“I Was Offered a Lump Sum to Drop my Workers’ Compensation Claim”

An injured worker who is receiving future care for their injury may be given a letter from the insurance company, where the insurance company is asking if the patient will agree to a settlement for the claim.

This is usually offered as a lump sum of money. Depending on many factors, the amount of money offered can vary greatly, and sometimes it’s a lot of money. It can come as a surprise, as many people aren’t often offered thousands of dollars in the mail very often. But there’s a very important question to ask: Should you take the offer?

In this blog post, we’ll examine the reasons for a Compromise and Release agreement, in order to help determine if agreeing to one is right for you.
Continue reading “I Was Offered a Lump Sum to Drop my Workers’ Compensation Claim”

RateFast GigaRating: Don’t stop the press!

It’s an exciting time at RateFast as we announce the rollout of the RateFast GigaRating, the most powerful tool in RateFast’s toolkit to date! Inspired by the work of Tesla, Inc. Dr. John Alchemy outlines the next great step on the work comp path to perfection.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!


RateFast GigaRating: Don’t Stop the Press!

Dr. John Alchemy: Oh and I was thinking um for a picture for it I can get a picture of inside the Tesla with a big screen we could have RateFast on it and get a picture of the Tesla steering wheel next to it.

Cory Oleson (Host): It sounds good we give you a worker’s compensation while you while you’re on the road. Yeah.

Welcome to the California Work comp report. It’s Thursday, October 28, 2021. This is your host Cory Oleson here with Dr. John Alchemy, discussing the RateFast GigaRating. How are you today, John?

Dr. John Alchemy: Hey, Cory, we’re back again doing well.

Cory: Yep, that we are and we’re talking today about the RateFast GigaRating and if that’s making your ears perk up because you haven’t heard about RateFast GigaRating before and you also have heard that word used somewhere recently Giga, Giga this, what is that? We are speaking about the RateFast GigaRating against the backdrop of the Tesla Giga Press model. And if you don’t know what that is, that’s great, because we’re going to explain what the GigaRating and the Tesla Giga Press model is for you today. So we’ll start off with the Giga Press the thing that we are sort of making an analogy to today. So John, what is the concept behind? The Giga Press? I mean, I know I’ll be telling you, I’ll be I’ll be saying along with you, but But how would you take? How would you take that away from from the start?

Dr. John Alchemy: Yeah, the Giga Press was something that Tesla’s been leveraging in production to to get a massive advantage, not only in quality and safety and engineering, benefits, but also in time, it’s, it’s a tool that they’ve designed, it’s a machine they’ve designed, that creates the skeleton of the cars that they’re building. And, you know, it was a very, very labor intensive process with multiple little parts that had to slowly be assembled into a bigger part before the car could start to be assembled onto the frame.

Cory: That’s the way it’s been for a long time, too.

Dr. John Alchemy: Absolutely, yeah, yeah. And we keep talking about Tesla, and I like to keep talking about it and watching it, because it’s so much about, you know, innovation and doing things that people never, invested in or thought to invest in. And getting out of the old ideas of this is the way that it’s done, and we’re just stuck with this really inefficient process. And we have to live with it. You know, and that’s what’s so exciting, I think about the Giga Press model in, in anyone doing business these days, you know, looking to, to a company like Tesla for inspiration and saying, We don’t have to do it that way anymore. And maybe we don’t know how we’re going to do it, but we’re not doing it that way anymore. That’s what I really liked about, about the whole Tesla’s story and the energy around the company.

Cory: We were talking, I think we were talking, it was a few episodes, we’re talking about how people get very used to doing things in a very certain way. And especially when the technologies that have advanced are built upon doing things a certain way, but then there comes a certain point where one does or ought to look back at the original technology that everything is built upon and say, well, is this original technology, any good because if it’s not, then all that, you know, all this stuff that you’re building upon it to make that technology better is only as good as that original technology is going to be.

And I mean it is a good opportunity to reexamine the wig. An automobile is put together, something that was established at the beginning of the last century, and has just kind of gone a certain way. And we built all these robots to do it faster, and everything like that, but it’s the same sort of idea, you have a bunch of pieces coming together to make a car and everything like that, and it gave an opportunity to examine, you know, is the original idea, any good and so what was really cool that they did with the, the Giga Press is that they they scaled up the concept of, of making a die cast, Hot Wheels car, to the size of your car that you drive.

And that I think, if I read it correctly, that was sort of the inspiration behind the idea. It’s like they’re doing this for toys. And, you know, we’ve been able to do that for a long time. We’ve also scaled up things to you know, this size on a much larger scale. Why don’t do this with the things that we need to make 1000s of a day. Or intend to make 1000s of a day rather.

Dr. John Alchemy: Well, and I think you brought up a good point too. You know, the stuff that we’ve been doing for decades, it was probably the best at the time when it was invented. And I think that people just forget or become ingrained that there’s no other production methods or ways of thinking about creating things. And that I think is the take home here is that, you know, if we don’t think about it, we’re not going to improve it. And if we don’t improve it, we’re going to be stuck with the same level of quality, mistakes, errors, time and costs that we’ve always been been saddled with. And so you know, the big take on your stuff, stop doing the same thing and expecting a different outcome.

Cory: That’s it? Well, I’m not going to say this definitively in front of you, John, but I that’s what I’ve heard the definition of insanity is. But I’m not a medical doctor.

Dr. John Alchemy: Yeah, well, I think it’s pretty close. I think it sure feels like that, because I think a different outcome doing the same thing.

Cory: So yeah, this is obviously a competitive advantage against the older model, which, again, the older model, the way of kind of meticulously piecing together a car from what it you know, several 100 pieces and doing things is, the bog standard, so if you’re the only one doing something in a new, and I guess, you know, largely more efficient, more intelligent way, then you have the competitive advantage in that case. So previously vehicles would be made up of three, or I think the body of the vehicle loan was made up of around 370 individual parts, and then you need 600 robotic actions, or, there are over 600 robotic actions that are needed to do this. And then in the original method, you have all this stuff going on, right? And, actually I’m going to step back and say, 600, robotic actions have been removed from the process of creating the frame of the body of a car via the GigaRatings.

So, before that, who knows how many there are, and also the, when you look at these gigantic machines, I mean, it doesn’t, it does, it almost doesn’t even hit you until you’re either like standing in front of one or see one at a good enough resolution video to see these gigantic machines moving incredibly fast with incredible precision. And you got to think like, oh, how much energy is being wasted by these gigantic machines just moving around all day, producing an amount of cars that has like a ceiling just due to just the bedrock technology that it’s built on?

Dr. John Alchemy: Yeah. And the tremendous time savings, I mean, they’re talking about turning these things over in 80 to 90 seconds, this is what they quote and 40 to 45 pieces an hour. I mean, that’s unheard of.

Cory: Yeah, absolutely. I mean, I need to see the numbers on how long it takes to, construct a car body the standard way, but I guarantee you that it’s not that much. Or it’s far, far more than that, so it’s just everything seems to be done in a more efficient manner. Especially because, you know, the assembly of 370 pieces itself requires all of this screwing and just twisting and everything like that. I don’t know if we describe this well enough at the beginning of the episode, but this is literally a die cast. It’s a mold in which the steel that makes up the car frame, is poured into, and then the cast releases and then you have the shape it’s the same as if you make like a casting, is a technology that’s as old as time and I mean, it’s talking about a time, your time proven technology and stuff. I mean, they do that with candles I know why would they do it with you know, everything like that.

So, yeah, so this is a new technology, replacing an inefficient technology that’s built using an older and definitely time tested technology, which which works rather well. Yeah, at least the eye that the hot wheel and the Yankee Candle Company would like to believe and I’m with them and believing that so, so yes, so we’re improving the quality. Because we you know, as far as I know, the more joints that you have to screw in and screw together and everything for a car, that just makes it more vulnerability is more likely, there are things to go wrong, I am not an engineer. So I do not know anything about this. But you know, I’m just speaking for what I think is common sense. And it improves the speed, as you said, yeah, 80 to 90 seconds for producing one of these car frames, and it lowers the production costs, because of all of these things.

Dr. John Alchemy: Yeah, and in this day and age of supply chain problems, and all that stuff, think about the maintenance that goes into 600 robots, maintaining coding pieces that, break the maintenance, people that have to, fix these things, one breaks down, the whole machine is down, and all of these things that are really, really replaced in one fell swoop of, you know, let’s just make the piece all at once.

Cory: Yeah, absolutely. It makes you think, and since we’re talking analogies here to the workers comp, the whole the infrastructure of workers comp, it’s one of those things where I think, over time, as you were building these robots that put together the hundreds of pieces that made the older a, are they still existing car bodies, and the still existing robots that are still doing that, is, so much of that was probably a lot of people that came in and sold these car companies a nice shiny robot to keep the thing going instead of a, something that could fundamentally change what they were doing, and who knows if that was intentional or not, but you know, you do see people just just sort of, consequently, just moving forward in a thing that that doesn’t work. You know, coming up with all these ideas, when the resources, the mental and physical resources could be put into fixing the problem, which I think is a, if we’re talking a gestalt for the world today, I think that’s a kind of a way to look at it as well.

Dr. John Alchemy: Well, yeah, and I think transitioning as we begin to move this concept into RateFast and what we’re doing with this kind of concept, going from an action of many to an action of few or one, I mean, think about it, most people hopping in a Tesla and driving it, they really don’t care how the frame was built, they just, they want the car to work, they want to go from point A to point B, they want it to be a good experience, and they want it to be reliable. That’s really what it comes down to. I mean, how it’s made, and the technology and stuff is interesting, but the common person doesn’t really care about it. And I’m going to, and I say that because I want to tie it in people’s minds as we transition over to work comp ratings. It’s the exact same thing. Most people who review these ratings, insurance adjusters, attorneys, judges, you know, patients, QMEs, they don’t really have a good grasp about the detail, and all of the pieces that go into an impairment rating. And it’s not being disrespectful, but they just can’t, there’s yeah, there’s so many layers, that they have to be able to look at a rating and understand, where it came from, and the quality and the integrity of the source. And is it consistent? And can it be reproduced? And is it fair? That’s, that’s really their equivalent of the test drive of an impairment rating.

Cory: Yeah, absolutely. And I mean, physicians shouldn’t feel bad. For when we say yeah, it’s pretty near impossible to collect all the ADLs of somebody, there’s something in me, like, you shouldn’t feel disappointed in that because it’s like, you know, you shouldn’t feel disappointed for not being able to dive to the bottom of the Mariana Trench, with just holding your breath. I mean, it’s just not feasible. It’s darn near not possible. I dare somebody to prove me wrong in the Mariana Trench thing.

Okay, so we see the problem. And as we know, RateFast is about solving that problem. And the problem is the inefficiency of work comp reports and the fact that you can’t do it in the way that it’s outlined in state law and everything with the resources that physicians are given it everything so what does the what does the GigaRating look like against the you know, apocalyptic backdrop of have, you know that the climate change of work comp? You know, which, in many ways, I mean, one could, in many ways, looking at the field writ large, I think one could almost make that argument. But yeah, I mean, what so how does it How does the GigaRating look in this sort of context?

Dr. John Alchemy: If once upon a time before, you know, the GigaRating was even a concept or was reality a person who is trying to do a rating would have to sit down, they would, if they gather the data themselves, you’d hope you’d have a decent data integrity collection, you know that most of the questions were asked, there’s probably, you know, well over 300 or 400 pieces of input data, for instance, on a cervical spine rating. And if you look at the average QME report, or primary treating physician report, you’re probably going to see more in the neighborhood of, you know, maybe 30, 35.

And then when you look inside the report, and the way that it has to be constructed and rated, you realize that there are several processes kind of like that, that frame moving down the production line, you have to figure out the pain in the ADLs, you have to score that, you have to look at your measurements, you got to check them for consistency, reproducibility, you got to go to tables, you know, and there’s all these different steps. And if, if you look at one of our GigaRating tools, the cervical spine, for instance, there’s 50,000 calculations in that tool. And that’s, that’s the GigaRating happening at one time. And if we step back and say, wow, what would it take a person with extreme deep knowledge in this area, I’m talking to an expert that knows everything cold sitting down, and doing this manually.

Think about that, you’re sitting down, but you have to do it manually – 50,000 calculations and checking tables and accuracy, you know, and let’s say that you’re good at math, maybe you even have a calculator, where all the tables are in the book. So it’s not like you’re hunting around for them, let’s say you have them all taped up on the wall, you know, it’s going to take you at best probably 90 seconds to do each calculation, look it up, verify it, multiply it by, the value to make sure that it’s in the 10% variance, for instance, and all that stuff. And and if you do the math on that, it comes out, and it’s pretty amazing that that person would have to work without sleep for 1.7 months to do that kind of detail.

Cory: As soon as you said calculations, I was out. And then. And then you said 50,000!

Dr. John Alchemy: And then I also want to say, this is not checking your work. This is just going through at one time.

Cory: Yeah, it’s at that point that you run your work through a computer to check your work, you know? And at that point, why don’t you just have the computer do the thing in the first place anyway?

Dr. John Alchemy: Exactly. But again, it’s one of these things that no one has really had the resources, the time, the interest, or the expertise to sit down and create the GigaRating, all we have are, some services that people can use cottage industry, a couple of feeble calculators that have been out there that are very generalized, or don’t consider everything. And the trouble is, is that people don’t really have insight into the low quality of those ratings. They just say, oh, here’s a rating, here’s a car, I’m going to get in it. The wheels haven’t fallen off as far as I know, and that kind of thing. But there’s a lot of work that passes as impairment ratings that probably shouldn’t be accepted as valid results. But the problem is, we’ve talked about this before, insight, opacity in the system, how it’s done, and a lack of the of the customer, being a stakeholder not being able to check the work. That’s a real problem when you’re handed a number, but you have no way to check the value.

Cory: Yeah, absolutely. And it’s very interesting, because I feel like probably one of the things that has kept people from automating or computerizing a system, like workers comp or something like that, there might be a lot of stigma that because I’m just thinking about how my mind is just going back through my life and the way that technology has been viewed throughout my experience. You have like y2k and stuff like that there used to actually be a lot of skepticism around computers and actually like, storing documents on them is they were seen as unreliable. And these were all things that were before, what we would come to know is the cloud. And as well, it’s just the implementation of computers and technology in every other aspect of life, except workers compensation. And other ones.

