline), when applicable, for determining the loss of function in the body part being evaluated, and by reviewing reports concerning prior injuries to the same site.

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1. If flexion and abduction are less than 10 degrees difference in calculating a shoulder deficit, would you only use the greater of the two and only add the 10% if there is 10 degrees or more difference?

   "If a deficit of both flexion (forward elevation) and abduction are documented, the greater of the two deficits must be used, not both. However, if the deficit in both ranges of motion are moderate or higher, and the measures are within 10 degrees of each other, up to 10% may be added to the overall schedule loss of use, not to exceed ankylosis." In the 2018 Guidelines, note Table 5.4(a), p. 31. Only add "up to 10%" if loss of ROM of both flexion and abduction are moderate or higher and the measures of ROM are within 10 degrees of each other.

2. If the patient was previously awarded an SLU based on the earlier Guidelines, how should a provider assess an SLU resulting from a new injury to the same body part using the new (2018) Guidelines?

   The examining physician should evaluate the injury based on the current (2018) Guidelines to determine the SLU that resulted from the relevant work-related injury, as opposed to other causes. To obtain an increase in an SLU previously awarded based on the earlier Guidelines, there must be: (1) objective medical evidence that claimant's anatomical or functional loss (e.g., ROM) has increased since the earlier SLU was awarded; and (2) evaluation under the 2018 Guidelines results in a higher SLU than the one previously awarded. No increased SLU should be awarded if claimant's anatomical or functional loss is substantially the same as it was at the time the SLU was awarded, even if an assessment pursuant to the 2018 Guidelines would result in a higher SLU percentage.

3. How is the SLU calculated when comparing the non-affected to affected side?

   The impairment is determined based on the percentage of loss of range of motion when compared to the contralateral side. The contralateral limb should be used as the baseline for assessing the injured limb unless there is evidence that a prior injury to the contralateral limb resulted in ROM restrictions, or is otherwise unavailable (e.g., contralateral limb amputated).
   
   Example 1: When the ROM for the contralateral shoulder is not available, use the normal shoulder flexion ROM 0-180 degrees according to the Guideline table. If, for example, the claimant's ROM is 135 degrees, this results in a 20% SLU of the arm (See 2018 Guidelines, Table 5.4(a), p. 31).
   
   Example 2: However, if the contralateral shoulder ROM is available and flexion ROM is 0 to 160 degrees, this becomes the baseline comparison for ROM. For example, flexion ROM of the injured shoulder is 0 to 135 degrees.
   160/180 x100=89%
   135 degrees=20% x 89=18% SLU

4. If the normal value for the uninjured side for shoulder is 160 degrees for abduction, is this the baseline for the injured side when performing SLU?

   Yes, the impairment is determined based on the percentage of loss of range of motion when compared to the same body part on the uninjured side.

5. Is there an SLU after surgery when the patient achieves full range of motion and strength?

   There is no SLU if there is no loss of ROM. However, the Guidelines contain instances where a specific surgery may have a Special Consideration that warrants an SLU.

6. How do you determine the SLU percentage when the ROM falls between the mild and moderate values? For instance, normal flexion/abduction of the shoulder is to 180 degrees, ROM to 135 degrees is a mild deficit, which is equal to a 20% SLU of the arm, and ROM to 90 degrees is a moderate deficit, which is equal to a 40% SLU. What if flexion/abduction is to 105 degrees?

   The ROM of 105 degrees falls between the mild and moderate categories with an SLU of 20% for ROM of 135 degrees and 40% for 90 degrees. For each 45 degree change in ROM, there is a 20% change in SLU. In the example, the ROM of 105 degrees is a 30 degree change (135 to 105) and equals 2/3 of the baseline 45 degrees (30/45). Proportionally, this equals a 13.3% change in SLU value (2/3 x 20%). The resulting SLU=20% + 13.3%=33.3%

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1. Do all established body parts need to be examined during an SLU exam, especially when they are in maximum medical improvement (MMI) for certain body parts and not others?

   "The provider should complete Attachment A and/or Attachment B for each body part and condition for which the patient was treated." (See Subject No. 046-1067A, which contains a link to a 5/22/18 update).

2. Who is expected to do the SLU exam?

   The provider who has treated the injury, or an IME who is qualified to perform such treatment.

3. How would you handle neurologic findings associated with extremity injuries, i.e., mild femoral nerve injury?

   See 2018 Guidelines, Section 10.3(E), p. 57.

