Upper Extremities: Giving Credit Where Credit is Due

Upper Extremities: Giving Credit Where Credit is Due
by Donald R. Barthel, Esq.
Every week B&B's Rating and Consultation Services is requested to review and analyze MMI reports purporting to determine impairment for upper extremity injuries. Inasmuch as range of motion (ROM) is the primary AMA-based method used for upper extremities (see AMA Guides, p. 450-479), we see this methodology misapplied time and again. Invariably, the doctor has overestimated the true level of impairment.

Where do the doctors go wrong? Most physicians simply identify the injured joint, measure that joint's remaining ROM, and apply the applicable AMA chart(s) to obtain their final Whole Person Impairment (WPI) percentage. For example, in the case of an injured right shoulder, if the doctor measures 160° of shoulder flexion, he/she uses Figure 16-40 (page 476) to award 1% UE (which converts to 1% WPI).

The Audit Unit Is Made Up of People Too

The Audit Unit Is Made Up of People Too
by Sherri Dozier
Do I have your attention? Allow me to explain: The Audit Unit is made up of people with backgrounds not dissimilar from most experienced claims professionals. They are given a set of labor codes and case law, along with orders to go out and apply them.

Sounds similar to California's litigation system, doesn't it? One side views a law one way; the other side has a different perspective. The difference? The Audit Unit has authority to assess penalties based on its own legal interpretations, much like the IRS. This recognition can go a long way towards assisting you in handling a dreaded audit.

Bradford and Barthel, LLP is committed to servicing to each client. This was evidenced in a recent venture in which we aided a client to prepare and survive an audit. Much can be learned from that once-in-a-lifetime (hopefully!) experience.