Medical Impairment Rating

A key component to the value of your case

The medical impairment rating is one of the most significant factors in determining the value of a Tennessee Work Comp Case. As such, it is crucial that the rating be correct. The Tennessee Workers Compensation Act requires the doctor to determine the rating pursuant to the applicable American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. There are several different editions of the AMA Guides and the correct version that must be used for a particular work injury depends on the date of the accident. Specifically, for injuries occurring before January 1, 2008 the 5th Edition of the AMA Guides should be used.  For injuries occurring after that date the 6th Edition of the AMA Guides is in effect.  This will remain in effect until the American Medical Association releases the next edition.   Unfortunately, the different Editions can provide drastically different ratings for the same injuries. As such, if a physician uses the incorrect Edition, it can cost an employee a significant amount of money on their work comp case.

It is also important to note that the Guidelines are just that... "guidelines". As such, doctors can have different opinions as to what is an appropriate impairment rating for the same injury. For example, our office has had cases where employees sustained significant injuries, such as broken bones and injuries requiring surgery, yet the treating Work Comp Doctor assessed a zero percent (0%) impairment rating. This 0% rating standing alone would have left the employee with absolutely no compensation for their permanent injury. Accordingly, when this has occurred or an impairment rating is deemed not to be in compliance with the AMA Guides, our office will often seek an opinion from an independent doctor as to the extent of impairment. It has truly made the difference in an employee receiving nominal compensation to an amount that will fairly compensate them for a permanent injury.

GETTING A SECOND OPINION AS TO YOUR IMPAIRMENT RATING

As set forth above, a second opinion on impairment can often make a drastic difference in your workers compensation case. However, it is not advised in every case.  When considering whether you should get a second opinion there are several factors to keep in mind.  To begin, the insurance company is usually not required to provide a second opinion doctor with regard to your impairment rating.  As such, if a second opinion is sought the cost of this expert will usually come out of final workers compensation settlement.   As such, you and your lawyer need to determine if the second opinion will likely increase the value of your case enough to offset any costs.  Generally, there is no black and white answer to this question but an experienced Tennessee Work Comp lawyer will have a good enough understanding of the guidelines to give a valuable opinion on this issue.  It is also important to know the impact of competing impairment ratings.  If the case goes to trial a judge will decide which rating is valid.  Realizing this the parties may simply leave it up to the judge or they may reach a compromise based upon some blending of the two ratings.  Additionally, when there are competing ratings either party can request the department of labor to appoint an independent doctor to give an opinion on the issue.  Once that occurs the independent doctor's opinion will be presumed correct.