Posted on by

Answers to Your Most Pressing Questions About Impairment Ratings

Thank You for Attending the Webinar

“Answers to Your Most Pressing Questions About Impairment Ratings”

We sincerely thank you for participating in our recent webinar. We hope it provided valuable insights and practical guidance on navigating impairment ratings in clinical and medicolegal practice.

Questions or Inquiries

Should you have any follow-up questions about the topics discussed or wish to learn more about our services, please contact us at:
📧 support@cbrigham.com

If you want to meet virtually with Chris Brigham, MD, please click here.

We Value Your Feedback

Your input is important to us. Please take a moment to share your thoughts by completing our brief feedback form:
👉 Click here to provide feedback

Webinar Recording

Click here to view the recording – Part One.

Share and Train Your Team

We encourage you to share this page with your colleagues. If you are interested in hosting customized training for your organization, please reach out to us at support@cbrigham.com.

Upcoming: Part Two of the Webinar Series

Join us for the continuation of our series:

🗓 Tuesday, July 9 at 1:00 PM ET
🔗 Click here to register

Timely registration is required to attend.

Downloadable Resources

Access these PDF documents discussed during the webinar:

Additional Educational Resources

ImpairmentCheck 

Report Screening Tool

AMA Guides Training

Advance your skills with the most cost-effective, expert-led training:

🗓 Free 1-day access from June 25 at 3:00 PM ET through June 26 at 3:00 PM ET

🎟 Use coupon code SPECIALOFFERJUNE for a 20% discount for AMA Guides – Mastery Training Courses by clicking at AMAGuides.com (valid through July 1).

Explore More Resources

We invite you to visit our affiliated platforms for additional tools and expert content:

Expert Case Reviews and Support

We are pleased to offer expert opinions on impairment evaluations and other complex medicolegal matters. Referrals can be initiated at:
🔗 www.cbrigham.com/referral

Thanks for joining us. Please let us know how we can assist you.

Webinar Summary Document

 Answers to Your Most Pressing Questions About Impairment Ratings – Part One
Presenter: Chris Brigham, MD
Date: Part One – June 2025 | Part Two – July 9, 2025

Welcome and Purpose

Dr. Chris Brigham opened the webinar with a warm welcome, expressing enthusiasm for the topic and for connecting with participants. He emphasized the goal: to provide a rich, educational experience focused on enhancing the accuracy and credibility of impairment ratings.

Dr. Brigham has been involved with the AMA Guides for over three decades and brings extensive expertise in impairment evaluation, having served in multiple editorial and leadership roles.

Objectives

The primary aims of the webinar were to:

  • Understand the implications of inaccurate impairment ratings
  • Identify and avoid common rating errors and red flags
  • Use structured tools and checklists to critique impairment reports
  • Apply AMA Guides correctly across editions
  • Explore how AI and other tools can improve rating accuracy

Webinar Structure

Given the volume of content, the webinar was divided into two parts:

  • Part One (June): Focused on foundational knowledge, common rating errors, and red flags
  • Part Two (July 9): Will explore best practices for evaluating reports, leveraging AI tools, and more in-depth case reviews

Case Example Introduction

An illustrative case was introduced: a 63-year-old male with a severe crush injury to the middle finger. The treating physician assigned a 15% whole person impairment rating—higher than the rating for full amputation of the finger. This case highlighted critical evaluation questions:

  • Was the rating justified?
  • Was methodology consistent with the AMA Guides?
  • Were irrelevant findings inappropriately included?

Key Concepts Clarified

  • Pain: A subjective experience; not the same as impairment
  • Impairment: Objective, measurable loss of function
  • Disability: Functional limitation relative to life and work demands

Dr. Brigham emphasized that someone can be impaired without being disabled and vice versa.

Why Inaccuracies Occur

Impairment ratings are frequently inaccurate—often in 40–60% of cases. Contributing factors include:

  • Lack of physician training
  • Treating physician bias
  • Misuse of rating methods (especially in the 5th Edition)
  • Causation errors
  • Inadequate clinical assessment

Dr. Brigham highlighted the importance of independent, well-trained evaluators and the value of standardized protocols.