4. If the claimant has an injury on the contralateral side, what start point does the doctor use?

   Use normal ROM tables in the Guidelines when there is evidence that injury to the contralateral limb resulted in ROM restrictions or amputation.

5. How does the Board expect the doctor to assess an SLU on a site where a prior SLU was rendered under the old Guidelines?

   The examining physician should evaluate the injury based on the current (2018) Guidelines to determine the SLU that resulted from the relevant work-related injury, as opposed to other causes.

6. Should each documentation of a visit include SLU, or only when doing impairment or Form C-4.3?

   No, only when using Form C-4.3 after the claimant has reached MMI.

7. What happens when a claimant is uncooperative during a physical exam and will not allow the doctor to perform the complete exam?

   The examining physician should note his or her belief that claimant was not cooperating with the examination in IME-4 report and decline to offer an SLU opinion if claimant's failure to cooperate makes doing so impossible.

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1. Can a patient still treat for an injury if an SLU has been done?

   Yes, consistent with the Medical Treatment Guidelines (MTG).

2. Would the continuation of palliative treatment preclude the injured worker from being deemed at MMI?

   "Reaching MMI does not preclude further symptomatic treatment. A finding of MMI is based on a medical judgment that (a) the claimant has recovered from the work injury or illness to the greatest extent that is expected and (b) no further improvement is reasonably expected. The need for palliative or symptomatic treatment does not preclude a finding of MMI. In cases that do not involve surgery or fractures, MMI cannot be determined prior to six months from the date of injury or disablement, unless otherwise stated or agreed to by the parties." See 2018 Guidelines, Section 1.2, p. 6.

3. Is permanent impairment different from permanent disability?

   Impairment and disability are different. The physician determines permanent impairment at MMI. The Judge determines the impact of that impairment, i.e., disability, on the claimant's ability to work. The WCLJ establishes the level of disability based on the available medical evidence. See 2018 Guidelines Chapter 1, p. 6.

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1. Can you really use the contralateral side without knowing if there was a prior injury to the contralateral side, even if years ago, and never treated or related to a work injury?

   When there is evidence that an injury to contralateral limb resulted in ROM restriction, the examining physician should use the normal ROM indicated in the Guidelines, rather than the ROM of the contralateral limb, as a baseline.

2. What if a claimant, at the time of the SLU exam, suddenly remembers an old injury to the contralateral side, so that side-to-side comparison cannot be used as a normal reference range, forcing the usage of 180 degrees of flexion, leading to higher percentage impairment calculations?

   The examining provider should use the normal ROM pursuant to the Guidelines as a baseline only when there is evidence that the prior injury to the contralateral limb resulted in ROM restrictions or amputation.

3. When contralateral is not available but the injured part is clearly limited, such as by obesity, how do we handle it?

   The examining provider should evaluate the injury consistent with the Guidelines' norms and, using his or her medical judgment, offer an opinion as to functional loss and resulting SLU that are causally related to the work injury, rather than other factors, insofar as that can be determined.

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1. How would you perform an SLU exam for injuries to extremities not covered by the Impairment Guidelines? For example, a mid-radius fracture.

   SLUs are based on permanent impairments involving anatomical or function loss, not on the mechanism of injury, absent a special consideration in the Guidelines which expressly provides that an SLU arises from a particular condition or injury. If an injury results in loss of range of motion to an adjacent joint, the Guidelines for the affected joint should be consulted.

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1. Are the Workers' Compensation Law Judges getting the same or similar education on the changes and are they able to reject medical evidence if it is not consistent with the SLU guidelines without the other side having contrary medical?

   WCLJs have been given training on the new Guidelines. An opinion with respect to SLU percentage should be supported by objective findings consistent with the Guidelines. An opinion that is not supported by objective clinical findings consistent with the Guidelines may be considered to have little or no evidentiary value.

2. What directions were the Workers' Compensation Law Judges given on understanding and evaluating the new IME-4 and C-4.3 forms and results?

   WCLJs have been made aware that new forms have been promulgated; however, these forms are largely self-explanatory. WCLJs will be able to understand and evaluate the documentation contained in them. The Board's primary concern is that physicians perform assessments that are consistent with the Guidelines, and fill out the new forms completely and accurately.

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1. Should we be using the term impairment instead of disability with the doctor's office visit notes?