I mean, there’s there’s plenty of things where we say like, oh, yeah, no, a human could do this job better. You know, things like that. And I think it’s, it’s time to reexamine that, that that very thought process. I mean, some of these, the things that are holding a lot of people back are just these sort of automatic thought processes, that we ourselves are just computing these these programs that are running in our mind that says, oh, we can’t do that. Because something I thought, something I’ve thought and haven’t reevaluated, 20 years ago, you know? And I think that the technology that we’re talking about, you know, updating fundamentally, the things that we’re going back to the very roots of and changing. And I think the thought process associated with with integrating technology into work comp is another one of those things that needs to kind of go back, be reevaluated and reconstructed. Which is probably why I think that’s a big reason why these things haven’t been adopted as a standard.

Dr. John Alchemy: Well and the other thing is putting together a GigaRating tool requires an incredible amount of resources, you have to organize people, you have to have people with the right skill set, it has to be checked, it has to be rechecked. Go through a series of quality assurance, work all the bugs out, run case after case, check it manually again, then go back in, tune it up, and it is a big job. And that’s why no one’s done it. Who is going to sit around and do this?

Cory: I was going to say, yeah, that is that sounds like torture, who would be crazy enough to go and do and make it available for other people to use? And it has been hard work. We’ve been discussing in the works, we may or may not have a future episode, where we discuss sort the milestones of RateFast as a company, and where it’s come to be, what it is today, including what RateFast used to look like and how it used to be. It was just as effective and efficient as it is today, it was just more steps for us on our side here. And we had to kind of fine tune everything to make sure that everything that we were implementing as technologies to make RateFast, better, faster and more productive and everything. We’re also effective at working within themselves, we didn’t want to build something that that was automated, that actually was was running a bad program and stuff. So it’s taken a while, but the model car that we built, and especially with our new GigaRating technology, it’s more efficient than ever, and there’s just always room for improvement. And yes, or rather always room for innovation. In our thing, and, once again, like we’ve talked about before, hopefully but by the time somebody else, oh, I’m gonna get started on a technology that makes workers called better it’s gonna be like, well, how about you check us out and see if see where we’re at and see what we’re doing at this point, too.

Dr. John Alchemy: Yeah and RateFast, I think has always kind of focused on what I believe is the most important thing, which is his timely, accurate and fair settlement. Because getting out of a work comp, case is it’s like being stuck in a tar pit, you can ask any patient that’s tried to had have, an injury of any significant magnitude get resolution. It’s just the most frustrating thing that you can imagine, it’s being stuck in a time warp where nothing happens and everything stays the same every single day, in the claim drags on and no one can seem to figure out the settlement and they’re fighting over it, and all the information in front of us yet the stakeholders just refuse to to To claim that, hey, we have an accurate settlement rating, and that’s what we set out to change. It’s like, let’s stop guessing about the value of this, we know what it is, yeah. How about we just get this claim settled, and, get this worker on their way? That’s really the most satisfying thing, I think, for doing all this work, is when a patient tells me yes, the claim got settled in, it got settled on the RateFast number, and I’m happy and I’m done. Those are the best days of going to work.

Cory: And something I have to say about that, generally speaking, when you do the same thing on a day to day basis, and when that thing that you do on a day to day basis is also, rife with, either both a rejection, or objection to, by a company that that can’t accept your work. And also, when things do go through, you’re not really sure why that all of these things together, it just makes life in general, kind of suck it just in general, you’re like, why am I doing this? You know why you’re doing it, but it’s just, it’s demoralizing, I guess you can say, and I can’t speak to that from a being a work comp physician, because I’m not, but you know, I can speak to that from other angles in my life that you know, that you get caught in the cycle. And you kind of think that that’s the way it is, and then all of a sudden, something comes out and says, oh, no, it’s, it can’t be better. I don’t, you know, like, you just need to kind of step out of that and see what’s out there for you. And that’s what we try to provide. I mean, it’s like, imagine that thing that you know, grinds on you or whatever, imagine that’s just not there anymore, and it’s that easy.

Dr. John Alchemy: Yeah, and do something else with your time.

Unknown Speaker: My goodness, there’s a, there’s a huge world out there, I was just looking, I get I get in my downtime, in these like, little kind of minimal minutes between doing things that was just, I was just looking today at pictures of the rain forest and in the basin in Congo, and just the flora and fauna out there. And it’s just amazing to think to stop for a second and just, you know, put on the brakes of all the crazy things and sort of remember that, wow, there’s this vast expanse of just like, just the planet that that, it’s just kind of exists outside of this, wouldn’t it be nice to go and visit that in some free time? And I think that anybody could say that it’s like, now you can have even, especially if you work in workers comp, and you us RateFast, then you can have more free time.

So that’s always for consideration, just throwing that out there. So yeah, we’re certainly not as a company, invisible by any means. But we’re also we also need to be seen by the entire industry, we just need to I mean, it’s either that or things are gonna go the same way forever and ever. And that is not our intention, either. So that’s not going to happen. So when we talk about the industry, and the industry, looking at what we do, and sort of accepting a certain model of things, why would the industry and why will the industry embrace the RateFast GigaRating model for work comp?

Dr. John Alchemy: It’s an interesting question. And, when I started RateFast, I thought, hey, people are going to want a better way forward, they’re going to be interested in it, they’re going to be enthusiastic about it. And as many things are, once you get into it, and actually put a product out and see how it plays, you get often a different response than you think you would. And the first feedback we were getting, not from our customers, but from, insurance companies that weren’t familiar with RateFast attorneys, the disability evaluation unit, they’re never quite sure how to respond to a process that they’re not familiar with. And yeah, in the in the easier responses. I don’t understand this, so it must not be right. You know, that’s just sort of the human response. And we had a lot of that. You know, I don’t understand how you’re doing this. I don’t know, you know, what a what a variance means? I haven’t heard this before. I’m just not sure what to make of it.

Cory: And then they turn around and say by the way, the work comp system sucks.

Dr. John Alchemy: Yeah. Everyone’s unhappy and complaining about it. That’s right.

Cory: Yeah, I wish something would come fix this, by the way, I don’t recognize this. So it looks nothing like this that I recognize this entirely broken system.

Dr. John Alchemy: Yeah. But it’s interesting, because when we have a client, and they’re using the RateFast impairment rating service, it’s always the same thing. For the first three to four months, the adjusters who are working consistently with that client will send letters and how did this happen? I don’t get this, this has never been rated before. Why are you rating it now? You know, it’s always the same question. So there’s a flurry of letters, sometimes from the disability evaluation unit, but mostly just from the insurance adjusters. And in its without fail there’s usually about, I don’t know, probably one out of every six ratings gets a letter, and that lasts for about three months, and then they totally go away. And the reason they go away is that when we response, and we welcome these letters of inquiry, because we always look at it as an educational opportunity. We start educating these people.

Cory: We have their full attention to tell him exactly how RateFast works.

Dr. John Alchemy: Yeah. And they can focus and apply it to their work. And without fail, they’ll always ask about one to two questions deep. And the RateFast answers go more like 15 to 50 answers deep. So we can take them as deep as they like to go or they’re willing to go, but the bottom line is most people are satisfied after one or two questions of inquiry.

Cory: They’re like, Oh, wow. All right. There’s a lot of stuff to it, like, you guys really did your work.

Dr. John Alchemy: I mean, I don’t know what the standard is people not doing their homework, that that’s been the standard. And that’s why people are skeptical. And they said, well, you can’t get a number like 27. You know, you just can’t do that. Yeah, it’s like, yeah, we can, and we can do it over and over again, if it’s really supposed to be 27.

Cory: Absolutely, yeah, absolutely. We’ll take it another doctor’s information on this rating and assume, assuming that the patient gave them the same answers that they need, and everything, it will be a 27% rating. So I mean, that’s what we’ve done is we’ve we’ve created a method to translate, the, what was it? Oh, my goodness, I’m forgetting our episode titles. Oh, no, it was the one it was the one. You know, we’ve we’ve created essentially the Rosetta Stone to communicate sort of the industry specific language between the different stakeholders. So yeah we’ve done a lot. That’s, the 50th thing for you to know about. When you’re reading, when you ask us how it works. We will just link half of this stuff, we’ll just link them to the podcast,

Dr. John Alchemy: But getting back to the answer. The answer is it’s been glacial. And it’s been mostly silent. And it’s been individual, we haven’t had a big breakthrough yet where the state wants to step forward and say we need to standardize this process where we’re wasting a lot of people’s time. And we need to use a process like RateFast to come up with settlements, if we’re really serious about saying we want injured workers and their employers to have fast, accurate, claim management settlement. That’s really the big piece that we’re looking for, is is the administrative piece, the regulatory people to step up and say, yeah, the process really needs to be more efficient. And until then, it’s going to be everyone else getting the benefit, but it’s not going to be truly adopted, until the regulators come in and say, Yeah, we need a platform, like RateFast that is comprehensive, detailed, and a Giga Press for everyone to benefit from and hopefully that’ll happen someday. I’m really hoping.

Cory: Yeah, well, I think that one of the biggest things that will probably help them do that is if these people look left and right, everywhere they look it says RateFast, RateFast, RateFast. So everybody’s using all these things, all these stakeholders are using RateFast and I think in order for the stakeholders to use repasts then they should, you know, they should be aware of the benefit fits of the read fast and the RateFast GigaRating. So how will the GigaRating benefit the stakeholders, John?

Dr. John Alchemy: Well, I think we just touched on it, it’s going to give rapid access to large scaleable amounts of data to the injured workers and the people that need to settle these claims and pay out the claims. And, I understand that there’s a lot of middle people in workers comp, you have all kinds of, you know, vendors and people doing steps and, trying to simplify things or take, things off other people’s plates and do them. But the bottom line is, let’s just stamp this value out at one time, and know that it’s a better system than trying to have 270 people assemble and impairment rating and hope that it sticks together on the road. I think, the take home from today. Yeah, is that if you if you value those things, simplicity, accuracy, efficiency, RateFast is going to be your tool, if you want to limp along businesses, usual: painful, slow inaccuracy, multiple opinions all of them wrong. And don’t use us. Keep doing what you’re doing.

Cory: Yeah, if you like that!

Dr. John Alchemy: Yeah. Maybe some people do? I don’t know. But I’m not one of them.

Cory: Some people are, if you’re a glutton for punishment, then that is your thing. And the status quo is very much around and therefore you. And so we would like to invite and say to anybody who is interested in what we’re doing, and how you can do it too, how you can join us and be a part of it and watch it all, as your, as your as your impairment ratings and your work comp reports, you know, in general, are created efficiently and in a way that we believe should be implemented not only statewide, but you know, everywhere.

Dr. John Alchemy: Yeah.

Cory: Come on down to RateFast at ratefastexpress.com. And learn how we can help you and I will give a couple of URLs that are plugs at the end of the episode too. So John, do you have any closing words about the GigaRating? And how it can help workers comp?

Dr. John Alchemy: Well, I’ll just say use the GigaRating, get the right rating and go out and explore the world with your free time. How about you do something else other than work comp?

Cory: Yes. You’ve got the Congo. You’ve got Patagonia. Yeah. You’ve got you know, you can go to the North Pole, I’m sure. I think yeah. Yeah, get it while you can. So we’re also hoping that in turn, we’re inspiring others to turn around that which is affecting our planet so that you can continue to go to your favorite vacation spots with all the time that you have that you’re using, RateFast GigaRating, boom.

Dr. John Alchemy: Okay Cory. Thank you.

Cory: Thank you, John. We’ll see you next time.

Dr. John Alchemy: All right, take care.

Cory: To find out more about the RateFast GigaRating visit our blog at blog.rate-fast.com and give requests GigaRating a spin at rate-fast.com.

Abstraction, a Higher Level of Understanding Workers’ Comp

The very first computers, we’re talking the ones the size of rooms, those computers had to be programmed by professionals who knew how the computer worked as a physical machine in order to write programs. A bug in the program meant breaking out the toolbox.

But the potential of the computer was being hindered by all of this complicated hardware and esoteric software. In order to program more and more complicated tasks, the entire structure of the computer had to be simplified for the user.We call this abstraction.

Continue reading Abstraction, a Higher Level of Understanding Workers’ Comp

The RateFast Self-Driving Impairment Report

New technologies are applied to old, outdated systems. People attached to the old, bad technologies will point out how the new technology bares no resemblance to what they’re used to. It makes you wonder why that is. We spoke to Dr. John Alchemy about a few analogies pertaining to those clinging to something that flat out doesn’t work.

For more information on this episode, and other helpful tips about workers’ compensation, visit the RateFast Blog.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!


The RateFast Self-Driving Impairment Report

Cory Oleson (Host): Welcome to the California Work Comp report. Today’s Tuesday, September 28 2021. This is your host, Corey Olsen. Back at it again with Dr. John Alchemy to discuss the self driving impairment report. You’re not going to want to miss this one, folks. So here we go.

Welcome back. How are you doing today, John?

Dr. John Alchemy: Doing great, Cory. It’s good to be back here and talking about more impairment.

Cory: Yeah, it feels good. Especially because it seems like we have have at least a bit of an audience because between last episode now we are celebrating over 4500 listens and downloads and streams to our podcast. So it feels good.

Dr. John Alchemy: It’s awesome. Awesome.

Cory: If you’re a listener, and you listen to us regularly, and you’re coming in again, and everything like that, we really want to thank you for doing this for listening to us and hearing all that we have to say because we were in it for a good cause. And we believe that just getting the information about doing workers compensation, we’ll combat all of the bad workers compensation that’s out there. And it’s not all bad. But it should be all good. For everybody.

Dr. John Alchemy: Well, and we have to start somewhere. So we’re starting here.

Cory: Yeah, the journey of 1000 miles, begins with 4500 podcasts, please. So today, our topic is the self driving impairment rating. And this is one of those ones, John, where I consider myself an audience member a bit because I’m very interested to hear what you have to say about it. So we have, in this climate we have the talk of and the horizon of self driving cars. And in many respects, we do have self driving cars, it’s just there’s all these kind of categories as to when when something is fully right, or, things like that. It’s an evergreen topic in the in the in the social. What’s that journey of Zeitgeist is? Yeah, I’m curious to know about the self driving impairment rating.

Dr. John Alchemy: Take it away, take it away. Yeah. Well it’s a good analogy to talk about what’s happened in the driving in the automotive industry compared to know what’s happening in the impairment industry. And I thought that today we could talk about the parallels. And the similarities between automotive of which there are so many transitions taking place now. And impairment rating, obviously, the Automotive Department is a little bit larger about market segment than impairment rating, but I think the analogies are valid nonetheless.

Cory: Without even accounting for the proportions of the size of the automotive industry, I think that it’s just as confusing as workers compensation.

