Experts say the removal of a scale for diagnosing mental disorders from the American Medical Association’s Guide to Disability Ratings is a welcome change for those processing mental injury workers compensation claims.
An analysis released September 12 by the National Compensation Insurance Board said the effects of changes made last year to the AMA’s guideline are “unconfirmed” when it comes to diagnosing and identifying a disability. The Florida-based rating agency, Boca Raton, said that “the only significant content and methodology changes were for mental and behavioral disorders.”
The changes appear in the sixth edition of the handbook, which was last updated in 2008. The new version aligns with “the latest (guidelines) in medicine and provides a basis for fair and consistent assessment and impairment assessments.”
Most states use the AMA Guide by law to determine a corporate-related disability.
The American Psychiatric Association and the American Psychological Association have proposed a comprehensive reform to be in line with the “Diagnostic and Statistical Manual of Mental Disorders” or the Diagnostic and Statistical Manual of Mental Disorders, which is considered a reliable guide for diagnosing mental disorders, according to the AMA.
The new guidelines, in both the DSM and AMA Handbooks, eliminated the global assessment of the performance measure as a means of determining vulnerability.
The GAF provides a score between zero and 100 based on a person’s job – the higher the score the higher the job – and the ratings are grouped into scores. Experts say the GAF is very inaccurate and creates confusion and conflict when defining a disability.
Mark Debus, clinical director of behavioral health at Sedgwick Claims Management Services Inc. In Chicago: “From a physician’s perspective, GAF has always been an issue,” adding that he expects little or no changes in companies’ claims as a result of his removal. “When they removed it, the community of healers sighed because it was just a ridiculous result. First of all, it is very subjective.”
Les Kertay, the psychologist who helped draft the AMA’s latest guide and senior vice president of behavioral health at Axiom Medical in Chattanooga, Tennessee, said GAF was removed from the DSM because it “had some significant reliability issues” and that it “taken it out,” especially Because it’s no longer in the Diagnostic and Statistical Manual of Mental Disorders, it made sense. If it’s bad enough that the American Psychiatric Association doesn’t want to use it anymore, we probably shouldn’t use it.”
“Maybe you and I would have classified someone completely differently in the GAF,” he said, adding that the AMA is still relying on other measures to diagnose and determine disability for mental injuries.
As part of their research, Mr. Kertay and other medical professionals examined disability ratings without measuring GAF. He said there were few or no differences in diagnoses and classifications without GAF.
While most states require medical professionals to rely on the AMA’s most recent guideline, California sticks to the earlier version, according to Ron Heredia, a psychologist, director and founder of Los Angeles-based Good Mood Legal, who specializes in reviewing psychology reports in insurance claims.
He said the GAF score is “another piece of information” for the claim and one of the reasons the state adheres to the AMA Guide V.
Mr. Heredia agreed that the subjectivity of the outcome was a concern. When the so-called “psychiatric claims” are challenged, medical records are often found to lack concrete details – such as what the affected worker is experiencing – and the GAF result is often ignored, he said.
“The GAF score is basically the doctor’s choice of the number from zero to 100, and if they want to, they can pick a number out of the hat and say that is the GAF score,” said Mr Heredia.
“And when challenged by either of the attorneys or even the claims examiner as to what GAF score they were assigned to, all the doctor really has to do is say, ‘Well, I gave that score because it’s my clinical discretion. “And they can just repeat it like a broken cylinder. There’s really no rhyme or reason, or formula that a doctor has to follow to come up with a GAF conclusion.”