Let's All Get a Grip on Grip Loss

• Publication year: 2021
• Author: Gregory Grinberg, Esq.

Let's All Get a Grip on Grip Loss

Gregory Grinberg, Esq.

San Mateo, California

It doesn't take long for practitioners new to the field of California workers' compensation law to realize that there are constant arguments on just about every point. Did the employer make a valid offer of regular, modified, or alternative work? Was utilization review timely? How should the average weekly wages be calculated?

One of the substantive areas of workers' compensation that sees a sizeable amount of sparring between applicant and defense attorneys is the use of grip loss in rating whole person impairment. The American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition (AMA Guides) allow for rating loss of grip strength in certain narrow circumstances, but the Almaraz/Guzman line of cases (Guzman III) has drastically expanded that narrow scope, leading to significant factual and legal disputes about when and how the sections on rating grip loss can be used. Because there is little binding authority on the subject, the landscape is rich with different opinions and results, and there is no shortage of things to keep in mind when evaluating the merits of cases involving alleged loss of grip strength.

The story begins in April of 2004, when then-Governor Arnold Schwarzenegger signed into law SB 899, yet another, and certainly not the last, in a long series of workers' compensation "reform" bills. One section of the bill amended Labor Code section 4660 to reflect that:

[f]or purposes of this section, the "nature of the physical injury or disfigurement" shall incorporate the descriptions and measurements of physical impairments and the corresponding percentages of impairments published in the [AMA Guides].

The AMA Guides certainly provided an abundance of "descriptions and measurements" to become familiar with. The topic of grip loss was no exception. Section 16.8 on page 507 of the AMA Guides discusses the use of strength evaluations in general, and it doesn't start on a very encouraging note:

Because strength measurements are functional tests influenced by subjective factors that are difficult to control...the Guides does not assign a large role to such measurements.

The authors of the AMA Guides continued to the bitter end with this tone of skepticism about the reliability of grip loss. In discussing the proper use of grip loss, section 16.8a on page 508 provides:

In a rare case, if the examiner believes the individual's loss of strength represents an impairing factor that has not been considered adequately by other methods in the Guides, the loss of strength may be rated separately.... [T]he impairment due to loss of strength could be combined with the other impairments, only if based on unrelated etiologic or pathomechanical causes.... Decreased strength cannot be rated in the presence of decreased motion, painful conditions, deformities, or absence of

...