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 and get the rate best workers compensation impairment rating service to try and

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