Dr. John Alchemy: I think it can be so and fortunately, I have access to a Tesla car. And so a lot of the analogies I’m drawing I’m not just talking about I’ve actually experienced personally. Yeah, and also the impairment rating, of course, I’ve experienced personally and I’ve had opportunity to see how it’s impacting the different segments of impairment rating and, and how people’s acceptance of it is coming along, how it’s, how it’s changing behaviors, and changing what people used to do and what they’re starting to do now. About five years ago, the automotive industry really changed with Tesla and the electric car industry. And it for the most part kind of went unnoticed. A lot of people, including myself, so self entrenched in fossil fuel cars, and the whole infrastructure of gasoline that we grew up with, and taking the car in for oil changes and buying parts for your car, and all of these things, and this do it yourself. I think Cory probably our parents used to change their own oil in the driveway.

Cory: I’ve been known have been known to do it.

Dr. John Alchemy: You’ve been known to do it? Well, you stay tuned to this podcast. That’s right. I’ve got a few things to say to you.

Cory: Yeah, alright,

Dr. John Alchemy: The point being is that cars went from something very simple and something very kind of kind of taken for granted to something very different. Now, I don’t think probably any of our listeners could do a repair on their own car as they sit now in anyone’s driveway, just because of the computer and the technology, regardless if the cars electric or gas, and as users, we become less and less able to affect or change, or participate in the actual maintenance of our cars, and the cars have just become something that we use. And because of that it has to be simple, and it has to be no-brainer, or it’s just not going to make it in the marketplace. And that’s kind of the old concept, I think, behind any type of technology or innovation that’s looking to disrupt an entrenched market, like cars. Tesla did some really interesting things all at once. And this is even just leaving out their whole play on, sustainable power power storage. As they’re, I think they filed in Texas to become an energy supplier people.

Cory: Texas of all people!

Dr. John Alchemy: Yeah. Yeah. and I mean, look at the problems with the power grid, when they froze last year.

Cory: A couple inches of snow and the whole thing fell apart.

Dr. John Alchemy: Talk about disruption. But it’s interesting, when you look at one company, all of the technologies, markets, it’s changing. And so just a couple basically going from the crisis of greenhouse gas and global warming, to electric versus fossil fuel probably the most obvious. And I listed in my notes, just no-brainer, right? Getting off the fossil fuel. I was listening to it to a podcast from Elon Musk. And he said if you really think about it, our dependence and use of fossil fuel is probably the most stupid experiment in the history of mankind. Because we know we’re using a finite source as our energy we know, it’s damaging our planet, our living environment. And still, we’re doing it and what’s up with that, and it’s true, you you can only kick the can down the road, so many, so many generations.

Cory: Yeah, it’s such a, kind of a microcosmic picture of just a lot of philosophies that just kind of need to change, you just kind of hang on to momentum until a lot of these, it’s sort of like multi generational, like, it’s, uh, I’ll just hang on to this momentum and hope that me, nor my son has to deal with his baby. Right, him and his son will have to deal with it.

Dr. John Alchemy: Hopefully I don’t have to deal with that conversation.

Cory: That’s right.

Dr. John Alchemy: So anyway, there’s that obvious the other thing Elon Musk has talked about multiple times is that he was not going to be successful at converting the market to electricity unless he had a super compelling product that was I think the word he used hands down better than any fossil fuel car ever made faster, more efficient, more options just a better experience all of these things, it just it just had to win and not just win, but when big in all of these categories safety all of these things that an electric car had to prove to everyone driving a fossil fuel car to get them to pay attention and say, well, maybe this is a change and not just as an environmental thing, but as a quality of life and just a better car that had to happen.

In the whole approach to cars, not something that you sell to someone to get from point A to point B but, a computer on wheels, that is continuously monitoring data using that data for multiple dimensions, be it driving patterns, safety, finding the fastest route the software that goes into that the pioneering of updating the software in your car, in your garage at night through your home WiFi as opposed to bring going into a dealer and having them operate an operating system. And here’s really where we see a lot of the dependence going away from the user as far as the technical understanding and needing to know the workings of their vehicle to more of what I’m here to use this car, and it has to be simple. And it’s got to work for me and more of a model that’s plug and play. And some people want to know how their cars work, and that’s fine, but most of us probably don’t.

Cory: Yeah, the operative word for that being like layers of abstraction as an armchair programmer, abstracting layers, which is done in programming, like when you do that, when you run into, you call like a higher level programming language and stuff, like a lot of those things are done, just to kind of streamline the process for you, the user to kind of get it will get to your destination quicker, and things like that. So in that respect I mean, that levels of abstraction are good when, you don’t want to be driving one of those jalopies while also taking the traffic and the weather and the condensation for the area and updating the firmware on your model T and stuff like that. It’s nice to have technology to do that for you, you know?

Dr. John Alchemy: Yeah. And, impairment ratings are very similar, we’re taking away a lot of the technical understanding and requirements for users, be them, doctors, claims adjusters, attorneys, judges, anyone who needs to have an accurate impairment rating, rather than here’s an impairment rating, you can have confidence in, it’s consistent, it’s accurate. Here’s your impairment rating. Yeah, we can give you the details, if you have a question, but here it is, stop worrying about it, we’ve been worrying about it since impairment ratings came into existence, that someone in the back room with a pen and paper sat down and did this, and there’s probably an error, and you’re probably right. But as we go forward with digital impairment rating, and the slicing and dicing of customized impairment ratings based on the individual, a lot of these concerns are going away, and we’ll talk about that a little bit more an example.

And then obviously, the better quality of life back to the car. And back to the car analogy, being dependent on volatile pricing of fuel, out here gas, for 55 bucks a gallon and being dependent on these wild swings. And, and how about just, you don’t have to go to the gas station anymore. You know? That’s huge.

Cory: Yeah, especially, it’s it’s wintertime, you don’t want to get out of your car. Do all that. Yeah, yeah, it’s all those things. It’s not winter time yet, but when it is, you don’t want to get out.

Dr. John Alchemy: Well in it all adds up, it’s not only the cost, but the inconvenience, once a year, I don’t know how much or a week how much you drive, but the gas station, 1520 minutes filling up, and you do that 52 times, a year and that’s stuff you could be doing with your life elsewhere.

Cory: It’s true. I would I shudder to think about the person that, St. Peter handing me the kind of the analytics of my life afterwards showing the files. Yeah, at the gas station, or, in my younger days on the side of the freeway waiting for somebody to bring me a thing of gas, things like that. Right. Think first car things, but yeah, definitely. Yeah. And especially when you have a when you have a system, that just just like a what, like a well put together workers compensation system that does sort of a similar thing, as we’ve talked about that RateFast does, is collects collects data on our good, our reports that have been accepted and everything like that. So not only is it doing the physician a favor of saving all that time and effort and such that would just be spent kind of stressing out over how to do a worker’s comp report, but also the data that’s collected helps every other doctor that’s using RateFast to get through their impairment reports quicker and better as well.

Dr. John Alchemy: So yeah, you don’t have to keep looking over your shoulder and saying, Gee, I wonder if this report is right or did you know someone, put the decimal in the wrong space, or did they forget all that stuff, it just, it just becomes much less of a concern and you can focus more on okay, let’s get the next page go and let’s do the next exam. Let’s get the next impairment report started, and it’s really a whole different quality of life for the providers. Absolutely.

And then this last part, which is the whole podcast is about is self driving. And that’s something obviously, Tesla’s been in the news a lot about is their Driver Assist or auto steer feature or autopilot, however you want to call it, but eventually, it will go to the point where cars will do self driving on surface streets and understand complex situations. And the only question is, what system is going to be triumphant in getting to that point the fastest. And that there are different ways of looking at it. But Tesla’s view is A) going to total visual system cameras only, no radar, and none of that, for reasons of conflicting information cost hardware costs delivery to the end user at an efficient price, and then this new concept of the neural net, that many years ago, this concept of the neural net was, machine learning and being able to put layered systems of logic and understanding and almost a self realization of a program to learn more, the more data that it’s given.

And it was interesting, because I was listening to a comparison between Whammo, that have has these cars out driving the streets with all these spinning whirly gigs, and things that it’s measuring the environment, and they maybe, let’s say they maybe have 600 cars out there, and you’re looking at Tesla collecting it now from a growing fleet of a million in some cars and going up by 30, 40,000 cars per quarter. And that is, that is their data collection system, you kind of think about, it’s like, Gee, I wonder who’s gonna win that one?

Cory: Yeah, it’s completely incidental to the, just the making electric cars, if suddenly you think that you can rely on kind of like, when Uber first came out and everything, it’s like people said, well, I have a car, I can put that to work.

Dr. John Alchemy: Yeah. So these these big transitions, these big disruptions, there’s some books written around this concept and the kind of the standard, the books that I’m familiar with, call it the zero to one divide. And that means going from nothing to something significant, like a major change a major step, a major disruption, and that is to be compared against something, as opposed to an iteration. So you have Uber come down the pipe, for example. Or you have Tesla come down the pipe, and then you have people that also want to get into the space, and they’re not really there to disrupt it, they’re there to take advantage of the new market segment, and tweak it a little bit so it’s like one to 1.1, or one to 1.2, or we’re making those little buttons that pop off the back of your phone that you can hold it in green and yellow, as opposed to black, stuff like that.

Cory: Yeah. It’s, kind of outside of the utility at that point.

Dr. John Alchemy: Yeah. Right. But as that as an industry when when something happens like that, you’re either on the front end or the back end of the tidal wave of the change that’s coming. And as, as a person and a company you really need to make the decision, if you’re up for the journey, or not sure, you can wait and get a cheaper, more polished, product five years from now. But, but you’re not going to have the opportunity to leverage the disruption in a way that can be beneficial to what you’re trying to do for the industry, as someone who comes along late and I think, as a phone analogy, most of us can say that not many of us are using the phones on the wall anymore in the house. It’s just kind of sits there.

Cory: There’s no phone that has a cord in my house that isn’t intended for charging it.

Dr. John Alchemy: Yeah, yeah. In my phone on the wall, really, in case there’s an emergency and I can’t find my cell phone. I mean, that’s the only reason I continue to have a landline. That’s it.

Cory: Yeah, and I mean, what you were saying about being sort of kind of attaching yourself onto something that has already crossed the zero to one, divide the on off the IO divide. As a person who plays music, just thinking about historically, bands and everything, a lot of times you’ll hear about like, oh, this this band was the first metal band ever, something like that. And then right, you find out oh, no, that was built on a foundation of, of all these other things that are happening. And I think a lot of people not not that they’re thinking about the first metal band when they’re making their startup company or something like that.

But I think a lot of people are sort of afraid to do something that is that is so radically new, because it’s a risk, there is a risk involved with it. So what it requires in order to successfully pull it off is an original vision, I think that it’s invaluable, and it’s, it’s necessary, but I think a lot of people, it’s almost like the time and effort that’s required to get to the point where you’re having that original vision, it’s like, oh, I could just make the thing with the green and orange buttons on it instead. So yeah, that is why it’s important to see what divides need to be crossed, especially if it’s relevant to something that will help people.

Dr. John Alchemy: So yeah, and you really have to be ready to do a pivot. And getting back to the Tesla analogy, Elon Musk, in his interview with saying, look, when Tesla started, they just wanted to build electric motors for other car companies. And lo and behold, no one would buy them why because they wanted to make gas cars. And then they thought they would drop it, in a lotus, and, just put a battery in lotus. And now they have, they don’t have to manufacture a car, and they can just put in a battery and electric motor, well, they found out that they basically had to rebuild, 90% of the car to make it electric friendly. And that’s when the light went on and said, we’re building cars from the ground up. And that was really the beginning of Tesla’s we understand it. Yeah, absolutely.

Cory: Yeah. When I was living on on the coast, I used to drive by the Tesla factory all the time. And it was kind of when they were coming up, it was before I knew much about it. So it was just like, oh, what is that? what is that huge place?

Dr. John Alchemy: Yeah, and back when I got one of my first Tesla’s in 2017, I remember the delivery center, you walked in there, it looked like an Apple store. And there was someone that would greet you, and they would put the app on your phone. And then you would go sit down and have an espresso from the Tesla embossed espresso machine. And then they would take you out and walk you through your car, and make sure that you knew about it and off you would go and to me, that’s when it really clicked on me that hey, this is the new model of software transportation, essentially. And if you haven’t bought your stock, yesterday, you better buy it today because, this is really going to take off and it’s very clear, like when the first smartphones came out, it was it was a wildfire when it switched over. And I think we’re seeing that in electric cars now too. With with a production constrained Tesla, they just cannot. I mean, there’s a chip shortage, but aside from that, they have a difficult time keeping up with demand.

Cory: Absolutely. Yeah, absolutely. Hopefully that is bringing up lay interest in programming as an embedded programmer. I hope that that it’s funny, you get into something, you find a hobby that you really like doing and then suddenly there’s a worldwide shortage on that thing that you just, have to have.

Dr. John Alchemy: Yeah, you have to have to have it.

Cory: But we have here, something that something that you’ve called A Tale of Two ratings, and I’m intrigued about this, John.

Dr. John Alchemy: Well, if this is something commonly that we’re seeing at the timeline for RateFast right now, and I’m seeing it, I’ve seen it more and more and now I’m actually starting to see it less and less but but the example I wanted to bring up was actually an insurance adjuster company that purchased the RateFast directly, there was a doctor that didn’t want to do it, and they couldn’t get access, QME. And I won’t go into my feelings about QMEs and doctors impairment ratings in general. But anyway, so they purchased the report directly from RateFast, RateFast wrote the report for them. And then the insurance adjuster felt for some reason compelled or I think, I think systematically required to obtain a second party review service of the report that they had purchased from RateFast. And, I won’t go into the details about, what triggers in an impairment report to be reviewed by a second service.

Cory: We have plenty of material on that already.

Dr. John Alchemy: But anyway, so the second review service basically lifted up the hood on the Tesla car and saw a Fronk or just an open space in there. And they’re like, where’s the motor, and if I can’t see a motor, this car can’t drive. And if it can’t drive, it must be broken, and therefore the rating must be zero. And that’s exactly how they reviewed the report. And they even went as far as to say, this RateFast rating value is arbitrary. And it they simply, they just had no explanation as to how the rating, was done to such, detail on the amount of information that was in the report they were reading.

Cory: Essentially, what I’m imagining in my mind is that you traveled, it’s almost as if you traveled back in time and then handed somebody a cell phone and told them it was a telephone, they’re like, this is not a telephone.

Dr. John Alchemy: Yeah, it’s very similar to that. And what we’re dealing with is an adjuster who wants to be on the leading edge, definitely wants to do the right thing wants to get an accurate impairment rating. So they have, they have one foot in, I want to be innovative, I want to get this done, I want to do the right thing. And then the other foot has kind of stuck back in this, oh, I better hire some, cottage industry impairment rater, to make sure that this is okay, because I still need that blanket to hold on to in order to feel good about the rating, because I don’t know how to check impairment ratings. I’ve hired a service with a great reputation. But yet, I think I better have my, gasoline mechanic, take a look at the electric car here. And give it that. The 20 point maintenance check in, there’s no oil dipstick. Now what do you do?