   Yes. Impairment and disability are different. The physician determines permanent impairment at MMI. The Judge determines the impact of that impairment (i.e., disability) on the claimant's ability to work. The WCLJ establishes the level of disability based on the available medical evidence (See 2018 Guidelines Chapter 1, p. 6). This is covered in the Introduction and was covered in the 1996 and 2012 Guidelines.

2. What does reduction to the sum of two major values mean?

   Generally, multiple range of motion deficits, when added together, should not exceed the total SLU of the affected site of injury, and should therefore be reduced to the value of a total SLU of the body part.

3. Can you please clarify and define what new cases are?

   As that term is used in Subject No. 046-1067A, it means permanency evaluations performed on or after May 16, 2018.

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1. Can claimants still get SLU evaluations by way of IMEs of their choosing (versus attending physician's submission of Form C-4.3)?

   Yes. Nothing has changed in this regard.

2. What is the rule when the patient is still in treatment and an SLU has been requested?

   An SLU evaluation should only be performed after the claimant has reached MMI. "The need for palliative or symptomatic treatment does not preclude a finding of MMI." See 2018 Guidelines, Section 1.2, p. 6.

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1. How should completion of the SLU exam and Form C-4.3 be billed by providers? Previously in Subject No 046-472 the WCB indicated physicians are not entitled to enhanced CPT code (99245) for SLU exams. Do the additional criteria for Form C-4.3 completion warrant a 99245 charge?

   No, a code will be provided for the completion of the C-4.3 in the forthcoming Medical Fee Schedule.

2. If the C-4.3 is not being replaced by the CMS-1500, will I be able to submit the C-4.3 electronically using an XML submission partner?

   The CMS-1500 form must be used to submit medical bills for MMI/permanency evaluations, whether the CMS-1500 is being submitted in paper form or electronically using an XML submission partner. To do so, medical providers should:

   • Only use CPT codes 99243 or 99245
   • Only use ONE CPT code (99243 or 99245) on the medical bill (a "completed medical bill" is defined as the CMS-1500 form, and the accompanying medical narrative, which in this instance is the CMS-1500 form and the attached C-4.3 form)
   • Attach a completed C-4.3 to the CMS-1500 form as the medical narrative, as noted above
   • Do not separately send a C-4.3 to the Board, as these will be rejected

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1. Should all three ROMs be documented in reports or just the highest ROM?

   All three consecutive measurements must be reported and the highest value used.

2. Can we use the range of motion testing machine instead of goniometer?

   No. The Guidelines state that examining providers should use a goniometer. See 2018 Guidelines, Section 1.3, p. 7.

3. Should the values used for ROM be active or passive?

   Use active ROM.

4. Do you need all three measurements of ROM documented for both affected and unaffected joints?

   Yes, all three ROM measurements must be documented.

5. How do you assess ROM if patient is non-compliant with ROM testing?

   The examining physician should note his or her belief that claimant was not cooperating with the exam in his or her IME-4 report and decline to offer an SLU opinion if claimant's failure to cooperate makes doing so impossible.

6. If the range of motion is 130, 140 and 150, should the physician should use 150?

   If there is such a significant disparity, it may indicate a problem, such as inconsistent effort by the claimant, which should be documented. Use the greatest ROM reading (150) and document any additional relevant information regarding the examination.

7. Since ROM of the contralateral side will be a consideration at the time of the SLU evaluation, should it be measured during the first exam and reported on the CMS-1500 form?

   Yes, the ROM on the contralateral side should be measured and documented on Form CMS-1500.

8. Regarding ROM of the shoulder, if flexion and extension are not within 10% range, then can the internal rotation and external rotation be included in the SLU?

   No, internal/external rotation deficits of the shoulder "are only considered where no other ROM deficits exist." See 2018 Guidelines, Table 5.4(b), p. 31.

9. How are percentages applied when ROM falls between the designated ROM, or if the ROM does not correspond to a specific percentage loss?

   It should be adjusted proportionally.

10. When there are multiple ROM deficits in a body part, how is that calculated? Are we using the biggest impairment as the SLU percentage? Is anything added beyond the biggest impairment and can multiple additions to the impairment be made or just one addition?

    This is set forth in the Guidelines with respect to each extremity.

11. When doing an IME, how should it be addressed if the examinee's ROM is significantly less than the findings recently documented by the treating surgeon?

    Note the inconsistency and consider whether the claimant is giving maximal effort or whether the claimant is at MMI.

