ORLANDO, FLA

More than 75 percent of workers' compensation physicalimpairment ratings are incorrect because doctors “are not heldaccountable,” an expert told an industry conference here.

That comment came from Dr. Christopher Brigham, seniorcontributing editor of the “AMA Guides to the Evaluation ofPermanent Impairment, Sixth Edition,” speaking at the NationalCouncil on Compensation Insurance Annual Issues Symposium.

Dr. Brigham is the chairman of Impairment Resources LLC, whichrecently allied with health insurer Coventry to offer tools forinjury impairment ratings.

According to Dr. Brigham's data, the vast majority of cases seeinjuries rated with a higher degree of disability than they deserveand the overall error rate for the states is 76 percent. Amongthose, he said, California has an error rate of 83 percent.

The average difference from a correct rating in California, hesaid, amounts to a cost of $1,325 or 13.5 percent.

According to the doctor, impairment ratings account for 20percent of total workers' comp benefit costs.

Most ratings are incorrect, he said, because grading impairmentis a tedious process that most physicians have not studied and areill equipped to perform.

He noted, however, that in Hawaii most impairment ratings havebeen found to be accurate, in part because physicians who make themqualify through a certification process.

One factor that increases disability ratings, he observed, isthat treating physicians must be advocates for their patients–abias that contributes to inflating costs.

Diagnoses that involve more subjective judgment are also morelikely to result in errors, Dr. Brigham said.

He said critics of the latest American Medical Association guidewho score changes for certain injuries fail to take into accountadvances in treatment and that “certain stakeholders” in the compsystem resist science and data.

A survey of reaction to the new AMA Guide and whether it is animprovement, he said, found 100 percent of chiropractors disagreedthat it is an improvement, most lawyers strongly disagreed, andmost doctors agreed it was an improvement.

In the comp impairment area, the doctor said he sees manyphysicians who are “self-fulfilling prophets of doom and attorneyswho use their clients as pawns.”

He urged his audience to focus on creating a positive attitudetoward worker injury impairment to “change the future in theworkers' compensation field.”

Dr. Brigham added, “Needless impairing is occurring all toooften in the workers' compensation arena.” He called for a stand tobe made for a focus not on disabling but rather empowering injuredworkers.