Cory: And so yeah, so we have kind of two, I wouldn’t even necessarily say competing, because it’s not, to this point, it’s sort of a, just just two things that are introduced to each other. So to two philosophies here. And so we have one that is sort of, I mean, pretty much at this point, your only real knowledge of it is that it’s just another philosophy, and their only real knowledge of it is, I don’t know what I’m looking at, therefore, it must be wrong.

Dr. John Alchemy: It has to be wrong. Yeah. What well, it is in their context in their world, it can’t be correct, because, it wasn’t written old school, and that they don’t have the tools to understand what they’re looking at. So the easiest thing to say is, yeah, the money you paid me to look at this as correct, and I’m telling you, it’s just a wrong report. So, therefore, your money was wasted, which I will argue with a little bit later. Yeah, probably was wasted.

So but the issue is, RateFast, and digital impairment rating as it continues to grow and become more of a flywheel, the more information we get, the more data we get, the more things we’re able to infiltrate with, digital determinations and algorithms and stuff, is that we’re only getting better and more granular at what we’re doing. And it’s simply just another example of software eating up an industry. It’s not that the invention of the electric car is is is all that, earth shattering, it’s the way that the software is being overlaid on the car. That’s the real innovation that’s happening.

Cory: It’s the way that the individual components kind of dovetail into other kind of aspects of life. Kind of irrelevant or tangentially related topics and industries and stuff.

Dr. John Alchemy: Right. So the adjusters to be commended on, wanting to, to invest in the new technology, and that’s exactly what they did when they purchased the report and the report’s fine, there’s nothing wrong with it, but it’s understanding it and getting your head around, wow, the things I’ve worried about in the past, I don’t have to worry about now. And I can either use that time to do more work more efficient, more meaningful work, or I can, give it over to an old mechanic that doesn’t know what they’re looking at and pay them money to do something that really is not going to affect the outcome or the validity of the report in any way. You know.

So we have these Luddites. Yeah and it’s, I don’t want to use his negative term, but these people who hang on to manual calculations and narrow understandings, those things are kind of gone, we’re not worrying about the things that they worried about, because there’s so many metrics that are now used in a report to determine a rating, that you can’t go at it from one angle and say, yeah, I’m going to, get a get the correct impairment rating by using one approach when we’re now using five, let’s say, to arrive and adjust for values. So I think we’re finding a lot of these people stuck on the zero side of the divide, and there. And it’s been interesting, because doctors are really the first ones who want to do the crossing, they traditionally don’t like impairment reports, it sucks up a lot of time. It’s not good revenue. It’s just a loser in every direction for a doctor.

Cory: So I mean, you’ve explained this, so I’m not asking you directly, but I have, asked you this directly. It’s like, how do you get into an industry where, that it’s just bad, it’s just made in a way that it just, things are just don’t work? And I mean, for you, John, you had a vision of making it better. But, yeah, for the people that don’t want to adjust to that, it’s sort of like, what, you’re just a masochist at that point. Because you clearly got into it, knowing that into work on knowing that it was like an inefficient system and everything, and then when presented with something that could be a better option. If you don’t want it, then you are hurting yourself, or you’re wasting your time or something.

Dr. John Alchemy: Yeah, I mean, I guess there’s a lot of ways we could, we could talk about that. But the one thing that, that I think we’re coming across is that I’m seeing a lot less resistance from stakeholders on RateFast reports than I ever have. And I’m seeing things in reports saying, send this case to rate fast for rating, that’s just part of their treatment plan. And, hopefully, it’s becoming a brand that people have faith in, they know, it’s an unbiased, standardized report that’s getting better and better. And it’s something that they can invest their reputation in, as well by knowing it’s the good faith and credit of RateFast. And that’s really ideally what we want, we want value in our reputation and our product, above all things. And if we don’t have that we really, we really don’t have anything to bring to the market.

Cory: The good news being that we do have some very enthusiastic customers of ours, so yeah, yeah. So we’ve got that part covered, that’s good.

Dr. John Alchemy: Well, and they’re doing well, and they’re spending their time on things to grow their business and their market share, as opposed to arguing with adjusters and attorneys and the DEU about, ratings that were manually done, and getting caught in that they can be freed from that, which is really nice. And we’re, I think we’re just at a point now where, and this has happened to me personally, a couple of times that, the first time you hear about Google or Facebook or Uber, like it’s already happened, it’s like, when did this happen? And then suddenly, everyone’s using it. But, the company was started, like, six years ago, where was it? And how did it come out of the blue? It didn’t it just, it was just such a useful concept and so disruptive that, it had to prevail. And I was back on the zero side of it, and just learning about it.

Cory: Sure. Yeah, absolutely. Sometimes you think you’re on the one side, then you have yet to make the leap and things like that.

Dr. John Alchemy: Yeah, and RateFasts the exact same way. I think that eventually the markets going to wake up and say, yeah, what were we thinking? And wow, this did happen a long time ago. And we either discounted it or didn’t know about it or didn’t understand it. But of course, everyone uses it now. And there’s a lot a lot less angst about impairment rating, hopefully. And we move on and innovate something else.

Cory: Yeah, that needs to be done. When they discover that we will be at the at the subatomic granularity level, we will have, in the way that we’re talking about sort of incidental innovation coming from, like, a larger idea or something, we will have discovered the meaning of life by that time.

Dr. John Alchemy: The meaning of impairment ratings. Yeah. Right. But it’s going to come down to those that will follow us into the space and the message is simple, if you want to correct and you want it accurate, come with us. But, if you don’t, we’re not your company. And I’ve always wanted to keep it very clear, and very simple that, if you if these are your values, correctness and accuracy, and getting a fair rating the first time, buy from us, buy our car, charge with us, whatever, but if you’re but if that’s not your game, and you’re looking for, a rating that you’ve predetermined, and you need someone to massage or somehow find that result, we’re not your company. If you’re a glutton for punishment, we are not your company.

So anyway, I wanted to wrap up just with kind of the things that we’re using to disrupt impairment ratings, and then we’ll close it up. It’s been a long podcast, but I think a lot of the generalities we’ve raised are valid, and maybe someone out there who’s has some influence in the industry or really wants to scale their business of work comp, or their footprint, is going to hear the podcast and say, yeah, that’s us, and we want to invest in those values. And become part of that RateFast DNA in the business, we do whatever aspect of work comp they’re in. So, but anyway, getting back to the arbitrary comment of the of the cottage industry impairment rater, who was looking under the hood and found themselves staring into the abyss, actually, of computer chips, and in motherboards and so forth.

Cory: It sure like looks like the Abyss when it’s your first time looking at it.

Dr. John Alchemy: Yes, it sure does. But just to kind of walk people around again, what we do is that, when we look at impairment ratings, we do not look at it a narrow set of data. In the report, we’re looking at a report, that’s run in parallel, and three different dimensions that we document and we review. And the first one that we do is something that basically, I’ve never heard anyone talk about, and that’s the data integrity, what’s the quality of the data here? How much of it is, is here? And how much is missing? I’ve never, ever seen an impairment report and impairment reviewer talk about data integrity, they say, oh, yeah, these measurements were wrong, or they’re incomplete.

But there’s never any number on it, and you never have any idea if it was a little data missing or a lot, or if it was good quality, or if it was, junk data, which we’ll see lots of times in reports. And it, yes, and then we do the standard WPI, based on the objective findings, or lack thereof. So yeah, we create the WPI, and figure that out for you. But then the last thing is that functional loss rating, and that’s really the big elephant in the room that controls all AMA Guides, ratings, is how much function has this individual lost, and it’s not always accurately reflected in the objective findings, doctor didn’t do everything they were supposed, or the dog cut off part of their data set? I don’t know.

Cory: What that’s what the we hear that from doctors all the time, we were inclined to believe them, you know?

Dr. John Alchemy: Yeah, the patient ate my data set. The other thing that we do that’s unique to us as we’ve started to classify reports, based on natural language terms, and that’s really a big deal in the industry. What does it mean when someone says that there’s some loss, there’s minor loss, there’s significant loss, those things just, have never really been documented or standardized or defined and RateFast is doing this in conjunction with all the data that comes in and of course with with the rules, and in demonstrations outlined in the AMA guides. So, it makes it powerful to be able to take a report a standard report that’s written in terms, that reports are actually written in and generate some type of impairment report from that, instead of running it through the med legal system and, getting 10 different results. And everyone claiming they’re right.

So anyway and then we take all that data, and this is really another big advantage, once you have mastered the data and have obtained it and digitized it, you can use that for other aspects of the report. And another elephant that sits in the room is impairment is apportionment. So apportionment is the stuff that’s non industrial that’s contributing to the permanent disability that’s going to be recognized in the in the settlement. And these are things like preexisting injuries, obesity, degenerative changes, arthritis, etc, etc. And I’m just saying if you like the old school, where the doctor writes down, it’s 80%, industrial and 20%, non industrial, and that’s my medical opinion, which in parentheses means that’s my guess. Yeah, you’re really, really not going to like our reports. Yeah. If that’s what you’re wanting. And we stopped guessing 10 years ago, we stopped this, but people have been guessing ever since. And they continue to guess. And it’s just like, what champ? Do you really want to get your business in? Do you want it on something that’s justified and defined? Or do you want to guess, like it’s been done in the past?

Cory: The year, the year is 2070. And us? You still have a gas car? Yeah, you’re finding you’re finding it harder and harder to find a gas station, let alone rolling reserves on the planet?

Dr. John Alchemy: So anyway at the end of the day here, I want to revisit the comment that they made on the RateFast report, the reviewing service. And just the suggestion of arbitrary, and the report is everything but arbitrary. Again, if you understand that the engine is not under the hood with an oil dipstick, but the engine is in the data and the algorithms that help that data talk to each other to make something of it.

Cory: Absolutely. And then if the thing is also, if we show you the work, if somebody says, hey, I saw this, I didn’t understand what was under the hood, I want to see the work, what you will see is what you should have done, which is the work that the entire time, we just made it more efficient. So there’s no, there’s nothing, it’s abstracted insofar as we have the, probably the quickest and most efficient method of doing it the best. But again, like, if you deconstruct that it’s the same thing that you should have been doing the entire time. Just made quicker. So yeah, and that’s kind of why it’s always fun when people challenge when people challenge it, because it’s like, oh, you want yeah, go ahead. Like this is what we used, and we hand them the AMA Guides, fifth edition.

Dr. John Alchemy: Well, in and it’s an opportunity to educate, we’re not here to, at least I’m not here to have, gotcha moments with people out, but I’m just really here to say, look, it doesn’t make any sense doing this, please join us in going forward, if you’re really committed to something that’s more accurate and correct. And getting this case settled, let’s did we forget about that along the way that this case has to be settled at some point. And this worker needs to move on with their life. That’s really what it’s all about at the end of the day.

Cory: Yeah. Workers compensation, right, but you’re trying to compensate worker fairly.

Dr. John Alchemy: Right. Yeah, and the other thing too, that came out of this this tale of two ratings was that the insurance adjuster probably spent the amount of money they spent on having this this review done on the rate fast report probably could have purchased them another four or five impairment reports from RateFast and closed that many more claims. Yeah, use that money towards something that actually moves the needle forward. As opposed to introducing, guessing and confusion into your report.

Cory: Once again, it’s one of those like those dovetail, dovetailing outwards things is you save a lot of money when you save a lot of time.

Dr. John Alchemy: And in closing, Cory, I’m just going to say I was at the science museum in San Francisco a couple of weeks ago, and I saw this shirt on someone walking around there. And it basically said it had like, the NASA insignia on it, and it said the world is not flat, we checked. And it’s kind of the same way with impairment ratings. These impairment ratings are correct. And yeah, we did check.

Cory: Yeah, absolutely. And we continue to check. So, yes, we’ve got satellites in space, we could show you the pictures. So yeah, well, so what we’ve learned here today is that there is an event horizon of sorts for which, on the other side is his vast unknown treasures of things that will just make life easier and better, especially when you’re kind of trying to, similar to the Tesla situation, when you’re in a scenario where you’re not only trying to do something better, but you’re trying to kind of clean up what’s been kind of made a mess of already. And it’s very scary for a lot of people to kind of cross that barrier. And it’s even if you, crossing that barrier doesn’t necessarily mean that you’re like, following somebody or doing something, but it just means that the doors open for you to go and, and partake in this sort of new thing. And that’s what RateFast is done. And we encourage people to come with us and take the easier route than to hang on to a jalopy that’s leaking oil and everything like that.

Dr. John Alchemy: Yeah, and just in closing, I’ll say, and I just want to be clear, everything that comes out of Elon Musk’s tweet account, or his mouth, I don’t 100% agree with.

Cory: You don’t want to have a coup in Bolivia?

Dr. John Alchemy: But they asked him in one interview, really, why are you doing all this? What’s SpaceX and the boring company and Tesla, and giant batteries, saving the world and all that stuff. And really, why are you doing this? And he said, and something that resonated with me was that, I just don’t want to think about the future and be sad.

Cory: Yes. Yeah. And I think that sometimes it takes something that simple, to be an incredible motivator.

Dr. John Alchemy: And I don’t want to think about impairment ratings and be sad. No, because I’ve been sad for a very long time thinking about them.

Cory: And there are many things to be said about with an impairment rating, because there again, there’ is a person on the other side of that, so it’s very easy to be sad about thinking somebody’s not getting out.

Dr. John Alchemy: So, Cory, maybe in closing, when we post this blog for this podcast, you could put the link on there to finding the nearest Tesla Supercharger for.

Cory: Alright, John, well, thank you so much. And we will talk to you next time.

Dr. John Alchemy: We will. Thanks again Cory. See ya.

Cory: If you want to learn more about RateFast, the self driving impairment report, visit our blog at blog.rate-fast.com and take RateFast out for a little test drive at our website, www.rate-fast.com.

Vertical Impairment Rating and Case Settlement with RateFast!

When everybody has a stake in the claim, the best possible conclusion that all parties can come to is the truth. For this you need an objective party, and RateFast is that party. This month, Dr. John Alchemy explains vertical impairment rating in RateFast reports.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!


Vertical Impairment Rating and Case Settlement with RateFast!

Cory Oleson (Host): Welcome back to the California workers comp report. Today is Wednesday, August 25 2021. Back again are your hosts Cory Oleson and Dr. John Alchemy here to discuss vertical impairment rating and case settlement with RateFast.

Here we are back in the studio with the with the California Work Comp report podcast. It’s me Cory Olson and I’m here with Dr. John Alchemy. How are you today, John?

