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Abstract
A nationwide study in 2005 of 2100 cases referred for impairment rating review found 80% to be erroneous, and 89% of these erroneous ratings were higher than appropriate. Among whole person erroneous ratings (839 of 1037 cases critiqued), the original physician's rating averaged 15.5% whole person permanent impairment, but following rerating by physician experts, the corrected rating averaged 5.6%; only 7% of the cases were underrated. All ratings were based on the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. Tables and figures show error rates according to portion of the body affected, expert vs original rating, and other explanatory variables. Two physicians who use the AMA Guides should arrive at similar conclusions about impairment ratings, but most physicians have not received instruction about assessing impairment, disability, or causation and lack an adequate ability to assess these issues. Causation requires a given cause and a given effect that are associated with a reasonable degree of medical probability and also requires documentation with appropriate scientific evidence (not self-reports or historical time frames). Those who prepare and review assessments of impairment should ensure that clinical causation assessments were accurate, that the rating was performed at maximal medical improvement, that examination findings were consistent, and that the individual's normal state was determined.
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1.
Barth RJ, Brigham CR, Who is in the better position to evaluate, the treating physician or an independent examiner? The Guides Newsletter. November-December 2005.
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Rainville JR, Pransky G, Indahl A, Mayer EK. The physician as disability advisor for patient with musculoskeletal complaints. Spine. 2005;30(22):2579–2584.
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Englund L, Svardsudd K. Sick-listing habits among general practitioners in a Swedish country. Scan J Prim Health Care. 2000;18:81–86.
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Zinn W, Furutani N. Physician perspective on the ethical aspects of disability determination. J Gen Intern Med. 1996; 11:525–532.
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Szpalski M, Nordin M, Skovron ML, et al. Health care utilization for low back pain in Belgium. Influence of socio-cultural factors and health belief. Spine. 1995;20:431–442.
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Ensalada LH. The importance of illness behavior in disability management. Occup Med. 2000;15:739–754.
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Rainville J, Sobel JB, Hartigan C, et al. The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain. Spine. 1997; 22:2016–2024.
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Ensalada LH, Brigham CR. Somatization. The Guides Newsletter. July-August 2000:1–3,10.
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Barth RJ, Bohr TW. Challenges in the IASP's diagnostic conceptualization for CRPS-1 (formerly conceptualized as RSD). The Guides Newsletter. January-February 2006:4–8,12.
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Ensalada LH. Fifth edition: causalgia, RSD, CRPS impairment evaluation. The Guides Newsletter. July-August 2001: 1–2,11-12.
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Brigham CR, Talmage JB, Ensalada L. The dangers of diagnosis. The Guides Newsletter. May-June 2000:2,6.
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Brigham CR. Lumbosacral corticospinal and cauda equina injuries. The Guides Newsletter. November-December 2003:1–3,8-9.
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Brooks CN. Maximum medical improvement. The Guides Newsletter. September-October 2000:1–3.
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Brigham CR, Talmage JB. Assessing maximum medical improvement in carpal tunnel syndrome. The Guides Newsletter. July-August 2003:4–5.
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Brigham CR. Consistency in measurement. The Guides Newsletter. July-August 2004;6–8,12.
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Haralson RH, Brigham CR. Objectifying the spinal impairment examination: fifth edition approach. The Guides Newsletter. November-December 2001:1–4,14.
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Mueller K, Brooks CN. Causality in workers compensation. The Guides Newsletter. July-August 2000:8–11.
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Brigham CR, Roth HJ. Apportionment analysis. The Guides Newsletter. July-August 2004:1–3, 11.
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Walker P. Apportionment and California workers' compensation reform. The Guides Newsletter. January-February 2005:4–5.
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Becker, Nora, Gomes, Stringari, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clinical Neurophysiology. 2002;113(9):1429–1434.
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Brigham CR, Brooks CN, Talmage JB. Knee osteoarthritis. The Guides Newsletter. March-April 2005:1–3,7,12.
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