AMA Guides Impairment Ratings Erroneously Elevated: California Study Confirms Best Practices Approach is Expert Review of all Impairment Ratings : Insurance News Onlypunjab.com- Insurance News

AMA Guides Impairment Ratings Erroneously Elevated: California Study Confirms Best Practices Approach is Expert Review of all Impairment Ratings
Publish Date : 3/9/2007 7:40:00 PM Source : Insurance News Onlypunjab.com

Most impairment ratings are incorrect and often readers of these reports are unaware of the significance of these errors. Assessment of impairment according to the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition is the first step in defining Permanent Disability for State of California workers' compensation cases. A review of California cases revealed the vast majority of the ratings were incorrectly elevated. Often these evaluations are performed by physicians who are either unskilled or biased in performing impairment evaluations. Claims management best practices must include expert review of all ratings.
Brigham and Associates, Inc. (www.impairment.com) provides both expert consultation on impairment evaluation and extensive national data analysis of permanent impairment critiques. In July 2006 the organization implemented a new web-based database system with extensive tracking capabilities, including that for diagnoses (by ICD-9 code), impairment numbers (California Permanent Disability Rating Schedule), and physician performance.

One of the purposes of this system is to provide a better understanding of impairments and the etiology of erroneous ratings. The developer of this system is Christopher R. Brigham, MD, CIME, FACOEM, FAADEP; Dr. Brigham is Editor of the Guides Newsletter, a Senior Advisor to Sixth Edition of the AMA Guides, and the author of several texts.

Reports are provided for review and analyzed by a team of highly trained professional claims and medical staff who are very experienced in the use of the AMA Guides. If a report is incorrect a detailed written narrative report is prepared explaining the errors in the original rating and what the correct rating is. These reports are then used by clients for case management, as feedback to the original rating physician, as evidence, in negotiation, or to assist in preparing an effective cross-examination.

Of 658 California impairment critiques performed between July 2006 and February 2007, 751 (87%) were incorrect, with the average original rating 18.7% whole person permanent impairment (WPI) and the average revised (corrected) rating 4.9% WPI. Although most ratings were incorrectly elevated, some evaluations underrated impairment. Impairment ratings are typically expressed on a whole person scale where 0% WPI represents normal functioning and 100% WPI represents death.

The high error rate cannot be attributed solely to selection bias, i.e. a client only referring cases suspected of being erroneous. Clients have recognized the value of having every rating screened by Brigham and Associates, Inc. and having detailed critique reports prepared on ratings that were significantly incorrect. 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. Of the 18% of the reports that were found to be correct the average rating was 2.2% WPI.

The financial impact of incorrect ratings is significant. In the State of California the whole person permanent impairment is used as the initial basis to define permanent disability (PD), with the rating being adjusted per California Permanent Disability Rating Schedule for Future Earning Capacity, occupation and age. Using the data observed in 73 sequential ratings (i.e. without selection bias) with the findings of an original rating of 12.3% (12%) WPI and a corrected rating of 3.7% (4%), depending on the modifiers, this would result in approximate original PD ratings in the range of 18% to 19% PD and corrected PD ratings of 6% to 7% PD.

Assuming a January 2005 date of injury and maximum weekly wages, the California PD benefit award based on the original ratings would be between $14,410 and $15,510 and the corrected ratings between $3,960 to $4,620, i.e. a difference of between $10,450 and $10,890 per case. Utilizing the data obtained and assuming lower values for derived PD awards, per 100 cases involving suspected PD, if ratings were based on the original impairment rating, the total cost would be approximately $1,236,048, however upon correction the cost is $368,698, i.e. a difference of $867,350.

The practice of having every impairment evaluation reviewed by external experts results in a very high return on investment. Analysis of the resulting data is essential to continuous quality improvement, provides a basis for profiling individual physician performance, and provides information on the extent of impairment associated with specific diagnoses.

The assessment of impairment evaluations requires a unique skill set and must be performed by evaluators with knowledge, skills and abilities in both clinical medicine and the use of the AMA Guides to the Evaluation of Permanent Impairment. It is very cost-effective to have every impairment rating reviewed by an AMA Guides expert to determine if the rating is accurate and to utilize the clinical data provided to reassess the impairment. Evaluation and feedback is essential to quality improvement and review of every rating reflects best practice.

About Brigham and Associates:
Brigham and Associates, Inc. (www.impairment.com) was founded in 1995, and is recognized as the nation's leading resource on impairment, disability and causation evaluation. Their well-trained and highly credentialed professional staff utilize advanced Web-based technology and database systems to provide high quality, cost-effective consultation services, including impairment report critiques and case reviews. The firm also provides evaluation resources, publications and training in live, web-based and online education formats (www.guidesiq.com).

Onlypunjab.com

The Best Benefit in The Travel Insurance Industry Just Got Better Publish Date : 11/5/2007 7:25:00 AM
TravelSafe Insurance upgrades it's industry-first "Cancel For Any Reason" travel insurance benefit to cover up to 100% of travelers' non-refundable trip cost.

SASid and Markel Insurance Company Introduce Short Term Medical Health Insurance for Individuals and Families Publish Date : 11/5/2007 7:23:00 AM
SASid, Inc. and Markel Insurance Company announced today that they have joined together to offer short term health plans for individuals and families.

PrintsMadeEasy.com Announces Plans for New Line of Real Estate Business Cards Publish Date : 11/3/2007 6:26:00 AM
PrintsMadeEasy.com, the global leader in online printing solutions, today announced plans to release a new series of templates and designs for real estate business cards in 2008.

Sompo Japan Insurance Company of America Announces Selection of Millbrook and Oracle® Business Intelligence Solution Publish Date : 11/2/2007 7:16:00 AM
Millbrook Incorporated is pleased to announce that Sompo Japan Insurance Company of America has selected a solution based on...

Life Insurance Opportunities in Qualified Plans to be Focus of Nineteenth Annual Henry A. Deppe Lecture Publish Date : 11/1/2007 7:07:00 AM
Five financial experts will participate in Life Insurance Opportunities in Qualified Plans as part of The American College's nineteenth annual Henry A.

Lighthouse1 Announces CDH Event of the Year Publish Date : 11/1/2007 7:07:00 AM
Lighthouse1, the industry leading provider of consumer driven healthcare administration solutions, announced that Revolution '08, the first Lighthouse1 OnDemand™....

Partners Advantage Insurance Services, Inc. Merges with Maxx Financial Partners, LLC Publish Date : 11/1/2007 7:07:00 AM
Partners Advantage Insurance Services, Inc., and MAXX Financial Partners, LLC, announced today the completion of their merger, creating one of the ...

Website Exposes Dirty Little Secret of Private Mortgage Insurance (PMI) Publish Date : 11/1/2007 7:07:00 AM
Go.Toby.com, the popular real estate news and information website for Palm Coast, Flagler County, and Northeast Florida posts an article revealing ...

Silanis Sets the Record Straight on Electronic Contracting Myths Publish Date : 11/1/2007 7:07:00 AM
Leading electronic signature provider Silanis Technology has posted a recording of its recent Webcast, "Electronic Contracting - Dispelling the...

Employers Tackling Health Care Challenges with 21st Century Benefit Design Publish Date : 11/1/2007 7:07:00 AM
A new approach to health care in the 21st century should address the most acute challenges of our time and chart a new course through better use of data, ...

Total Results : 3507
More News (Opens in New Window) : [1] 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 Next Page

Canada News

Gadget News

Infotech News

Europe News

Health News

Middle East

Sports News

Advertising News

America News

Application News

Asia Pacific

Software News