Impairment Ratings and Reports

From a medical point of view, impairment is essentially, a loss of function. From the legal view, when it is the result of an injury, it is a loss that must be compensated. How to compensate someone for a loss of function due to an injury has been a subject of contention for decades, with major arguments being centered on the actual value of any particular loss.

In attempting to resolve these arguments, the AMA has spent millions of dollars studying, documenting and objectifying various aspects of different losses of function, or impairments, and how they detract from the overall function of a hypothetical “whole person”; i.e., a person who has no discernable impairment. The result of their efforts is The AMA Guides to the Evaluation of Permanent Impairment (aka - the Guides). It not only instructs the reader in how to clinically evaluate the loss, but, also, in how to calculate the loss as a percentage of impairment from the 100% whole person. It is only one system of evaluating, or “rating” impairment, but it is the system that has been mandated by more state legislatures, including California’s, as the basis for rating impairments within their worker’s compensation programs than any other. In addition to legislated mandates by the States, most Liability Insurance companies are now using automated claims adjustment programs that place a Guides compliant Permanent Impairment rating as one of the highest factors in determining a claim’s value.

For these reasons, we have endeavored to create a system of gathering data from images (primarily X-rays and MRIs) and converting that data, based on the parameters of The Guides, into the most compliant and accurate impairment reports that can be produced. Our primary focus, presently, is on spinal impairment, but similar processes can be applied to extremities, and efforts are being made to make those reports available in the near future.

The AiM Report

AiM stands for Anatomical Impairment Measurements.  The Guides describe the process of gathering the necessary information required to produce a ratable report in extensive detail.  Basically, there are two main aspects of impairment analysis, clinical and anatomical.  The clinical exam is relatively routine, involving sensory and motor exams that most physicians perform on a regular basis.  However, The Guides also call for anatomical assessments which include the very tedious process of drawing lines on X-rays and MRIs, measuring angles in both directions, subtracting one angle from another, and comparing to tables in The Guides to find numbers that must be compared to other tables.  It is no surprise that most doctors simply ignore the anatomical assessments, because it takes too much time and effort.  The problem with not doing these assessments is that, without that information, the ratings are incomplete, which means that the patient is not being compensated fully for their impairment, according to The Guides.  We have created proprietary systems that complete these anatomical analyses for you, translating the results into an easy to read AIM Report that identifies the abnormalities.  The AiM Report describes exactly what effect each abnormal finding has on the impairment rating, so that a Guides compliant, accurate and complete report is obtained, allowing the best and most objective rating possible.

The CLA-AiM Report (CLinical Analysis + AiM)

No one likes writing essays, least of all doctors.  To help relieve the doctors of this burden, we have developed a carefully laid out, check-box form that the doctor can use to perform the clinical exam portion of the impairment rating process, normally done when the patient has reached the end of active treatment.  It’s the same exit exam they would normally do for this purpose, and many doctors have expressed their thanks for putting the process into a logical and efficient flow.  But our forms have been structured specifically to accomplish two major goals:  1) To carefully follow the process laid out by The Guides, citing page numbers and paragraph references throughout, 2) To place the data in a retrievable format that makes it possible to assimilate the data with the information from the AiM Report, allowing us to do the proper combining of values and produce the Whole Person Impairment due to spinal injuries.

The Formal Pain Evaluation

If the patient has reached MMI (Maximum Medical Improvement) and still suffers from pain that is severe enough to interfere with their normal activities, you may want to consider our Pain Assessment Package.  The process outlined in The Guides for estimating impairment due to pain is a daunting one, and most doctors’ reports, if they attempt it at all, do not comply with the required standards.  We have, again, created simple, multiple choice forms that simplify the decision-making process, which include self-assessment forms for the patient to fill out, in both English and Spanish.   When completed, our doctors review the data and produce a completely Guides compliant Formal Pain Evaluation Report and Whole Person Impairment rating due to pain.

The FAIR Report (Final Analysis & Impairment Rating)

CLA-AiM + Pain + Loss of Enjoyment of Life + Duties Under Duress

This is a summary of the CLA-AiM and Pain reports, along with a patient-based description of loss of enjoyment of life and duties under duress, due to their impairment. This report may be incorporated by the parties involved in the final demand letter in personal injury cases.