April 11, 2007
Did you know...?
A recent study shows that many impairment ratings in workers’ compensation cases err on the high side and have the potential for negative financial and human consequences.
Brigham and Associates, Inc. reviews impairment evaluations nationally; the goal is to determine if ratings are accurate and the probable impairment based on the available clinical information. In a study performed by Brigham and Associates (between July 2006 and February 2007) 874 impairment ratings were reviewed and 751 (84 percent) were found to be incorrect. The average original rating was 18.5 percent whole person permanent impairment (WPI) and the average corrected rating was 5.2 percent WPI. A typical impairment value is approximately 6 percent WPI.
Of all the cases reviewed, lumbar region sprain was the most common diagnosis (23 percent). The average original rating was 10.3 percent WPI and the average corrected rating was 0.9 percent WPI. The most common errors were associated with ratings based on pain complaints or erroneous use of the Range of Motion Method. The Diagnosis-related Estimate Method is the primary method used to evaluate individuals with an injury. The Range of Motion Method is used when an individual’s condition is not well represented by a diagnosis-related estimate category. The finding of minimal impairment with most low back injuries is consistent with recent studies in which minor trauma did not appear to increase the risk of serious low back episodes of disability.
Among all reviewed cases, 10 percent were for carpal tunnel, with an average rating of 10.5 percent WPI and average corrected rating of 3.2 percent WPI. The most common errors were associated with inappropriately rating grip strength, rating on patient complaints rather than objective findings and inadequately addressing causation.
Additional findings of the case review showed that shoulder injuries averaged 8.8 percent WPI and upon correction were found to be 3.7 percent WPI. The most common error was failure to consider the opposite extremity as normal for the individual. Internal derangement of the knee averaged 7.9 percent WPI and 3.3 percent WPI with correction.
Based on the study findings, Brigham and Associates recommends that employers, insurers and other stakeholders retain experts to critically review the accuracy of 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.
In the impairment rating review process, if the original rating is judged to be incorrect by an expert reviewer and there is adequate clinical information to rate impairment, then the case is re-rated using AMA Guides criteria and the data provided. According to Brigham and Associates, the assessment of impairment evaluations requires diverse skills in clinical medicine and use of the AMA Guides.
The Disability (Missouri) and Impairment rating should have the following:
· The physician doing the rating should be certified by the American Board of Independent Medical Examiners.
· The basis of the rating must be based on objective findings. The objective findings must be clearly stated in the report.
· The answers to any specific questions you have asked must be clearly answered in the report.
If additional information beyond a Disability or Impairment rating is required, then an IME can be requested. Questions such as: causation of the injury, work relatedness of an injury, appropriateness of treatment, is additional treatment indicated, apportionment of current injury with pre-existing conditions, and is the patient at maximum medical improvement can all be answered by having an Independent Medical Examination performed. This broader type of exam can also include a rating, if requested.
For more information regarding impairment ratings, visit http://www.impairment.com.
To find out how OHS-COMPCARE can help with your IME and/or rating needs or to learn more about services OHS-COMPCARE has to offer, contact our Client Services Team at (816) 561-2105 or by e-mail at customerservice@ohscompcare.com. You can also visit us at www.ohscompcare.com.
*Please feel free to forward this information to any member of management in your company who would benefit from it.*
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