Is incomplete data affecting the accuracy of your impairment rating?

This article is for medical providers, insurance adjusters, attorneys, and injured workers who want to understand common causes of inaccurate impairment ratings.

Correct impairment ratings save time and money for all stakeholders; they result in correct apportionment for subsequent claims, and allow predictable trends and costs for data analysis and work risk assessment. Of course, the inverse is also true: inaccurate impairment ratings cause claims to consume the time and resources of everybody involved.

One of the best things you can do to check the accuracy of an impairment rating is to make sure that you’re working with a complete data set. In other words, make sure that the provider—or whoever is doing the impairment rating—has all the necessary information.

A complete data set supports an accurate rating, which decreases the risk that the rating will be contested, which means a faster, easier workers compensation claim for all parties.

So why don’t all workers’ compensation claims have complete data? Here are three common circumstances that lead to incomplete data sets:

  1. Sometimes the required information is not obvious. This is especially common in cases involving the spine with patient symptoms such as radiculopathy.
  2. The importance of some data about the injury isn’t always clear to medical providers, so they don’t ask the necessary questions or take the necessary measurements. For example, if an employee has injured her left shoulder, then the provider might not ask detailed questions about the pre-existing history of the right shoulder. However, for upper extremity injuries, the history of the uninjured side of the body can actually affect the impairment rating of the injured body part.
  3. A stakeholder might omit data in order to intentionally increase or decrease the impairment rating. This is considered fraud by the state of California, which you can read more about here.

Let’s look at an example. A twenty-year-old old delivery driver has a back injury. When she reaches maximal medical improvement, a provider examines her. She is pain free and takes no medication, has no problems with her activities of daily living, and takes no medications. It seems as though her injury has not impacted the employee at all, and so the provider concludes that there are no ratable findings. The provider skips the medical history and assigns the patient a 0% whole person impairment. Is this correct?

No. The rating assessment was incomplete. If the provider had taken the full history, then they might have discovered that the patient had L3 dermatomal sensory loss directly after the injury, with imaging showing a concordant herniated disk at that level. Although there were no ratable findings at the time of the final exam, the AMA Guides 5th edition mandates a 5% whole person impairment because she had radiculopathy, even though it is now gone (Category II, Table 15-3, Page 384).

However, only providers who are intimately familiar with the AMA Guides will check for radiculopathy.

In summary, incomplete data are more common than you think. For this reason, we recommend using a tool such as RateFast to ensure that all the relevant questions are answered. Get your free account today.

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Submitting and Signing Your RateFast Report: Treating and Supervising Physicians

This post is intended for RateFast users who want to ensure the correct digital signature appears on their report.

So you’ve completed a workers’ compensation report in RateFast. It’s ready to be officially “submitted” or signed. But whose signature is going to appear on the report?

The answer: it depends on who submits the report.

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How to Update Your Credit Card in RateFast

This post is for RateFast users who want to update their credit card information on RateFast. This article assumes that you already have an account with RateFast. Last updated October 26th, 2016. 

If you get a new credit card or if your old credit card expires, you will need to re-enter your credit card into RateFast.

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How to create PR-4 reports in RateFast

This post is for RateFast users who want to use the RateFast web application to write a PR-4 report. This article assumes that your patient and their injury have already been created in your RateFast practice account. Last updated August 30th, 2016.

Do you want to use RateFast to write a perfect PR-4 report—complete with an accurate impairment rating? You’ve come to the right article. Here’s what you need to do to write a PR-4 report for your patient and help conclude their work injury claim.

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Gender Discrimination in Workers’ Compensation

A lawsuit filed in July of 2016 argues that female workers receive fewer benefits than males in the California workers’ compensation system. According to this USA Today article, the lawsuit makes a case that women are systematically prevented from receiving full benefits for two primary reasons:

  1. Some medical conditions, such as carpal tunnel syndrome, are allegedly more common among women.
  2. The consequences of some conditions, such as a mastectomy performed in order to treat breast cancer, are not seen as causing disability.

Although we don’t know the full details of the lawsuit, the news coverage about the case raise some important questions that everybody involved in workers’ compensation should understand.

In this article, we’re going to take a close look at how apportionment, functional loss, and gender can impact an injured worker’s disability rating and benefits.
Continue reading Gender Discrimination in Workers’ Compensation

How to update your organization address, phone, and other contact information in RateFast

RateFast Express is an even easier alternative to the wonderful RateFast software. Try RateFast Express today!

This article is for RateFast users who want to change the address, phone number, fax number, office locations, and billing information in their RateFast account. Last updated on July 25th, 2023.

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How to Download a RateFast Report in 5 Easy Steps (with images)

This article is for RateFast users who want to save a completed report from RateFast to their computer. Last updated on July 5th, 2016.

After you finish your RateFast report, you may want to save it to your computer so that you can easily access, print, or fax it. You can quickly access and download a particular report in RateFast by following the steps below.
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What does 0% WPI really mean?  

Whether you’re a medical provider, an injured worker, a claims adjuster, or an attorney, this article is relevant to you if you’ve encountered a 0% whole person impairment rating in a California PR-4 or QME report.

If you receive a report—or are writing a report—with 0% WPI (whole person impairment), this number should raise some flags.

Why?

Because, when it comes to the AMA Guides and impairment rating, a 0% WPI is a very special number.

If a report claims that a patient has 0% impairment, then it needs to meet some specific requirements. If it doesn’t meet those requirements, then the number is inaccurate—and as we all know, an inaccurate impairment rating can lead to unnecessary delay, litigation, and expense for all stakeholders.

[Photo credit: www.gotcredit.com]

Continue reading What does 0% WPI really mean?  

3 Critical Questions to Ask About your Qualified Medical Exam

This is article is meant for injured workers’, medical providers, qualified medical examiners (QMEs), insurance adjusters, and other stakeholders in a California workers’ compensation claim.

When a medical condition has reached Maximal Medical Improvement (MMI), the QME (Qualified Medical Examiner) is required to perform an impairment rating exam.

The impairment exam consists of a series of detailed questions and measurements defined by California law and the American Medical Association (AMA) Guides, 5th Edition.

An accurate and correct impairment exam leads to faster settlement and delivery of benefits, whereas an incorrect exam leads to delay, confusion, and or costly litigation.

As a stakeholder in the system, here are three simple questions you should ask in order to determine the accuracy of your orthopedic medical exam.

Continue reading 3 Critical Questions to Ask About your Qualified Medical Exam