12. What should the physician do if the patient complains of severe pain with the initial ROM measurement?

    The examining physician should use his or her medical judgment. If reasonable, ask claimant to repeat maneuver to a point that is acceptable and document the evaluation limitations in detail. The examiner should not push the patient beyond tolerable limits.

13. How does the Board expect the doctor to assess an SLU on a site where a prior SLU was rendered under the old guidelines?

    Assess the current injury using 2018 Guidelines.

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1. Where can I get information on rating neurological disabilities, extremity weakness/paralysis, paresthesia/pain, fatigue/exhaustion related to pain?

   Neurological impairments (except for limited exceptions) are addressed in the non-schedule injuries section of the 2012 Impairment Guidelines. The 2012 Impairment tables take into account a range of expected severity and duration of pain and those tables cover all but a few individuals. Table 16.1 was designed for those individuals with extraordinary severe persistent painful conditions (See 2012 Impairment Guidelines, pp. 111-117).

2. Where can I get information about obtaining WCB authorization to perform IMEs?

   Please see the WCB website for information on how to become a WCB authorized treating provider and/or IME.

3. Have there been any changes regarding loss of vision?

   There has been no change to the vision loss guidelines.

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1. If a claimant is at MMI, and had both a cervical spine injury and low back injury, does the determination of permanency for one take precedence over the other, or should permanency be determined for both?

   Permanency for both should be determined.

2. Can an IME doctor find permanency and SLU within the same IME report? Also, if there is permanency (PPD) can you also have SLU?

   "The IME evaluator must fill out the IME-4 cover sheet, along with the appropriate listed attachments for either Schedule Loss of Use [Form IME-4.3A] and/or Non-Schedule Permanent Partial Disability [Form IME-4.3B]. The IME evaluator should also provide a narrative report. All three elements (Form IME-4, with attachments, and narrative) are required for a complete IME report." Subject No. 046-1067A. What awards are ultimately made is a legal issue.

1. If both schedule and non-schedule body parts are involved, should the IME doctor give both an SLU opinion and a non-schedule opinion in the same report? And fill out both the IME-4 A and B forms?

   Yes. Please see response to question 2 in the SLU Exams with Schedule and Non-Schedule Body Part Injuries section, above.

2. What determines a scheduled injury versus a non-scheduled injury?

   See 2018 Guidelines, Sections 1.4 to 1.6, pp. 7-9.

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1. Are there any special considerations for carpal tunnel syndrome at MMI?

   See 2018 Guidelines, Sections 3.5 (Special Consideration 6), p. 25 and Section 10.3A, p. 56.

2. A patient with wrist fracture had evidence of carpal tunnel at SLU evaluation but this was not listed at time of treatment. How should this be addressed?

   The examining physician should assess and offer an opinion with respect to permanent impairments resulting from work-related injuries, rather than other causes.

1. Are physicians now required to document permanent facial disfigurements? How is this done?

   Physicians have always have been required to do this. See 2018 Guidelines, Section 11.3, p. 63.

1. If a patient has a loss of sensation on the thumb side of the hand of about 3 x 6 cm, is this a loss that can be scheduled?

   No, thumb SLUs are based on loss of ROM, not sensory loss (See 2018 Guidelines, Section 2.4, p. 13).

1. What Guidelines should be used for inflammatory conditions, like epicondylitis?

   Assess ROM of elbow pursuant to Guidelines. See Guidelines, Section 4.5, Special Consideration 3, p. 27.

1. What Guidelines are used for nerve injuries since there is no reference in the 2012 or the 2018 guidelines?

   See 2018 Guidelines, Chapter 10, p. 54.

1. Since osteoarthritis is associated with pre-existing but exacerbated by a work injury, how does that figure in the SLU?

   That is why the contralateral extremity is used as the baseline whenever possible.

1. What criteria should be used for mental impairments?

   See 2012 Guidelines, Chapter 17, p. 118.

2. What criteria should be used for mental impairments?

   See 2012 Guidelines, Chapter 17, p. 118.

1. If there is a shoulder deficit and there is a deficit in both flexion and abduction, if the difference in degrees between the two falls at or under 10 degrees, would the physician use the higher of the ROM between flexion and abduction?

   You would use the ROM value that reflects the greater deficit. According to the 2018 Guidelines: "If a deficit of both flexion (forward elevation) and abduction are documented, the greater of the two deficits must be utilized, not both. However, if the deficit in both ranges of motion are moderate or higher, and the measures are within 10 degrees of each other, up to 10% may be added to the overall schedule loss of use, not to exceed ankylosis." See 2018 Guidelines, notes under Table 5.4(a), p. 31.