Dr. John Alchemy: Cory. Good afternoon.

Cory: So today’s topic is vertical impairment rating and case settlement by RateFast. And we’re going to talk about how RateFast has assisted in claims, and specifically one claim today and exactly how it assisted that claim and how it sort of eased the typical problems or challenges that all the stakeholders of physicians, the adjusters, the employee and the employer face in a work comp claim, how RateFast, kind of took a took a very standard case of just a problematic work comp claim, and made it fluid and better. So, John, yeah, I’m curious to know about this, about the claim that we’re speaking about today.

Dr. John Alchemy: This is a case that came across my desk maybe about three, four weeks ago, and it really impressed upon me the value of RateFast and the power of knowing a report value correctly the first time, you know, we talked about this before. You know, everyone, I think this is the system everyone envisions ideally, an efficient a correct an accurate system where workers claims can be assessed, valued and settled, you know, just going forward.

Cory: But that a system that I’m sure everybody in work comp has imagined, but not not everybody has seen yet. So that’s that’s our job is to get in front of everybody’s faces.

Dr. John Alchemy: Absolutely, you know, the biggest thing for anyone who’s been in workers compensation on any end of the stick is delay, and the friction with getting stuff done. And the impairment rating is absolutely no different. In fact, it’s sometimes even a little bit more contentious, because we’re talking now about, you know, money in the future and the permanence of the claim. And once it’s signed, you know, there’s no going back, so to speak. So this is, you know, this is a big piece of the workers comp, you know, if you cannot get your case, across the finish line, you really have not succeeded in successfully, you know, taking care of the injured worker.

Cory: Oh, absolutely. And it makes me think of, you know, when you see those, I hope you, I hope nobody has to, like watches these videos or anything, they just sort of come across my eyes from time to time, but you have those those car accidents that happen in the fog or whatever, where, you know, all you can really do is like one one car crashes, and then just then you just have miles and miles of cars behind them. And that’s kind of what I imagined happens when one workers compensation claim gets delayed, it’s just sort of like the pile begins to stack up. And so not only does delay severely affect one worker’s compensation claim, it’s sort of affects kind of all the subsequent claims in the office, because even if you put one aside, you’re gonna have to get to it later, it’s going to cost you more time. Whenever you get around to it inevitably.

Dr. John Alchemy: Yeah and these open claims, you know, they just hemorrhage money right and left, you know, a lot of it’s invisible, that you don’t see, but, you know, these injured workers have to be getting paid their, you know, temporary disability payments week after week, you know, and it’s, it’s just, you know, my every direction you look getting spent or it goes to a third party vendor, and they can’t get a hold of the patient. And now it’s six weeks later, and they never went to the therapy that they were approved for. And you have to start over. And I mean, it’s just, you know, it’s amazing that the system can function if we guess if we even call it that in its present state. It’s just a lot of paralysis.

Cory: Yeah, yeah. So, yes, and this patient that the claim that you were working on?

Dr. John Alchemy: Yeah. So, so again, just to kind of address the problems at the top of the podcast here. So we can clearly identify them. The first one is delay. The second one is friction and friction is, you know, obviously a component of delay. There’s confusion, probably the biggest piece about settlement is confusion of the correct claim value. And we’ve had multiple podcasts on, you know, people’s bias, and you know, what they think an injury is worth, before they even see the injury or read about it, and all these things, but you know, trying to understand the correct value of the two people that really need to do that are obviously the doctor of creating it, the report, but the injured worker and the insurance adjuster, then, you know, obviously have to sell it to the state and have them sign off on it. So the case, you know, can be legally settled and recognized as settled.

Cory: So many,, you know, sort of hands in it, the cookie jar or whatever that that have a say over how, you know, how much this should be, like, at least two of the parties are not, not opposed, not like diametrically opposed to each other. But, you know, it’s in one party’s interest to well, I guess, you know, if you’re the doctor to make it as fair as possible, you know, and the other party’s interest to sort of, you know, to kind of protect the capital of the, you know, the investment of the employer and things like that. So, you know, there will be friction, no matter what, and, and confusion.

Dr. John Alchemy: Absolutely, you know, and then, depending on the claim that’s gone, you know, what were their delays, you know, that the injured worker feel that they were listened to, did they get the treatment that they perceive that the doctor told them they needed, then you start to build up this distrust or this animosity between the adjuster and the injured worker and often, you know, with the doctor to the doctors get fed up, you know, dealing with this or getting utilization review call this doing five minutes, you know, that? Yeah, all that stuff. So, this trust becomes a factor.

And then finally, you know, the nuclear option, well, should I get a lawyer? And sometimes, you know, it’s a good idea, but sometimes it’s not, depending really on, you know, the claim and the complexity and, you know, multiple factors. But, you know, lawyers have to pay their bills, too. So they get a cut of your claim, obviously, and I don’t think the injured workers always think of that. And then you really lose that that direct communication with the insurance adjuster when you get represented, you know, the injured workers can’t call them directly anymore. That’s that that is that’s another wedge.

Cory: Oh, yeah. You see those things where just sort of like any legal situation where somebody you know, is trying to talk the other party, it’s at this point, and it’s, it’s at no fault to either parties, I guess, but it’s like, hey, I can’t I can’t speak with you about this anymore. You know that that window is past? It is so yeah. And I mean, it’s I think it’s just in everybody’s best interest to avoid getting to that point entirely. Even everybody except for the lawyer, of course, whose job is to do that. But yeah, I mean, yeah, introducing that, that extra stakeholder to the claim, even if it’s the patient, or if it’s the adjuster that gets that extra stakeholder, it’s still more expensive, it’s still going to take longer, you know, it’s not, it’s not the best option to have. So yeah, it’s best to avoid it, if possible.

Dr. John Alchemy: Yeah, so let’s talk a little bit about this case, it’s pretty straightforward. This guy in his mid 40s, had a non surgical elbow injury, meaning he, you know, got treatment medications, maybe tried an elbow strap. A couple of other things, let’s say some acupuncture, maybe even went on to get the MRI, and saw the surgeon just, you know, didn’t want to proceed with a surgery and or wasn’t really a surgical candidate. So, you know, maybe eight months out from the date of injury right now. And the primary trader determines that and to be at maximum medical improvement, and the patient agrees with that, too. Everything’s been done in the patient really doesn’t want to do anything more invasive.

So the primary trader used RateFast in this instance, determined that the elbow was a 6% whole person impairment based on the physical exam. And the key right here that I want everyone to listen to, is that the unique thing about impairment rating with RateFast is that your impairment rating gets double checked, it gets checked based on the physical exam and history, you know, the traditional, quote unquote chapter rating, as we’ve referred to it before the AMA, four corners rating, but then it takes a look at the data from another angle called the activities of daily living rating. And remember that 1% of whole person impairment has to equal 1% of ADL functional loss, according to the AMA Guides and somehow that gets overlooked by the stakeholders.

I don’t know where or how that ever happened. Yeah, but it has, but RateFast has not overlooked it. And we have a way of cross checking these impairment ratings to make sure that they’re within the 10% variance. And that it’s an accurate and correct ratings. So the 6% was checked, it was correct. And in the report was turned in the data integrity, which we’ve talked about before.

Cory: So it’s kind of your letter grade for how good your report was?

Dr. John Alchemy: Well, yeah, kind of. How much was there? How much was missing?

Cory: Yes. Getting your your report back with with heavily annotated.

Dr. John Alchemy: Yeah. What did I miss what’s in the report? Okay. And, you know, this one had an integrity report of 78, you know, percent. So, you know, maybe B- but, but as good or better than many qualified medical evaluations or med legal reports. In California. And remember, this is just a PTP, primary treating physician, doing our exam, his exam, and, you know, this is a good outcome, this is a pretty solid report, you know, just taking a look at it. So, you know, the RateFast reports, they’re well documented, you’ve got all the references, it’s as good or much better than a report analysis that you’re going to get from one of these rating services that, you know, insurance companies sometimes use, I mean, it’s just head and shoulders, in technology and data crunching above anything you’re going to find. And fortunately, in this case, the adjuster recognize that, so. So the adjuster said, this is a good case, you know, send it off to the disability evaluation unit, state has to okay it, and they did no problem at all. And and here’s the amazing thing. So two weeks later, the adjuster sends the injured worker a settlement letter. And the settlement is for $7,800, payment for the injury loss and future care option. And so the patient comes into the doctor, and this is universal. Should I sign this? You know, and because the patient doesn’t really understand how all of this works.

Cory: As I’ve said before, the patient is at work, and then you take one wrong step, and then you slip. And then the next thing you know, you’re in a, you’re on the phone with somebody talking about MMIs and PTPs and QMEs and it did lawyers and all this stuff. It’s like they did you know, nobody plans for this from the from the employer from the employee perspective.

Dr. John Alchemy: Oh, not at all, you know, and you’re just trapped there. So, you know, the injured worker, that this individuals unrepresented. So, you know, they turn to the doctor and say, you know, what do you think, and this happens all the time. Now, the doctor can say, you know, legally, I think you should settle it or not, but the doctor can say, I know that the rating that was used as a basis for this calculation is correct. And if the question is, is the case settlement, correct, based on my impairment loss? The answer is yes. The doctor can say that, because all they’re talking about is the accuracy of the whole person impairment rating that they created. Now, whether or not the patient wants to do future care and stuff, that’s totally up to them. But the real question in this case was, is $7,800 the right value for? For this case? For the financial? Yes. Yeah. Then we knew it.

And we knew it was right, because it not been checked, not only once but twice. And and the treater, very confident, we can say, yeah, you know, they didn’t throw in a QME, they didn’t do all this other stuff and claim, you know, it was this or that or the other thing. And fortunately, the system worked like it’s supposed to work, a correct rating, a timely rating signed off by the state, and a check being proposed based on a correct rating, which was 6%, in this case, and the injured worker went on to sign the settlement papers, and hopefully lived happily ever after. And that’s the whole point of the podcast. We don’t get to say that very often.

Cory: I know. I was going to say what’s unfortunate here is that poor worker now has a has a terribly skewed opinion of how the workers comp system works! God forbid they have to go through or to get or somebody, somebody that they know, you know, who isn’t in the RateFast reach or whatever, which we can reach just about anywhere. But, you know, they’re the work comp system is so easy. I recommend everybody.

So, but that’s, that’s good for them. And I mean, we have a couple cases. You know, we have a very, you know, very evergreen sort of posts on our blog about one of the first successes of RateFast which is when it overturned a QME finding in court, you know and this was the QME whose observations that it overturned, you know, and so we’re sort of collecting these cases. And I mean, we’re not, we’re not doing it with any sort of, like, you know, a sadistic joy or anything like that. But no, we keep seeing these these times when, you know, RateFast as has simplified things for people and, you know, owing owing largely to, to our work and everything, but also just the fact that like, this is, this is what happens when something is broken so badly. And then somebody looks at it says, okay, all right, I’ll do it, you know? Which, yeah, oftentimes, that’s what it really takes to kind of start changing things.

Dr. John Alchemy: Yeah. Well, you know, it helps if you have an adjuster that values objective data. That values correctness.

Cory: Absolutely. Well, when you when you had mentioned that it was the, the adjuster that reached out to you that was sort of how do you say kind of a spark, in my mind is like, wow, that, you know, because because they realize the same thing as, as everybody else, like, you know, if the claim drags on, then that’s costing everybody that’s costing them, too. It’s not sensible, you know.

Dr. John Alchemy: You know, and no one really wins when that happens. Yeah. And unfortunately, that happens all too often.

Cory: Absolutely, absolutely. It’s not, it doesn’t, behoove them whatsoever to, I don’t know, I guess you could say gate keep, you know, or, whatever, you know, it’s, it’s just sort of part of the part of the whole shebang, you know, the doctor doesn’t write great reports, they have to put it away, they’re, they’re spending money, the, you know, the poor employee is just caught up in all of this, the employers waiting on the news, and, you know, just all this stuff, it’s a mess, you know, it’s the best thing that you can do is find the most efficient way to do it. And so, you know, we’re getting out there to try to find other, you know, find find people that are in need of these things, which is a lot of people.

Dr. John Alchemy: In closing above this, you know, the I always like people to have a little bit of a take on well, why is this story substantial? Or why is it significant? You know.

First of all, I want to say this is excellent customer service from the work comp system. We just talked about that. You know, but I think the bigger story here is that the stakeholders can be assured that the settlement value is accurate. And that cannot be said in other situations where you’re looking at a QME report, or the attorneys are arguing over this or that because, you know, often they’re arguing over a number and not over the substance of the case at all. And so unfortunately, you get into these things where someone throws out a number, and then it gets halfed, and then, you know, horse traded a little bit, and then that’s your settlement case, at the end of the day, it really had nothing to do with the actual value of the claim.

Cory: No, yeah. Because the value that everybody was arguing was was just wrong. It’s just yeah, it was built by by bad, hardly support, well, not hardly supported, but incomplete data, everything, it’s assuming it sort of making the assumption that everything was done, you know, the most efficient way possible, leading up to that final number, which is just right, it’s not not true. And, as we said before, if this is your first episode, listening, we’ve said this many times before, you know, we don’t, you know, we at RateFast, we believe that, you know, the ills of workers compensation isn’t on part of any one stakeholder, anyone group of stakeholders, anything like that. It’s the whole system, you know, that that’s why it works inefficiently.

And I mean, you know, at this point, there’s no one that you could particularly you know, blame or put that on or anything like that. It’s just a large, inefficient sort of monstrosity. And and so yeah, it’s not, you know, there are people who are, I guess you could say to blame when it when a when a claim goes badly, but I wouldn’t say that it’s 100% anybody’s fault. If and, you know if a claim goes badly and you know, in our experience when a claim goes badly, so yeah, yeah so it’s also sort of what we’re doing is to is to shift the focus on to what is important and luckily for everybody, you know, it’s not it’s not empty, it’s not just, this is what’s important. It’s, this is what’s important, by the way, here’s how we can help you with it. And that’s sort of what we do at RateFast.

Dr. John Alchemy: Yeah, and I think the other hidden story here is that by settling this claim in the fashion that we have described, alright, we saved the stakeholders, the injured worker and the insurance company, probably 18 months, if they had chosen to contest it. First of all, report that we all know is right, if they chose to contest it, they would have gone into the med legal QME system, it would have been at least another 18 months, on average, most, you know, QME cases have two visits or more.

You know, and so, you know, you’re looking at 18 months, and you’re looking at having saved again, this case saved, I believe, conservatively $4,000 in money, then that would have been extra cost of temporary disability payments to the injured worker, while they’re waiting for this QME, the net legal costs, which have essentially tripled, you know, this last year, and hands down really fast is, it’s better, faster, it’s cheaper for the stakeholders, and that’s the big story. It’s like, you know, this needs to happen more often, we have a platform, let’s start using it, you know, why aren’t we using it more.

