Academy of Chiropractic’s Lawyers PI Program

Narratives #59

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

”Impairment Rating Reporting Update”


In the conclusion of the narrative that must be placed in the beginning of the narrative, you MUST add an impairment rating in spite of lawyers claiming they don’t need them. It is your job to explain that the impairment rating is 25% of the settlement offer in the “Colossus” environment and then detail as explained in the “magic language” how many legal practices are upside down in preparing for trial on every case when 99% of them are settled. 

Therefore, the lawyers need to prepare for settlement first while concurrently handling the trial needs. You cannot handle trial needs first and concurrently handle settlement requirements in the second position as the carriers have positioned the settlements to suffer as a result. this is evidenced by the ever decreasing settlement offers lawyers have been getting over the last decade.

If… your patient has suffered from a traumatic event involving the spine and there is a loss of range of motion and pain, then x-ray digitizing should be considered to ascertain if there is a loss of motion segment integrity, or ligamentous laxity. This will change your diagnosis, prognosis and treatment plan while concurrently render a 25%-28% whole person impairment. 

In the absence of digitizing you could add the impairments based upon your other clinical findings from simple strain/sprain (don’t yell at me, but they do occur although abused as well chronicled in these writings) to radiculopathy to herniated discs. 

OR… you can have both and then you need to use the combining charts at the end of the Guides. As a result, EVERYONE needs to buy the AMA Guides to the Evaluation of Permanent Impairment both 5th and 6th editions. The 5thbecause if you have an outside doctor (which is strongly recommended) digitize your patients, then this doctor cannot personally evaluate your patient and you are relegated to the 5th edition. To date, not one court to my knowledge has discounted the 5th edition findings in the nation.

It is also strongly suggested (as brought to my attention from Josh Johnston in Denver) that you add both the page number(s) and graphs that were used in the Guides to conclude the impairment rating. It adds credibility to the value and removes any subjectivity. That is the goal in the medical-legal environment to making everything demonstrative and bulletproof when cross examined based upon definitive clinical findings. X-Ray digitizing is just that, conclusive that can have minimal arguments to overturn the mensuration findings of the computer. 

Suggested narrative language could be as follows: 


Impairment Rating

Whole Body Impairment Rating: This has to be taught to lawyers in all states to understand the significance of whole person impairment, when clinically present.

Based upon the finding of laxity of ligament as described herein and using the guidelines of the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition on pages 379-393, graph (lumbar) 15-3b (and/or)(cervical) 15-3c the patient qualifies for 25% whole person impairment based upon the DRE Category IV: Alteration of Motion Segment Integrity.

And/or use this if there is no ligamentous laxity or this needs to be combined with ligamentous laxity. 

Following the Diagnosis Related Estimates (DRE) protocols of the AMA Guides to the Evaluation of Permanent Impairment, 5th EditionMr. Old McDonald qualifies for ?% whole person impairment.  This impairment is based on DRE Category II for the body part injuredas described in Table---, page ---, as the patient has history and examination findings compatible with the injuries sustained in the motor vehicle crash on 08/14/15, and after a reasonable course of care has concluded.