Strategies to Assure Accurate Impairment Ratings

There are 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.

To achieve accurate ratings it is necessary to utilize strategies that are proven to reflect best practice. It is important for both the rating physician and the party requesting the rating to recognize the high likelihood of error and to become knowledgeable about the Guides.

Assuring Accurate Impairment Evaluation

Proactive management of impairment ratings starts by assuring the initial impairment rating is correct and is performed at maximal medical improvement. Claims organizations may establish processes driven by specific triggers.

Physicians performing impairment evaluations should be experienced in the assessment of injuries or illnesses being rated and in the use of the Guides. Ideally, the physician should have had formal training on the use of the AMA Guides and demonstrated competency in the knowledge, skills, and experience required to assess impairment. Impairment evaluations should be performed by a board-certified 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. 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 ), and other organizations. A careful review of that physician’s curriculum vitae and sample reports is often useful.

The client requesting an impairment rating by a physician may want to work with an organization that has identified, and credentialed, physicians skilled in assessing impairment. The client requesting the evaluation should provide a cover letter describing the specifics of the evaluation which should be carefully reviewed by the physician. Providing guidance on the assessment process and defining standards for the evaluation and the report will improve the probability of obtaining a correct rating. All relevant medical records and any other nonmedical documents that may be helpful in the rating process should be provided.

Assessing and Managing Impairment Ratings

Since there is a high error rate with impairment ratings, 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. Impairment Resources has identified specific triggers associated with erroneous ratings. Please contact us to discuss these triggers.

The reviewer of ratings should be experienced in the use of the Guides and the process of auditing reports. Clinical knowledge, skills, and judgment are required to adequately analyze the clinical data and to appropriately apply the AMA Guides. Typically a nonphysician, working independent of a physician, will be unable to accurately determine the reliability of ratings, since he/she will not have the skills to judge the significance of specific clinical findings upon which an impairment assessment is based.

The impairment review may be used to provide feedback to the rating physician, and will promote improvement in the rating process (particularly if constructive, tactful feedback is provided from a credible expert). Reviews may also be used as a negotiation tool, as basis for effective cross-examination, and for evidence.

It is important to track the return on investment from an impairment management program. Since the error rate is high, the difference between the original rating and corrected rating is often several rating percentage points, and the dollar value per percentage point is often more than a thousand dollars, there are opportunities for significant cost savings. Beyond the opportunities for financial savings, there is the opportunity for human savings by not portraying someone as seriously impaired, i.e. damaged, when they are not.

Impairment ratings should be reviewed for accuracy. Inaccurate ratings often are the result of bias, confusion, and misapplication of the Guides. It is imperative that physicians perform impairment evaluations according to the processes defined in the Guides, in an effort to avoid errors in rating. Strategies are available to assist stakeholders in obtaining an accurate rating at MMI initially, or to reduce or fix errors in ratings that are received. Clients requesting ratings should be aware of the high incidence of error and take steps to drive accurate impairment ratings. Impairment Resources, LLC will assist you in assuring accurate impairment ratings.