So, you know, the clients and the stakeholders that use RateFast, are really getting a leg up in the whole system, because they get to know the correct rating the first time instead of, you know, going through all of these unnecessary steps into ways and basically rolling the dice with an unknown outcome, when the outcome can be known before you start, and that’s my take home.

Cory: Absolutely. And you know what, if you’re a work comp professional, and you haven’t heard about RateFast, yet, there’s a chance that one of your peers has heard about RateFast, and they didn’t tell you because they, they just want to make it look like they’re just suddenly the master.

Dr. John Alchemy: That could be happening, as far as we know.

Cory: So we’re here to blow up their case. So that you know how to do it the best and easiest that way, you could be that person while you’re here. But this is a collaborative effort to fix the wrongs that have, you know, and it takes a village to to save workers compensation.

Dr. John Alchemy: Well said, Cory well said.

Cory: Yeah, as we’re approaching time here, is there anything else that you would like to say, John?

Dr. John Alchemy: I’m gonna keep it simple: get vertical, get RateFast.

Cory: Hey, that’s you know, that’s just like RateFast. We’re keeping it simple. Well, thanks. Thanks again, John. We’re gonna plug in where you can get RateFast and everything right after this. So yeah, once again, thank you for coming on.

Dr. John Alchemy: All right. See you next time.

Cory: All right. For more about vertical impairment rating and case settlement, visit our blog at blog.rate-fast.com and get the rate best workers compensation impairment rating service to try and rate-fast.com.

Workers’ Comp: the Central Issue in California’s Battle over Prop 22

Hector Castellanos, a full-time driver for rideshare giants Uber and Lyft, was injured in the course of work when he was struck by another car “I was hit by another driver while I was working, ended up needing the surgery and months of physical therapy, and I had to stop working for about a year,”

This issue was taken to court after Castellanos alleged that he had been promised a pay raise and increased healthcare by the company, a promise that had not been fulfilled.

Continue reading Workers’ Comp: the Central Issue in California’s Battle over Prop 22

A California Nurse Case Manager’s Guide to Discussing MMI with Patients

Dr. John Alchemy answers questions submitted by Nurse Case Managers regarding ways of discussing common work comp questions with their patients.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

A California Nurse Case Manager’s Guide to Discussing MMI With Patients

Cory Oleson (Host): Welcome back to the California Work Comp report. Today is Tuesday, August 3, 2021. This is your host Cory Oleson here with Dr. John Alchemy. For today’s episode, we have a California nurse case manager’s guide to discussing MMI with their patients.

And we are live with the California workers comp report. It is me Cory, like you heard in the introduction. And I’m here with Dr. John Alchemy. How are you today, John?

Dr. John Alchemy: Good afternoon, Cory. How are you doing?

Cory: I’m doing all right, just a kind of a humid day over where I’m at. But that’s just fine.

So the topic of the podcast today is a nurse case managers guide to discussing MMI, which is maximal medical improvement with patients in California workers compensation. And we had previously done an episode on nurse case managers, that will be linked in the description. But you know, we owe it to ourselves to do a little brush up of it. And remember what what a nurse case manager is, and a couple other points about them. So John, what is a nurse case manager as in respects to California workers compensation?

Dr. John Alchemy: A nurse case manager is a nurse with obviously nursing background, it could be a licensed vocational nurse, it could be a registered nurse, it could be a telephonic nurse. But this is an individual with a medical background that is assigned to assist with an injured worker for some reason, like for instance, if it’s a catastrophic car accident, multiple injuries, they’re in a wheelchair, they need home health, they’re going to be in a rehab facility, a nurse case manager will be assigned to that to help the injured worker and the insurance company navigate the work comp system, getting them to their appointments, logistics, making sure medications get to them on time and, and all of that sort of thing.

They can be assigned to someone who has a significant social challenge. Maybe they’re homeless, I’ve had that happen before and they’re living out of their car. They don’t speak English very well, or English isn’t their first language or they can’t read. I’ve had a couple of patients that are illiterate and just, you know, can’t read anything that gets sent to them. Maybe they don’t have internet, maybe they you know, can’t even get an email. So there’s a lot of reasons why nurse case managers can get assigned, but the main take home as they’re assigned, because the injured worker needs help.

Cory: Yes, absolutely. So it doesn’t, it doesn’t necessarily mean that there’s any sort of like, legal ramifications to the claim the way that you know, if an attorney was involved or something like that, it’s simply that the patient needs help. And, you know, that would help everybody else close the claim.

Okay, so a nurse case manager assigned to a claim to help a patient get to their appointments or do other things that, you know, they’re just kind of thrust into the system all of a sudden, and, you know, oftentimes they need assistance. And so this nurse case manager, where do they come from? I mean, who assigns them? And, you know, it sounds like there’s multiple reasons that one could, you know, come on a claim, but are there, you know, specific or common reasons why a nurse case manager would would jump on the claim?

Dr. John Alchemy: Well, usually they’re assigned by the insurance adjuster, the adjuster is either become aware that there’s going to be some significant challenges in delivering or coordinating care, or, often myself, I will identify that from the primary treater. The patient comes into clinic, you know, I just can tell that they’re going to have a hard time they, you know, really need a lot of help a lot of instruction, a lot of redirection. And I’ll actually just put in a request for authorization for nurse case manager, I’ll maybe put it in there for six months or three months, or just enough to help them get through a surgery and recover and then you know, we can kind of take it from there.

So it can be a doctor. It can be the insurance company, usually. But I would say, you know, either one can assign it. And the biggest question I always get from the injured worker, because nurse case managers come to the appointments so they know what’s going on. They ask questions, they find out what the next steps are. They write reports, submit those to the insurance adjusters, the adjuster knows what’s going on. But the most common question I get from the injured worker, is this nurse case manager hear from the insurance company to spy on me?

And most common concern is that, you know, this nurse case managers hear, you know, because they’re, you know, want the insurance, they want to help the insurance company out and they don’t want to help me. And I think that’s the biggest misconception that I need to realign people’s thoughts around and let them know no, this nurse case manager is really here as an advocate for the claim. The insurance company pays everybody they pay the doctor, they pay me you know, I’m paid to take care of you. It’s we’re all paid by the insurance company. But we’re all supposed to have the goal of you know, getting you better doing what’s right and not ordering things that are going to hurt you. So we often will have to get some of the patients back on track and let them understand that, you know, having a nurse case manager is really a benefit and not a handicap in the case.

Cory: Absolutely. Absolutely. To all of the people who developed a very, very specific and lofty ideas over the last year, I can say that nurse case managers are not a sysop.

Dr. John Alchemy: Thank you for clarifying that.

Cory: They work neither for the FBI or the CIA. As far as I know.

Okay, so you’ve clarified that they don’t work for the insurance company. You also, you know, it’s natural to assume that okay, who’s this person all of a sudden, who’s going to be giving me rides or something like that? But yeah, they’re nurses just kind of got, you know, they got assigned to the claim to help.

Dr. John Alchemy: Yeah, they’re a paid advocate. And obviously, the insurance company pays pays their bills.

Cory: And that’s a good point that, you know, for work comp claims and everything the insurance companies pay you as well. And that’s, you know, any, if there’s any nurse case managers listening, who has to tackle that sort of suspicion, or like, or establish some sort of trust with their patient or anything, I think that’s a wonderful point to make, or that would just drive them insane thinking about now the doctors working for the insurance company!

Dr. John Alchemy: It really becomes clear.

Cory: Yeah, at that point, if your patient is kind of on that on that vibrational level, then there’s nothing much you could have done anyway. And, and that’s what would happen if you got me as a patient if I didn’t talk to John. So, um, so how long is the nurse case manager on the case?

Dr. John Alchemy: Yeah, so they, they run on the case, typically, until the case reaches MMI. And on our podcast, we always like to talk about maximum medical improvement or time to write the case or 12 months, no change with or without treatment, which is MMI. So they’re there to get the patient as well as they can. And then they sign off the case.

Cory: Yeah. And MMI in the words that I could only understand when I started doing this podcast was as good as you’re going to get after. Which is a very subjective thing. And the funny thing is that, you know, the, I mean, it’s not the patient that walks up and says, I’ve reached MMI. If only it were that easy. Because it’s all the other people who think that it’s the doctor that’s supposed to say that and everything but or to determine that, but, um, so now, okay, so we have our framework for what a nurse case manager is, it’s a professional nurse who has been assigned to a patient, when a claim needs help, the person who assigns them can either be from the insurance company, or the doctor themselves, or possibly even another stakeholder in the claim, if there was like an attorney involved, I guess they could recommend it.

Dr. John Alchemy: Sure, yeah. Possibly.

Cory: And they do basically, any kind of task that is required to make sure that the patient makes it to their appointments, and that their work comp claim goes smoothly, including attending the appointments, which is just part of the part and parcel with being a nurse case manager, for a work comp claim. So the next portion of our podcast here today is that we actually asked a nurse case manager, what are the most common questions that you get from your patients?

And what we’re going to do is we’re going to provide those for you today. So that you have those answers kind of in your back pocket, when, as we understand, inevitably, these questions are asked to you. So I’m going to start off with the first question here. And the first commonly asked question from patients to nurse case managers, John, is, how does the MD come up with impairment ratings? And does pain come into play?

Dr. John Alchemy: Yes, common question, how does this number get made? So we need to tell these injured workers that when you’re done, we need to figure out what your loss is, and how much you’ve lost as a result of the injury. So we have a book, we have a book in California. It’s basically a doctor’s recipe book, if you will, and it tells the doctor how to do a special exam based on the part of your body that got hurt, and come up with a percentage loss of that body part. So for instance, your whole body is worth 100%. Meaning if you’re in a coma, you’ve lost 100% of your of your person, if your arm or to be removed, unfortunately from an accident, you know, you would lose 60% of your person for that, or 40% if you lose a leg, so it’s based on a percentage of an entire person.

And, and there’s special rules, it’s a special exam. It’s not the typical exam that you might get when you’re going in for a route, recheck or even your first visit. But it’s it’s a physical exam that allows the doctor and the insurance company to take your findings, your findings alone, and put them into a context of how much you’ve been injured, and how much function you’ve lost as a result of your particular impairment. And yes, pain definitely does come into play. Pain is considered in all of the ratings and all of the body parts, pain and or symptoms. So that’s definitely part of it, what you can do, what you can do at home, what you can no longer do at home, how fast you can do it, or if you can even do it at all. All of that is placed into the context of your impairment rating.

Cory: Yes, the way that I was thinking about the AMA Guides, when you were describing it just now as I’ve never thought of it in the context of if I was talking to somebody who had never heard of them before, anything like that, and I just had the idea. The AMA Guides is is a lot like almost like a math book, where instead of the one train leaves from Chicago when train leaves from LA, you know, it’s your body.

Okay, so question number two, does the PTP or primary treating physician have to agree with the final final report recommendations? What if a qualified medical examiner or QME says says that the injury is permanent and stationary, but they want to continue treating the patient? Or vice versa? What happens if, if the insurance company says you are not permanent and stationary? But the doctor says they most definitely are, what happens? I guess in either scenario?

Dr. John Alchemy: Well, let me just clarify for everyone. So the QME is a state assigned doctor and the insurance company can call that at any time. So if your treating doctor for some reason, you know, isn’t writing clear reports, or that doesn’t clear to be a clear arc on that treatment plan and stuff. Sometimes, the insurance company will order a state qualified medical evaluator this can be ordered by patients as well. And they’re supposed to step in, you pick a specialty, and they’re supposed to step in, and basically just give an opinion. Remember, these doctors are not allowed to provide any treatment, and they’re not allowed to direct treatment, they can make treatment recommendations, but they can’t say, you know, I’m going to give you Advil, or I’m going to do shoulder surgery on you next week to fix your problem. So they’re only there as consultants.

And the insurance company can choose to, you know, follow the QME report, or they can choose to follow the PTP or a combination of both. Often what happens is a QME report comes back, the insurance adjuster will say, hey, the QME he thought that this patient needs maybe some further testing, what do you think primary treater? And the treater can say yes or no. Sometimes the QME says, oh, no, I think this person is reached maximum medical improvement, there’s nothing more to do for them. And, you know, here’s the rating value, and that can go the wrong way, too. I had a case where a QME basically gave my patient who couldn’t raise their shoulders, at or above shoulder level, they gave him a 0% impairment and said, there’s nothing else to do. This case was MMI.

And I wrote back and I said, well, I respectfully disagree. The patient hasn’t had any therapy. They’ve had no X rays. Their arm doesn’t work. So it’s like, you know, I don’t I not really quite sure what planet that QME may have done this exam on, but I’m pretty sure that it’s not maximally medically improved. And you can always tell the insurance company and the patient yeah, take this into the state have, you know, have a judge look at this. You know, if this just doesn’t make any sense at all.

Usually, it’s not that extreme, usually other reasonable recommendations, but the bottom line is, at the end of the day, the PTP has to write their own impairment report, that’s part of California Labor Code. There’s no way around it. The PTP can adopt the QME report if they think is reasonable and accurate. But they are required to come up with their own version of the patient’s whole person impairment and MMI report one way or the other and that often gets missed because a lot of treaters think, oh, this person saw QME, I’m totally excused from having to do an impairment report. Not true. Not true.

For those of us who do impairment reports for living, after you’ve seen a few QME reports, you realize that some of them are less than complete, and less than accurate sometimes. And so it’s important that if you see a mistake in the system, you have to stand up and say something and say, look, this needs to be fixed. Or there’s an error here, because if we don’t address it, now, it’s only going to come back later with an attorney. And it’s only going to take you know, longer and be more expensive and more frustrating for everyone. So I tried to get these QME reports called out early if there’s a problem, because it only benefits everyone. You know, going forward.

Cory: Yeah, if everybody if everybody’s doing their job, then it’s gonna be a smooth work comp claim. Yeah. If people aren’t doing their jobs, you’re gonna have these stakeholders just walking in the door. You’re gonna have the patient in the doctor’s office, you’re gonna have a the rep from the insurance company… No, not really, but I’m just imagining you just the whole, kind of like the Richard Scaries book of Workers Compensation, then you’ve got this sub Rosa guy outside with the binoculars looking through the window, waiting to come in.

Okay, um, all right. So question number three, do the temporary disability benefits stop when injured workers are permanent and stationary? Or they’ve reached MMI? And and if they don’t, then when do they?

Dr. John Alchemy: Yeah, that great question. And an important question, because a lot of these injured workers are dependent on the income if they can’t work. So, in general, the payments for temporary disability will go on for about two years, and at two years, they’re going to stop regardless. But as soon as the patient becomes maximally medically improved, the payments also stopped. Because the patients no longer temporarily disabled, they are permanently disabled at that point, if they can’t perform their usual and customary work.