2. When adding on to an SLU for a shoulder notes section, page 31 states you may add 10-15 percent for marked defects of rotation and muscle atrophy. Is a defect in both rotation and muscle atrophy required to get the additional 10-15 percent or can the defect be in either rotation or atrophy to get the additional percentage of SLU?

   To be able to add 10-15%, there must be both defects of rotation and muscle atrophy.

3. If a shoulder injury has only one defect present in flexion/abduction, for example, and abduction is normal but there is a defect in flexion, is the worker entitled to an SLU for having a defect in one ROM or must both flexion and abduction have a deficit to get the SLU?

   A defect in either flexion or abduction can result in an SLU (See 2018 Guidelines, p. 31).

1. Would wrist SLU apply to CTS?

   For a discussion of CTS, see 2018 Guidelines, Sections 3.5 (Special Consideration 6), p. 25 and Section 10.3A, p. 56.

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1. How do physicians know the date that the first SLU evaluation was performed?

   The carrier/SIE, claimant's attorney or claimant should advise and provide a copy of report of the earlier SLU evaluations.

1. Is there any way to get the forms in a Word format?

   The forms are not available in Word format.

1. If MMI is not found, does a physician have to submit Form C-4.3?

   The C-4.3 permits the provider to indicate that the claimant has not reached MMI, to describe why the patient has not reached MMI and the proposed treatment plan.

2. If a claimant has multiple injuries to extremities from one claim, should the doctors use an SLU form for each schedule body part?

   Attachment A to the C-4.3 has room to include assessment of SLUs for multiple body parts. Providers can also submit additional Attachment A forms if necessary to evaluate all relevant body parts. See also Subject No. 046-1067A.

1. Can a claimant's physician use Form IME-4 for an SLU opinion?

   The physician is required to use Form IME-4 if performing an IME of the claimant. The claimant's treating physician is required to use Form C-4.3.

2. Is there an exact date of when these forms and updates are effective?

   See Subject No. 046-1067A.

3. With an addendum, physicians attach Forms IME-3 and IME-4. Here, since this is an addendum, can we place in the time slots "Not Applicable - Addendum"?

   That would be fine.

4. May the IME-4 be submitted without the barcode on page one?

   Do not submit Form IME-4 without the barcode. The Board's scanning vendor uses the barcode for form identification.

1. If an addendum is requested to an IME to address permanency, does the doctor submit Form IME-4.3A or IME-4.B with the IME-3?

   It really depends on the content to the addendum.

1. Can a physician include data in narratives rather than transferring this data to Form C-4.3A?

   A narrative is acceptable if it contains all the information requested in the form. The Board strongly encourages the use of the form.

2. For an IME, can the new forms be submitted in lieu of a narrative report?

   "The IME evaluator must fill out the IME-4 cover sheet, along with the appropriate listed attachments for either Schedule Loss of Use and/or Non-Schedule Permanent Partial Disability. The IME evaluator should also provide a narrative report. All three elements (Form IME-4, with attachments, and narrative) are required for a complete IME report." Subject No. 046-1067A.

1. Will required medical forms (e.g., Form CMS-1500) be available online?

   Online versions of the forms are available from CMS. Additionally, all approved XML Submission Partners electronically transmit CMS-1500 forms to the payer and the Board.

2. Will the online version of the C-4.3 change reflect the changes of the paper-based form?

   Yes, the online version of Form C-4.3 will be updated to mirror the paper form.

1. When is the mandatory effective date of Forms IME 3, 4, and 5?

   See Subject No. 046-1067A with link to 5/22/18 update.

2. Are all new revised forms effective now, Forms IME-3, IME-4 and IME-5?

   No change to IME-3. New versions of IME-4 and IME-5 are effective mid-July. See Subject No. 046-1067A with link to 5/22/18 update.

1. Would an IME doctor ever submit both a Form C-4.3A and Form C-4.3B form?

   No. The IME would use the IME-4.3A and/or IME-4.3B.

2. Can you give SLU and classification?

   The examining physician assesses both.

3. How are doctors supposed to assess the severity of an impairment to an extremity which they decide should be classifiable instead of schedule?

   In an attached narrative report.

1. Are the Start time and End time required for file reviews/addendums?

   No.

