In the prior issue we discussed our national
study of 2100 impairment rating reviews; 80% of all ratings
reviewed were erroneous, with 89% of the erroneous ratings
being elevated. We also explored reasons for erroneous
ratings. In this issue we will present several strategies to
assure accurate ratings, and to minimize misuse and abuse of
the
Guides. These include obtaining an accurate,
unbiased rating; evaluating impairment ratings; managing
erroneous ratings; and discrediting erroneous ratings. The
first step is recognizing the high likelihood of error and
becoming knowledgeable about the
Guides (
www.impairment.com).
Impairment evaluations should be performed by a
board-certified physician in an appropriate medical or
surgical specialty (www.abms.org),
experienced in the assessment of injuries and the use of the
AMA Guides to the Evaluation of Permanent Impairment,
Fifth Edition, who has demonstrated competency in the
performance of independent medical examinations, either being
a Certified Independent Medical Examiner (American Board of
Independent Medical Examiners, (www.abime.org),
a Fellow of the American Academy of Disability Evaluating
Physicians (www.aadep.org),
having obtained Certification in Evaluation of Disability and
Impairment Rating (www.aadep.org)
and/or a Certified Impairment Rater (www.certifiedr
ater.com). These organizations typically list their
members at their websites. It is appropriate to determine if
the physician has attended educational programs specifically
on the use of the AMA Guides. Training in impairment
evaluation is provided by American Academy of Disability
Evaluating Physicians (www.aadep.org),
American Academy of Orthopaedic Surgeons (www.aaos.org),
American Board of Independent Medical Examiners (www.abime.org),
American College of Occupational and Environmental Medicine
(www.acoem.org),
Brigham & Associates www.impairment.com and other organizations. A careful review of that
physician’s curriculum vitae and sample reports is often
useful. All impairment reports should be critically reviewed
to determine the accuracy of the rating, i.e. was the rating
performed consistent with the AMA Guides and does
clinical data support the rating. Red flags are warning
signals suggesting greater likelihood of an erroneous rating.
All reports should be reviewed by a physician experienced in
the use of the Guides. Clinical knowledge, skills and
judgment are required to adequately analyze the clinical data
and to appropriately apply the AMA Guides; this cannot
be accomplished by a non-physician reviewer. The collection of
data from individual reviews provides valuable insight to
ratings.
Upon obtaining the results of a review, utilize this
information for feedback to the initial rater in an attempt to
correct an erroneous rating, as negotiation, as a basis for
effective cross examination, and evidence. Often physicians
will correct their prior erroneous ratings if constructive,
tactful feedback is provided from a credible expert. The
Guides provide a wealth of material for effective cross
examination. Many physicians are unfamiliar with specific
requirements defined in Chapters 1 and 2 and the rating
chapters.
A 2005 Benefits Review Board decision by the U.S.
Department of Labor, Peter J. Desjardins v. Bath Iron Works
Corporation, BRB No. 05-333. A 2005 Benefits Review Board
decision by the U.S. Department of Labor, Peter J. Desjardins
v. Bath Iron Works Corporation, BRB No. 05-333 Benefits
Review Board Decision