And then the decision of accommodations need to be made. So when when the case becomes MMI, or permanent, and stationary, or PNS, whatever term you want to use for it, the employer has to decide if they can make a permanent accommodation and keep that injured worker on or if they can bring them back to work with the permanent restrictions like no lifting over 25 pounds. If they can’t, the employer can release them permanently and go out and find someone else. And then the injured worker is left with either going out and finding a job that’s within their capacity, or getting retrained in another vocation, another job.

Cory: Yes. And on to the next question, does the patient have to accept the settlement offer?

Dr. John Alchemy: Well, it’s an interesting question, because the offer is really based on the impairment rating. And the real question is, is the impairment rating accurate enough for the justification of the settlement offer? So if you think of a whole work comp claim, as like the building of a house, the impairment rating is the foundation it’s the bricks and mortar that support the entire building, if you will. And it basically says, you know, how much loss is there? Why is there loss? What are the basis for this? Where are the measurements? You know, what did you do? What are the tests, and all these things are the foundation of the claim.

So once you have the claim number, and it’s the doctor that delivers the whole person impairment, okay. And once that doctor delivers that whole person impairment, that is the piece that the injured worker needs to be confident in, that they’ve been adequately reviewed. And this is also a concern of the insurance adjuster too. Is this an adequate representation of the individual because if it’s not, you can bet someone’s going to come back and it’s going to go to court, and it’s going to get dragged out for months and years, if it’s not accurate.

So it’s in everyone’s best interest to know if the settlement offer is solid, you know, and that’s why I just plead with insurance people sometimes like, hey, do not go out hunting for a 0% whole person impairment. That is not what this is about. This is about going out and getting the accurate number to settle this claim. So it doesn’t bounce and keep coming back and keep coming back. Because, you know, the goal is to find the right value settle the claim, and have a basis to the claim settlement, as opposed to just saying, oh, I found a case with a zero. I’m going to use this one or likewise, the injured worker finds a case with 100% whole person impairment. I’m going to use this one.

And neither one of those are reasonable options, though, the real question is, what is the real accurate whole person impairment because once we have that number, it gets put into effect, a simple formula that calculates permanent disability. And those two things are probably the most easily confused by everyone in the system. It’s the whole person impairment, and then the permanent disability. And the permanent disability is nothing more than a number that is generated based on a fixed formula on age and occupation, as a main driver inside of it is the whole person impairment. And that’s what sets the price.

Cory: Yes. Okay, so we have two more questions here. But I’m going to kind of condense them together, because it’s just about the same thing, essentially. Yeah, the last question being, what if the insurance company offers a low settlement amount, but it has future medical care, versus a high settlement amount, but no future medical care? What should the person do? And why in that circumstance? And then regarding the future medical care and everything, is there a time limit on it?

Dr. John Alchemy: Good questions, excellent questions. And I think sometimes doctors, when they get this question, or insurance adjusters, or, well, probably more than nurse case manager and doctor who are in the field with the patient, when they get asked this, there’s always a tendency to, you know, want to try to give the patient your best advice. But, you know, doctors are really only supposed to give medical advice, they’re not supposed to give legal advice or settlement device or say, well, that claims too high or too low.

Now, the way I approach it, is I always take them back to the whole person impairment value. And I say, Look, this is a good value, or this value is correct, or this value is incorrect, in my opinion, and I’ve already told the insurance company about it. So I substitute money for whole person impairment, because that’s where I’m allowed to talk to the patient. And that’s where I’m allowed to do an analysis on the medical report that will ultimately determine their settlement amount.

Now, this whole thing about future medical care, and then this other concept, also known as compromise and release. So the way that this works is that you get a fixed payment for your loss based on your measurable permanent disability, which is, as I said, based on your whole person impairment, so you get an amount of money for that, that’s not going to change. But this future care means that you can continue with treatment, and the insurance company will continue to pay for it. So if I need medications for the rest of my life, or I was told I need a surgery in 10 years, if I keep my future medical care, the insurance company, theoretically will pay for that, which what what the patients don’t always understand, is that everything in the future has to go through utilization review appeals, just like everything before the whole before the MMI exam.

So that doesn’t change. So just because future care says this person is going to need a surgery in the future doesn’t mean that it’s going to be approved, because all the information has to be you know, brought up to utilization review, etc, etc. So future care simply means access to ongoing care, but it’s still under the same rules as your pre-impairment rating.

Cory: So everything’s not full smooth sailing right after you go. You can’t just get that face work you’ve been meaning to get? No, I’m kidding. Yeah, well, that’s is insanely practical advice. And I imagine that there’s so much going on in workers compensation that I imagine that the nurse case managers just might need to brush up on some of this stuff.

Dr. John Alchemy: And here’s the other road that I’ll just say, before we wrap this up, is that, you know, I think sometimes patients get this misunderstanding that, oh, I’m going to do a compromise and release, I’ll get this money in my pocket. And then I’ll just go out and get the treatment I want, you know, I’ll get that surgery done. You know, and what I caution them on is, first of all, you really need to understand what the horizon is on your treatment needs. So are you going to need treatment only for the next five years, the next two years or the next 20 years for the rest of your life, really. And then you have to remember that as a patient, you are paying retail, and as an insurance company, they are paying wholesale. So you know if they’re going to give you $8,000 In the future for you to go out and pay for your own shoulder surgery. And then they’re going to release you with no you know, with no responsibility for your future care in the future. You better go out and ask what a shoulder surgery is going to cost you have to pay out of pocket, you know, last time I checked is about 27 to $30,000 and there’s double double digit inflation in health care every year. So that it sounds like a good thing but you better check with your financial planner. Just to make sure that your numbers are correct.

Cory: Yeah, have a have some sort of exponential, use exponential when you’re planning years ahead. Well, great. So we have learned today that you know, nurse case managers are good and sometimes even necessary in moving claims forward and getting them closed, for sure. And, yeah, are there any kind of final words that you have today, John?

Dr. John Alchemy: Well, these are all great, really great practical questions, anyone who works with patients or nurse case managers, or even, you know, insurance adjusters, etc. These are just bread and butter questions this nurse case manager brought to us so I want to say thank you very much. And you know, always send in questions. And if you think that there’s a topic and a podcast you’d like to hear more about, let us know.

But just wrapping this up, nurse case managers absolutely are extremely valuable. They are advocates for the claim, they’re going to be with you until the claim is MMI. And you’ve got everything you need. They’re a great source of information for the adjusters for the doctors and the patients. And they’re really there to be used as a resource and support for the best outcome possible for the patients and that’s the way we need to think about it.

Cory: Well, thanks again for coming on John. And we will talk to you next time and nurse case managers, if you’re out there. Listen to this podcast and share it with your your nurse case manager friends, it might help them and it might help their patients.

Dr. John Alchemy: Thanks!

Cory: Thanks again for listening. For more information about our episode, visit our blog at blog.rate-fast.com and if you want your workers comp impairment reports done and your claims finally closed, visit us at rate-fast.com

Summer 2021 COVID-19 Report

In the months following the initial vaccine distribution early this year, it started to feel as though COVID-19 was soon to be a distant memory, a thing of the past. People began going outside, mask mandates were lifted, friends and families reunited. Much joy was had.

Of course, as we know having lived the past few months, this didn’t last very long.
Continue reading Summer 2021 COVID-19 Report

The Data Science and Impairment Rating Advantages of RateFast Digital Analytics

We’re in the age of data! Data helps us improve things in our day to day life, as well as track the progress of our ventures. Data analytics could be incredibly helpful to workers’ compensation as a whole, we know because we’ve seen it. Dr. John Alchemy expands on RateFast data analytics and how it helps close workers’ compensation claims.

For more information on this episode, and other helpful tips about workers’ compensation, visit the RateFast Blog.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

RateFast Podcast: The Data Science and Impairment Rating Advantages of RateFast Digital Analytics

Cory Oleson (Host): Hello and welcome again to the California workers comp report. Today is Monday, July 12 2021. This is your host Cory Oleson here with Dr. John Alchemy to discuss the data science and impairment rating advantages of great fast digital analytics.

How are you today, John?

Dr. John Alchemy: Hey, Cory doing great. Good to be back and good to chat.

Cory: Yeah, we’re back in the saddle again. A little a little update about last week’s episode. And this is not at all relevant to anything. But I did tell that I saved this for the episode, by the way, because I wanted to tell tell you and our listeners that I told a joke about cantaloupes last episode. And, you know, for those listening, you will know and for those who don’t know, I recommend the episode. But since I’ve had multiple opportunities to tell that joke, that it was just sort of like well, here’s the cantaloupe joke, again, all to different people. And I don’t know why, but it’s just a cosmic thing that I felt I had to, to mention it being the podcast being the first place, I want to say, this year that I told the, the jokes.

Dr. John Alchemy: It’s a good play to the wider audience, Cory.

Cory: Um, a lot better than some of the jokes. Okay. So today, onto the topic, the data science and impairment rating advantages of re pass digital analytics. We’re talking about basically the things that make RateFast incredibly powerful. And the reason that is still something that we highly recommend is because we’ve been waiting for anybody else to catch up in terms of doing what we do and doing it well and correctly. But in order to have any sort of idea or point of reference for how it’s how it’s good, and how it works in anything, we do need to know how it works.

So first off, John, if we’re talking about, you know, RateFast digital analytics, then what is it that we’re talking about?

Dr. John Alchemy: Well, you know, when we do impairment rating, across impairment rating, in whatever state you are, or in California, the two main things that are really, the basis or the foundation, if you will, is being able to have someone take a look at a report and know the integrity of it. Now, we’ve done other podcasts on data integrity. So you know, I’ll refer the listeners there to what data integrity is, but in short, it’s a quick score of what is in your report, and what isn’t.

And I’ll tell you, you know, a lot of impairment rating, as you alluded to earlier, is basically Stone Age, you know, it’s 1000 different people doing impairment ratings, 1000 different ways with different levels of you know, quality and scoring, and then throwing in the variable that I love, my clinical experience, that just kind of smears the edges of a rating and really doesn’t hold anyone you know, responsible in in a meaningful way that can be checked, or that can be compared against the next report that person does, or the same patient that’s reported on by a different provider.

There’s, just no way for the stakeholders to take a look at a report and say, you know, this doctor A did a 60% data integrity and his report, and this Dr. B, did a 78% integrity on her report. And it’s just crazy for the size of the market, and the money that’s at stake. And all of the cases in California that get rated every year. It’s just mind boggling to me that you know that it works or doesn’t work in the present system.

And I’ve talked about this previously that unfortunately, because the impairment rating has been such a black box or such a curtain with the Wizard of Oz behind it, that the stakeholders, mainly insurance adjuster and patients are left only to value reports based on the result of the impairment and a subjective gut check on what they think is fair or not fair. And that’s the big problem with the system. This system was set up so it stopped being a subjective, you know, quote unquote, gut check, impairment rating where you know, one person would say, oh, yeah, this is a great rating and the other one says, no, this is totally off base because that’s the way it used to be. But unfortunately, when we brought in the AMA Guides, no one has ever thought to create a system that’s like, hey, now that we have, you know, certain clear elements and report that are to be used for rating, why aren’t we tracking them? And why do we have no tool that will give us insight into the report?

So, you know, the data integrity with RateFast analytics is a huge benefit for stakeholders. And, you know, I absolutely love it, we’ve had these inner reports now for maybe 8 to 12 months. And I can’t tell you how valuable it is when someone brings up a complaint, or when someone wants to bring up a challenge on RateFast report, and they have some other report they’re pointing to and you say, okay, well, the RateFast for this provider found a fun and integrity rating of 78%, what’s the integrity of the report in your hand? And then you just hear crickets and a bunch of silence, because they don’t know. And, you know, that’s really what I want to do with rate fast and advancing technology. Is let’s get this into some type of transparent system. So we’re not wasting everyone’s time. And right now, there is a lot of wasted time and money in this space.

Cory: Absolutely, absolutely. You know, anybody that works in any sort of industry will tell you, you know, they, they sort of understand that there’s a totally nitty gritty side of it, which anybody that works outside of that industry, especially if it interfaces with the public in any sort of way. You know, if you ask anybody that doesn’t know about this industry at all, they they’re not aware of how inefficient this just gigantic thing actually is, I mean, work on being only one example of that, I mean, the other thing that comes to mind, is sort of like the way that people talk about AI, like the any sort of user that’s interfacing with Internet of Things product, there’s something things that there’s some sort of, you know, genius world of digital infrastructure behind sort of a lot of the things that they use, which is, in a lot of ways true, but sort of some of the, the tables are being held up by napkins, sometimes there’s things like that, um, and if you work in an industry that doesn’t have, you know, things that are sort of obscured from the public eye that are just messy than we were, I’m dying to know what industry works well.

But yeah, that said, we’ve had a previous episode about data integrity, which I, which I also recommend, and it’s essentially kind of solving this issue of you have this huge, bloated system where everybody that works in it is aware that it doesn’t work great, or at least to the point where people are spending extravagant amounts of money just to solve problems that are inherent in the system. And yet, a lot of the time, people just live with these problems, because fixing a certain aspect is sort of like untangling a huge, you know, not in 10 different cords or wires or something, it’s just kind of at that at a certain point. It’s just like, it’s not my job. It’s, it’s this is, but we at RateFast made it our job. So in data integrity, things like that, ways to tell how good your information was, after you’ve handed it over, instead of just defaulting to well, this information is probably bad, this is probably going to be a mid legal case or something.

Dr. John Alchemy: Yeah, exactly. So the integrity, you know, is a huge piece of kind of understanding what’s there, what isn’t. The next piece that’s really big about this technology? Is the reporting internal reporting consistency, and scoring the ADLs. You know, again, we’ve talked about ADL values and how they play into impairment ratings, and how fundamental they are, and the AMA Guides, you know, multiple other podcasts. But um, when when you have a system that can now consistently process data and answers from patients and scoring from physicians, you have a tool that is going to consistently give you you know, a value based on what’s actually in the report. And I alluded to earlier in the podcast, you know, one of my most frustrating answers to hear or see written in like a QME report or an impairment report is well this is based on my medical experience. And I mean, that’s, I just don’t know what to say to that because it just it doesn’t mean anything.

