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AMA Guides Impairment Ratings Erroneously Elevated – Best Practices Approach is Expert Review of All Impairment Ratings


The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition are the standard for defining the impact of an injury or illness. Unfortunately the vast majority of ratings are incorrect, typically overrated and the errors are often undetected. This observation was observed in our 2005 study and reconfirmed in our current study. The conclusion is that all impairment evaluation reports should be reviewed by an expert on the Guides – this intervention is very cost-effective.

California Study

Of 658 California impairment critiques performed between July 2006 and February 2007, 571 (87%) were incorrect, with the average original rating 18.7% whole person permanent impairment (WPI) and the average revised (corrected) rating 4.9% WPI. Review of 73 consecutive cases from one client revealed an error rate of 82% among the ratings performed, with the average original rating of 12.3% WPI and the revised (corrected) rating of 3.7% WPI. View Press Release. The marked difference in ratings between the old PDRS were predicted in our May 17, 2005 Workers Compensation Insurance Rating Bureau study

View a presentation by Dr. Brigham presenting the findings, examining the causes of the errors, and providing specific strategies you can use to assure accurate ratings  - View Handout

National Study

Of 874 national impairment critiques performed between July 2006 and February 2007, 751 (86%) were incorrect, with the average original rating 18.5% whole person permanent impairment (WPI) and the average revised (corrected) rating 5.2% WPI. In the automobile casualty arena every impairment rating was incorrect. View Press Release - View Presentation - View Handout

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Solutions

We provide comprehensive solutions, including the expert review of all ratings –a very cost-effective strategy - ranging from low cost impairment screen ($95), impairment rating reviews ($495 or less), to detailed impairment physician reviews. In addition to persuasive reports, we database the results. Referrals can be made conveniently online. We also offer consultation and training – including our highly acclaimed www.guidesiq.com online training and webinars.

It is very important that you choose the best resource for your reviews. We are the only organization that answers yes to each of these questions.

1. Does the reviewer have substantial experience with the Guides? (i.e. performed or reviewed > 500 AMA Guides ratings)
2. Does the review process involve, as appropriate, an experienced physician who is appropriately credentialed? (ABMS board certified, Certified Independent Medical Examiner, Certified Impairment Rater)
3. Do the participants understand the specific challenges of workers’ compensation in California and does the organization have an office in California?
4. Is there nationally recognized leadership in regards to the Guides? (Therefore resulting in higher quality review, better access to resources, and greater credibility.)
5. Can referrals and records be provided via the Internet?
6. Are reviews performed in a timely manner, typically within 5 days, with a low-cost screening review option?
7. Are detailed narrative critique reports available that will clearly explain any errors and the rationale for the correct ratings?
8. Does the organization collect and analyze data on every review and also provide you that data electronically?
9. Can the organization provide you with both case specific summary and narrative reports, and group data?
10. Does the organization have an effective quality assurance process?

Specific Recommendations

1. Implement on a trial basis for three months the best practices approach of having all impairment ratings screened by Brigham and Associates, Inc. and analyze the cost-effectiveness of this intervention.
2. Encourage all physicians to perform a self-assessment of their knowledge of the AMA Guides and to obtain needed training (www.guidesiq.com)
3. Assure claims and legal staff have needed understanding of the AMA Guides. (www.guidesiq.com)
4. Encourage physicians to seek assistance in performing impairment evaluations (resources available at www.impairment.com)

We look forward to being of service.