Docs Give Faulty Injury Assessments, Inflating Comp Costs, Expert MD Says

ORLANDO, FLA

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

That comment came from Dr. Christopher Brigham, senior contributing editor of the “AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition,” speaking at the National Council on Compensation Insurance Annual Issues Symposium.

Dr. Brigham is the chairman of Impairment Resources LLC, which recently allied with health insurer Coventry to offer tools for injury impairment ratings.

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

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

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

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

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

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

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

He said critics of the latest American Medical Association guide who score changes for certain injuries fail to take into account advances in treatment and that “certain stakeholders” in the comp system resist science and data.

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

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

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

Dr. Brigham added, “Needless impairing is occurring all too often in the workers' compensation arena.” He called for a stand to be made for a focus not on disabling but rather empowering injured workers.