Cory: Yeah, yeah. It’s it’s it’s pulling it’s it’s kind of like pulling the expert move or the professional move. I’m a professional but you’re speaking to other professionals who see right through it, or you know other professionals who are supposed to see right through it. Who didn’t, you know, whose job is to scrutinize your work and things like that. Yeah, it’s amazing how, how this could be sometimes if you think about you think about it, it’s kind of the way that I think about reports is that it’s almost like a, it’s almost like a pass fail grade for a test, where you have to solve like, one problem that’s made up of a bunch of, you know, small problems versus something like a, you know, this is what an impairment rating is, it’s like a holistic, sort of report on, you know, the human body and its injury and recovery. And it just seems like, just from what I hear, it seems like a lot of people treated almost as if it’s a kind of like a math test, where all the, all the questions are different questions, and you know, the answer to number one does not necessarily relate to the answer to number five, things like that. Not the case, we work on reports.

Dr. John Alchemy: Yeah, and I think the other difficulty with the marketplace is that I talked about, you know, price sensitivity, and people just having this subjective, you know, value in their head about what they want to pay for a knee or a shoulder, because that’s what they think they should have to pay for a knee and shoulder, not being able to see, you know, the data nuances between a shoulder one and a shoulder two case, you know, yes.

And, the big value of RateFast, is that, you know, when we tell you the value, it’s defensible. And it’s very clearly objectified in the report. So, you know, if we lay a number out, you know, one shoulder might be, you know, 4%, but the other one might be 15. And there’s a reason for that. And when you have that type of insight into the settlement of a report, it gives incredible power to the stakeholders that value consistency and objectivity. Because all of this, you know, my medical opinion, goes out the window, all the times that the Almaraz Guzman rating might be abused, for whatever reason, goes out the window. And, you know what the price is.

And so you can avoid the litigation or you can shorten the time of litigation, and you can promote a more equitable settlement than using this current system. Because I mean, think about it if you’re handed an invoice every month for the same service, and it’s wildly different between each month with no explanation.

Cory: Sounds like my electricity bill.

Dr. John Alchemy: Possibly, yes. I think that that’s excellent. You know, there’s no, I think, no rate hikes and times you use your electricity. It’s just all over the place. And it’s very difficult to understand impairment ratings the exact same way.

Cory: Yeah. Oh, absolutely. Absolutely. And so it’s, you know, it’s at least good to know what you’re paying for. And it’s good to have everybody to be in agreement that you’re paying for the right thing. So that’s kind of bringing it back around to what we’re doing. Um, so yeah, I mean, so the RateFast service, it’s important because it saves you time saves you money, it standardizes things, and it just takes care of a problem that was a problem that was too big for any, you know, one person that sort of in it and of it to tackle at the time because you know, it’s your job to see the patient or it’s your job to you know, read these reports or it’s your job to adjudicate these these issues and everything, so we did the job that everybody else is stupid to do.

Dr. John Alchemy: And most importantly, we’re still doing the job, you know, we’re still stopped but you know, at least we have a framework and a system and, you know, another example is, um, you know, the whole Almaraz Guzman thing, and the whole Almaraz Guzman thing currently, is prefaced on, you know, my medical opinion. And like I said, that’s a non starter for me, you know, to read that in a report yet, you know, the Almaraz Guzman was created because there was a sense that the impairment ratings were not always an accurate reflection of the individual’s functional loss, and I’m totally on board with that they weren’t. And part of the reason that they weren’t is because the integrity was not consistently in one report to the next or pieces one through five or in this report and pieces, you know, three through seven were in this report, and it was all over the place.

But the problem was, is that the Almarez Guzman was just thrown out there. But again, as we’ve discussed in prior podcasts, no instructions, you know, no basis for how it’s really used, you know, no guideline. But RateFast has proprietary algorithms. So we can take a look at it and anchor the value of that claim based on what I call the ADL functional loss, which is really what the ADLs are all about. They’re the things being rated in the AMA Guides and ranges of motion and strength and blah, blah, blah, are basically there to match up with what’s your functional loss is. And so we have that ability to say, here’s what came in, here’s your integrity, here’s your rating. And then here’s what the rating should be based on the functional loss. And then we can very simply tell, hey, this rating is within tolerance or not. And if it’s out of tolerance, here’s how many points it has to be adjusted to become intolerance.

So, you know, either way, you’re going to win with a system like that, because you have, you know, an expectation that’s pinned, and then you see where the exam comes in. So, you know, it’s so it’s a very interesting system, I call it the belt and suspenders of impairment rating, because either way, you’re going to get an accurate rating that you can use. It’s, it’s just a question of, you know, what the examiner is claiming, is the reasonable data in the exam?

Cory: Yeah. So when I, you know, if I say something like data scoring, intake and vector creation, for the AMA Guides, work comp isn’t the first thing that necessarily comes to mind. But it is something that is absolutely crucial in RateFast. Could you describe these things and how they work, John?

Dr. John Alchemy: Yeah, so, you know, data scoring is something that we’ve really been working on for the last couple of years. And you know, making sure that the way we process and intake data from an impairment report is consistent from report to report. And I’m going to take just a little sidebar here and step out and say, I think eventually what needs to happen in the space of impairment rating is that it needs to be brought into a digital environment, like we’re building as opposed to letting people just make up ratings off the cuff. And with varying levels of understanding, I’ve talked about this multiple times, the qualified medical evaluator in California has absolutely no testing to prove that they have any competency and impairment rating.

Yet, for some reason, the marketplace seems to think that you know, QMEs do better ratings in the PTPs. But, you know, not necessarily the case at all. And it’s just one of these big myths that have been propagated, you know, along with the system that, you know, has said, oh, well, we think, you know, for some reason, the QME has a magical better understanding of impairment rating than the primary treaters. But I mean, if you pull the curtain back, there isn’t one question. On the, you know, that the QME test about how to do an impairment rating, it doesn’t even ask you the color of the textbook.

Cory: Yeah. I’ve been reading edition six this whole time, I just figured I should buy the new one when it came out. That’s to those who don’t know, who are listening. That’s because California still uses the AMA Guides, fifth edition, where the sixth edition is currently out and used by other states. And as I’ve learned throughout the course of working with RateFast, people feel all kinds of ways about the new and the old editions and whether or not to use it at all. Different states don’t. Not all states, some states use old, you know, going back to the third edition states use versions of the AMA guide. So um, yeah, so there’s that. So what are the rating implications of brief, fast digital analytics? And, you know, the way that we use it advantageously?

Dr. John Alchemy: Well, I think one of the big benefits is, if you were, if I were to spread out, you know, three reports on the table from three different doctors. And I’m not gonna say that they were a QME or a PTP, let’s just say it was three impairment reports from three evaluators in the work comp system. You know, one report might say this patient has a 5 out of 10 pain 25% of the time, and can’t perform 7 of the ADLs on table one, dash two, okay. The next one might say, this patient has moderate pain and can’t perform most of their activities of daily living. That’s all you get in that one. And the third one might literally say this person and has back pain. Okay?

And that is the big issue here, when you’re looking at a series of reports, because if you have a system that can take these descriptions at varying levels, and put them all at the same vector, if you will, or measurable value for a pain, a frequency and an ADL, that’s really what this is all about. Because, you know, and I’ve seen reports from a QME that basically says the patient still has shoulder pain, that’s it, and the patient is working, modified duty. That’s the history, there’s nothing more than that. And this is a quote unquote, QME report.

And, you know, and so when you’re given that you have to make some type of understanding or sense of that, in the framework, have a digital analytic system, and you can, and this is the reason why trying to just get another provider and another rating, and another provider in another rating does not work, you know, because the next rating could be better, but it could be worse. And all it’s doing is delaying cases, minimizing the accuracy and the consistency. And again, why because people are looking for a number, instead of really looking at the data and saying, what should this really, you know, rate at, you know, what should this score be?

And what is the basis in this report, because it’s, it’s interesting, because the, the DWC, you know, has their impairment, raters to my knowledge, they have no standard, you know, infrastructure on how to interpret when someone says their pain is minor, or moderate, or 7 out of 10, or a 2 out of 10. You know, all they really do in my experience, is they look at the report and make sure that the doctor used the right table. And sometimes that’s even a little dicey with them. Because, you know, you could rate someone in a neurological chapter, you could rate them in the upper extremity chapter, you could rate them in the spine chapter and all be considering, you know, ratings of a nerve.

So, to me, the DWC results that I’ve seen are very superficial and very concrete. And they don’t really understand or they don’t appear to understand or discuss huge discrepancies in the data sets that are there in the reports. So they’re supposed to be there to help. And I think that maybe that’s their intention. But again, it appears to me as an outsider, having read, you know, many of these DWC, you know, quote, unquote, evaluation reports that, you know, they’re very limited in their scope and their understanding. And, you know, that they asked for, you know, maybe clarification sometimes, but, I mean, if you look at the stuff they’re actually asking, I think it often misses the big picture and is, you know, just focusing in on what we think you should use this table. You know, it’s just not a great oversight. Again, this is my opinion.

Cory: Yeah, totally. I mean, what you know, you get any thing that you buy a say it’s like a, you know, an electronic of sorts, or something like that, it’s going to be quality controlled. And then in an industry that has, you know, billions of dollars moving through it, you don’t get any sort of degree of quality control even though the people who are essentially it is their job to do so often. Don’t do it. So that’s a that’s always very reassuring. I’ll make sure I get injured at work as soon as possible so that I can go through this system.

So yeah. Okay, so let’s say I have made the decision to make my life the life of my patient, the life of the adjuster, the life of the employer and the life of everybody else a lot easier by doing such things as going with RateFast Express to write the impairment reports, and I receive the RateFast impairment report, or you know, if I wanted to see it back, because we also have an option of just letting us have it and putting it out of your life. So if you’re listening and you’re waiting for that in your life, then just run right down rate-fast.com right now, however, if you do still look at the report, or you know, you’re using RateFast for one of our other services, where will you see the calculations that we’ve described here today in the report?

Dr. John Alchemy: Well, each body part when it’s calculated with RateFast, you’re gonna see an analytics report at the very bottom, at the bottom line where it says, you know, the WPI of this shoulder is, you know, you’re going to see right below that you’re going to see what the data integrity is. And you’re also going to see what’s called the overage report. So those are, those are two very key metrics that, that if you understand the value, you can at least say, okay, I know this report has a minimal value of data in it that I’m willing to accept. Maybe that’s a 51% data mark, maybe it’s 75. You know, maybe it’s, you know, 90, whatever the stakeholders agree upon, either independently, but at least they can say, look, this rating has, you know, this amount of integrity in it.

And then the other big key is, they can look at the report, and very quickly see, how close is this report to spilling over into an Almaraz Guzman report, and I’m not aware of any reports that do this on a standardized objective level, like I said, it’s usually just goes to, you know, the provider saying, oh, in my medical opinion, the rating I provided in the four corners, does not rise to the Almarez Guzman requirement, and therefore we’re going to use this, you know, that’s basically the best you get. But when you’re doing a RateFast report, and if there is an overage or if the impairment load has exceeded the four corners rating, and remember that four corners rating is dependent on two things, the accuracy, and the amount of data that was actually collected for the report, we’re going to tell you exactly how much you’ve crossed the line, this rating has exceeded the four corners by 22%, 16%, 5%, 90%. You know, and so you at least know what you’re paying for.

And you know, that hey, look, this report, you know, shorted me 50% of the data set. And as a result, based on the patient’s functional loss, I know that you know, the individual has coming do a WPI of 17%. Okay, and that’s a very powerful thing to go into a settlement with, because no one else at the table is going to have that information as to 17%. The best you’re going to get is oh, it was the doctor’s, you know, medical opinion based on their experience, again, a total non starter from my standpoint. So you know, that is where you’re going to basically find the integrity. And you know, that borderline of crossing over into that, until now mysterious area of the Almarez Guzman ratings?

Cory:Absolutely. And as we’ve mentioned before, I mean, you know, it would be one thing, if somebody handed us a report, we wrote the most killer report that the insurance company had ever seen. But we turn that in from, you know, data that was, you know, the one set and say, you said this patient has back pain or something like that. That’s why we included the data integrity, kind of, you know, it’s not a good thing or a bad thing. It’s exactly it’s it’s a reflection of what was given to us. I mean, I guess being one of the very few, I guess, what have you implements of that disproved the garbage in garbage out thing, just because we’re very good at turning a trans mutating garbage into gold, if you will, you know, we couldn’t let it end there. We have to let people know, the human element. And if there is garbage going in, because it’s just important for the claim. In general, it’s important for all stakeholders.

Dr. John Alchemy: Yeah, and you know, and I mean, you have what you have, exactly, on the paper in front of you. And like I said, you can roll the dice, and you can spend 1000s of dollars on chasing that next impairment rating from the quote unquote, expert, and hoping that you’re going to get a number that you like, if that’s the way that you handle your impairment and claim settlement pricing, which is a big way that it’s handled right now. You think, oh, shoulder shouldn’t be more than 7. Because, you know, I’ve never settled a shoulder on more than 7% therefore, it cannot exist. You know?

Cory: Why have you never done a shoulder over 7%? Well, it’s because I’ve never done a shoulder. So, you know, there’s no logic to it.

Dr. John Alchemy: There’s a lot of circular reasoning that goes with it. But, you know, in closing the podcast, I would say how many of the listeners do their own tax returns and I would be willing to guess that probably less than 5% people sit down and you know, do their own taxes every year. No, you hand it over to someone who knows what they’re doing. And someone who understands and has the tools to write an accurate tax return for you. Because you don’t want to be getting audited and you want someone responsible if you do get a kickback, who understands what the question is, and more importantly, what the answer is, for whoever is asking the question, and that’s probably the greatest value of RateFast to our clients, is we give you that understanding and we’re able to answer those questions for you. So you don’t have to claim that oh, yeah, I know exactly what’s going on. Because you may not but it’s unreasonable to expect that the doctors and the providers can understand the AMA Guides to a granular level it’s just not a realistic expectation. So RateFast is out to change that.

Cory: Absolutely. For more information on why doctors don’t have the time to do this and why reports are written the way they are, to elaborate on the things we’ve said, check out any of our back episodes where we go into granular detail ourselves on these little things and why they happen. So that does it for our show today, John. Any closing words on RateFast analytics or the greater work comp field at large?

Dr. John Alchemy: Well I’m going to make it really short this time around and all I’m going to say is: stop guessing and use impairment ratings with RateFast.

Cory: Stop guessing!

For more information on RateFast analytics, visit our blog at blog.rate-fast.com and get your California permanent stationary reports for free at blog.rate-fast.com.

Factors to Consider Regarding the Future of California Workers’ Compensation

Dear reader, look into our crystal ball. It shows you the future of California workers’ compensation. All who gaze into it see something different. Some see a workers comp system running with the clarity and ease of a mountain stream. Others simply scream and run away.

In this post we will examine workers’ compensation as it is today, and see if we can use this insight to make a few educated guesses of what the future holds.

Continue reading Factors to Consider Regarding the Future of California Workers’ Compensation