Impairment Solutions™ for Workers' Comp Organizations
Impairment Solutions, a division of EME International, Inc. is a medical cost containment program that provides a unique service to the industry by reviewing a doctor's medical report which contains an Impairment Rating.
Impairment Ratings have long been the base for settlement purposes for Workers Compensation as well as Long Shoreman Act, Federal Workers Compensation and auto liability, nationwide and internationally.
What happens when that settlement is based on wrong Impairment Rating information? The settlement costs rise. In today's economy, this must be looked at very closely. Recent statistics done by several companies has shown that eight out of ten Impairment Ratings have mistakes and they usually render the IR higher, not lower, thereby causing the costs of settlement to increase, not decrease.
Has the doctor complied with the documentation requirements that are mandated by the AMA Guides?
That is the question and the answer is usually they are not in compliance with the AMA Guides either 4th, 5th or 6th Edition.
EME International, Inc. is uniquely positioned in the field of Impairment Ratings because:
- Experience: Over 19 years in workers' compensation/liability industry.
- Technology: Proprietary software which calculates an Impairment Rating for each edition of the AMA Guides.
- Education of physicians, adjusters and lawyers, fully accredited programs.
- Provider of National Impairment Rating Certification Program which has provided the Certified Impairment Rating Specialist test for Texas (TIRSAT™) and Nevada (NIRSAT™).
The Impairment Solutions' Service
An Impairment Solutions review is performed to assess the accuracy of the impairment rating based on the documentation provided and if the rating followed the compliance documentation requirements of the AMA Guides to the Evaluation of Permanent Impairment, 3rd, 4th, 5th, or 6th edition.
It has been proven that inaccurate impairment ratings have a significant financial impact to the insurance carriers and employers. If questionable ratings or errors are noted, the issue will be addressed by our reviewer's along with an explanation including reference to the appropriate section in the AMA Guides specific edition. This is intended to be instructional as well as helping the doctor to understand what they did wrong.
The Impairment Rating review helps the insurance adjuster to become more efficient with their time by not spending hours trying to verify the impairment. Our physician reviewer's are all Certified Impairment Rating Specialist who have passed a 4 hour competency exam and are highly experienced in impairment determination. Not only do they look at the appropriate use of the Guides, but also the medical accuracy of the impairment. It is not enough to say a claimant has an impairment but there must also be clinical objective documentation supporting that the outcome.
California Permanent Disability Rating, PD
PD rating in California begins with an accurate Impairment Rating. PD ratings are calculated by multiplying the Impairment Rating by three separate modifiers:
1) Future earning capacity (FEC)
3) Age. Apportionment issues are then factored in.
In the event that the Impairment Rating was incorrect, we provide two separate PD ratings. The first one is based on the "corrected" impairment rating and the second is a "would have been" rating. The later is based as if there was no correction to the report. The two separate ratings assist the carrier to make decisions on the case, dispute the rating, settle, or negotiate to a compromise.
This has been a highly successful component of our service.