Erroneous Rating Study Part VII

Saturday, June 17, 2006 | 0

In the prior article 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 article 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 physicians 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.

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