2. What is considered Start Time and End Time of exam?

   The start time is the time the physical examination starts. The end time is the time the physical examination ends.

3. If using an older Form IME-4, does the physician now need to add the start/end time requirements on the new Form IME-4?

   The new IME-4 form that is posted on the Board's website is mandatory and older IME-4 forms should not be used.

4. What happens if the IME doctor cannot provide the exam start time and end time on exams that already took place?

   If the doctor is unable to provide the exam start and end times on examinations that already took place, the report will still be accepted.

1. Do the claimant's physicians need to document which draft of the 2018 SLU guidelines they are using (first or second)?

   To clarify, there is only one version of the 2018 Guidelines (First Edition, November 22, 2017). This should be used and so indicated.

2. Often treating physicians have their office's NP or others fill out forms and they co-sign them. If Form C-4.3A is filled out by someone other than a doctor and signed by the doctor, is it acceptable?

   No. The permanency opinion must be provided by the treating physician.

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1. If the date of accident is prior to 1/1/18, which guidelines are the treating physicians supposed to use for SLU opinions?

   The date of the first SLU examination determines which Guidelines to use, not the date of injury.
   If the date of the first SLU examination is on 12/31/17 or earlier, use the 2012 Guidelines. If the first SLU opinion in the record is based on an examination performed on or after 1/1/18, the 2018 Guidelines should be used in any subsequent SLU examinations. For instance, if the claimant's treating physician examined the claimant on 12/28/17, and filed Form C-4.3 on 1/5/18, containing an SLU opinion using the 2012 Guidelines, a subsequent examination by an IME for the carrier should evaluate the SLU using the 2012 Guidelines. However, there may be exceptions: (1) If the first SLU opinion is based on an examination performed before 1/1/18, but the report is subsequently precluded, subsequent SLU opinions after 1/1/18 should use the 2018 Guidelines. (2) If the first SLU opinion is based on an examination performed before 1/1/18, but a subsequent event, such as surgery to the body part in question, undermines the reliability of the initial SLU opinion, subsequent SLU opinions after 1/1/18 should use the 2018 Guidelines.
   If the first SLU opinion in the record was based on an examination performed after 1/1/18, the 2018 Guidelines should be used in all subsequent SLU examinations.
   The 2012 Guidelines should be used for non-schedule injuries.

2. Are these guidelines going to be combined into one permanent impairment and LWEC guideline?

   The 2012 and 2018 Guidelines will be combined at some point.

3. If performing an IME this year, but a patient was first evaluated by the treating doctor prior to this year, which year's guidelines do you use?

   If the first SLU exam is on or after 1/1/18, use the 2018 Guidelines. If first SLU exam was before 1/18/18, use the 2012 Guidelines.

4. When determining which set of Guidelines to use for SLU, does the first examination of MMI need to be by a treating doctor or is an IME acceptable as the first opinion of MMI?

   Either one is acceptable.

5. If an SLU exam was performed prior to 1/1/18 on a knee but the shoulder was not evaluated until after 1/1/18 (same case, both parts injured), do you use different Guidelines?

   Use the 2012 Guidelines for the knee injury and use the 2018 Guidelines for the shoulder injury.

6. Are the Workers' Compensation Board Medical Guidelines listed as First Edition, November 22, 2017 the same as the 2018 Guidelines?

   Yes.

7. If there was a prior SLU award, do we use the new or old Impairment Guidelines for additional SLU%?

   Use the 2018 Guidelines.

1. If the WCB issues EC-81.7 directing IME/negotiation and it is clear from Form C-4.3 that the attending physician did not follow the 2018 Guidelines, can a carrier object and request before scheduling an IME that the attending physician conform to the 2018 Guidelines in their exam and report?

   Yes, the carrier can argue that the report should not be considered. The carrier may utilize any appropriate litigation strategy.

2. If an attending doctor's permanency finding clearly does not use or interpret the 2018 Guidelines correctly, does the carrier need to rebut with an IME or can they simply argue that the claimant med is not accurate?

   Yes, the carrier can argue that the report should not be considered. The carrier may utilize any appropriate litigation strategy.

1. If a physician has submitted SLU determinations using the 2012 document after January 1, 2018, are they invalid now, or will they allow admission and acceptance if not challenged until May 16, 2018?

   If not challenged, they will be considered. However, if the 2018 Guidelines were not used, the report may be afforded little or no evidentiary value.

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