Impairment Ratings - National Data

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Mindy Brigham

Leslie Dilbeck

Most AMA Guides ratings are erroneous, based on national data analysis; the average rating was 14.2% whole person permanent impairment, however in reality it should have been 6.3% whole person permanent impairment, if Guides criteria were applied correctly. Brigham and Associates, Inc. has the largest national database of impairment evaluations. Every time we review a case, we record the data permitting us to analyze impairments and associated factors. This provides valuable insight to the challenges we all face.

What does the data reveal?

• Lumbar spine ratings (including surgical) should average 7.1% WP, not 11.3%.

• Cervical spine ratings (including surgical) should average 10.2% WP, not 13.2%.

• Shoulder ratings should average 5.6% WP, not 10.8%.

• Wrist ratings should average 4.8% WP, not 15.4%.

• Upper extremity neurological ratings should average 5.3% WP, not 13.3%.

• Knee ratings should average 5.2%WP, not 8.9%.

What are some of the most common errors?

• Treating physicians may be biased as advocates for their patients.

• Patients rated prior to being at maximal medical improvement.

• Unreliable data used for the rating.

• Spine cases often rated by the Range of Motion Method should have been rated by the Diagnosis-Related Estimates Method.

• Grip strength is an often used rating when it should not be used.

• Multiple methods for rating the lower extremity are used when actually only a single method should be used.

What can you do to assure accurate ratings?

• Develop a thorough understanding of the AMA Guides.

• Request that your client provide all applicable information.

• Develop checklists & forms to assure that you perform a detailed exam, utilizing forms provided in the Guides, such as Figure 16-1, when appropriate.

• Devote adequate time to perform a thorough evaluation & prepare a supportable report.

• Document physical examination findings per AMA Guides standards, including recording all measurements bilaterally.

• Assess the reliability of your observations.

• Proof read your final report carefully and have it also reviewed by someone else prior to sending to the client.

Welcome to the impairment.com eZine designed to provide you, as a physician who is performing independent medical exams, with practical information critical to the assessment of impairment and other important case issues.

Brigham and Associates, Inc. is "The nation's leading resource on the use of the AMA Guides to the Evaluation of Permanent Impairment, providing you with useful tools and resources to assure accurate ratings." Please email us with suggestions for future editions of this publication.

As a colleague who performs impairment evaluations, Christopher Brigham, MD (the founding director of ABIME, leading author in the field, the president of our firm and my father) thought you would appreciate the value of this information. If you prefer not to receive this free periodic update, please follow the "SafeUnsubscribe" at the bottom.

Please let us know what information and resources would be of the greatest value to you.

~Mindy Brigham, Pacific Regional Manager, San Diego, California