The Question: What Is the Right Impairment Rating Standard?
What is the best impairment rating that serves the needs of all stakeholders in the work comp ecosystem? It is well understood that at the time of maximum medical improvement an impairment rating is assigned. In some jurisdictions, the standard is the American Medical Association Guides the Evaluation of Permanent Impairment 6th Edition. However, other states have adopted earlier versions. In Texas, there is an active discussion about transitioning from the 4th edition to the 6th edition. The next question is why is this transition important?
Clearly, an accurate and comprehensive assessment of impairment is necessary to calculate additional financial exposure. To be clear, the impairment rating calculation has little to do with claimant duration and is solely a financial implication. Some of the discussion concerning the adoption of the most current edition is to apply the most recent evidence-based medicine standards in the determination of a reasonably presumed to be permanent impairment.
The Problem With the 4th Edition
Some of the problems with the earlier versions were that there was a wide variability in applying the impairment rating processes outlined in the 4th edition. Studies and real-world experience in states that have already adopted the 6th Edition show significantly higher inter-rater reliability and fewer challenges to ratings.
Even with the same set of medical facts, the interpretation was vastly different. In a number of situations there was a significant reliance on the judgment of the provider of the impairment as opposed to the more objective clinical findings established. Personal bias was a frequent issue in the assessment of impairment. These differences led to protracted hearings and adjudication processes and unnecessary expense to the overall claim situation.
Greater Objectivity and Defensibility
One of the more significant benefits in the utilization of the 6th edition is that the shift has transferred from range of motion data to more specific diagnosis with the adaptation of additional factors modifying the final impairment. The emphasis is on a diagnosis-based assessment of impairment. Moreover, there is a clearer link between the objective medical evidence developed during the course of treatment and the appropriate impairment class selection made. What does this mean for all parties to the claim? For the claim file handler, it means a more predictable impairment outcome and more consistent assessment. For the injured employee, it means a rating grounded in objective clinical findings rather than provider discretion.
Moreover, there is an increased reliance on more specific objective diagnostic evaluations, and less on the subjective complaints offered that do not have specific clinical support. The impairments that are derived from this version of the Guides are easier to explain, understand and if necessary, defend. This results in a decreased need for multiple examinations or impairment rating calculations.
The Learning Curve: Training and Adaptation
There will be a need for training on this newer version of the Guides and there are any number of solutions offered to those providers delivering these impairments. It is said that the half-life of a medical education is rapidly decreasing, the most recent statistic is that medical information doubles approximately every 90 days. Consequently, there is much that an impairment rating provider will need to keep current with, and appropriate impairment rating processes will be one of those needs. Providers of impairment ratings will have to learn more about current clinical processes and be responsible for the changes made to the impairment rating procedures and the more recent data supporting those changes. However, this is the nature of all things clinical, nothing ever stays the same.
The net result is that the impairment rating assigned is more about accuracy, fairness, and a reflection of the objective clinical data noted as a function of the compensable injury sustained. Every injured employee needs to have the best possible impairment rating based on the most current clinical information and is a function of competent, objective, and independently confirmable medical evidence.