The 21 Red Flags in Impairment Ratings

A detailed checklist of 21 red flags was reviewed, with explanations for each. Highlights include:

  • Rating by a biased or unqualified evaluator
  • Use of outdated or non-standardized editions
  • Inadequate documentation
  • Improper use of range of motion or strength testing
  • Over-reliance on software without clinical judgment
  • Use of vague or incorrect terminology
  • Mathematical or methodological errors

Participants were encouraged to use the downloadable red flags checklist as a practical tool.

Critiquing Reports: A Structured Approach

Previewing content for Part Two, Dr. Brigham shared a structured method for evaluating reports, including:

  • Evaluator qualifications and potential biases
  • Completeness and professionalism of documentation
  • Consistency between history, examination, and findings
  • Use of AI-based tools for pre-review and critique

The goal: to ensure accurate, fair, and legally defensible impairment ratings.

Tools and Resources Provided

Attendees were given access to several valuable tools:

  • ImpairmentCheck: For validating expected ratings by diagnosis and body part
  • Report Screening Tool: AI-assisted critique of submitted reports
  • AMA Guides Mastery Training: Free 1-day access (June 25–26)
  • Red Flags Checklist: Downloadable guide to common rating issues
  • Guides Critique Checklist: Structured evaluation form

Websites shared:

Looking Ahead: July 9, 2025 – Part Two

In the next session, Dr. Brigham will explore:

  • Deeper application of the critique checklist
  • Live case reviews
  • AI applications in impairment assessment
  • Report formatting and expert review strategies
  • Legal implications and how to challenge flawed reports

Participants must register separately for Part Two.

Final Thoughts

Dr. Brigham concluded by encouraging participants to:

  • Provide feedback via the post-webinar survey
  • Download and utilize all shared resources
  • Engage in continuing education to improve rating accuracy
  • Share the webinar and tools with colleagues

Contact: For inquiries, training requests, or report critiques:
📧 support@cbrigham.com

Thank you for participating. We look forward to seeing you on July 9!

Transcript Summary

Note this is not the full transcript.

It’s truly a pleasure to be with all of you today. My goal is to make this an exceptional experience. And yes, I even thought of starting with music composed specifically around impairment ratings—perhaps a first!

I’m Chris Brigham, MD, and I’ve been deeply involved with the AMA Guides since the 1990s. Over the decades, I’ve contributed as editor, author, and educator, and I bring that perspective to our session today. I also want this to be as interactive as a webinar allows—please share your questions and insights in the chat or notes.

To start, I’d like you to take 15 seconds and type in what you want to achieve from this session. Go ahead—do it now.

Let me explain what we’re going to cover today and why this topic matters. We originally planned to review ten red flags in impairment ratings, but as we developed the material, we identified twenty-one. To do justice to the content, this is now a two-part series. Today we’ll explore foundational topics and introduce red flags. On July 9, we’ll dig deeper into applying checklists, reviewing reports, and leveraging AI.

Let me give you a case to keep in mind. A 63-year-old man sustained a severe crush injury to his left middle finger—comminuted and displaced fractures, tendon damage, two surgeries, and lasting functional limitations. He also had diabetes. The treating physician rated the impairment at 15% whole person—more than an amputation of the entire finger. He based it on reduced motion in all fingers and grip strength. Was that accurate? We’ll revisit this example.

Why are we here today? Because many of you review impairment ratings—as claims professionals, attorneys, auditors, or healthcare providers. Our mission is to ensure impairment ratings are fair, accurate, and evidence-based. That means preventing both under- and over-evaluation, which have serious consequences.

We’ve provided a set of resources via the shared link. Please download the slides, the red flags checklist, and the report critique tool. If you’re on a dual monitor setup, open them now. We’ll also review tools like ImpairmentCheck, Report Screening, and AMA Guides training—including a free 24-hour access window starting today.

Let’s clarify some concepts:

  • Pain is subjective.
  • Impairment is objective, determined using the AMA Guides.
  • Disability is about what one can or cannot do functionally.

I often share this example: years ago, I was hit by a car while biking from Savannah to Titusville. I ended up with multiple spinal fractures and a 40% whole person impairment—but I wasn’t disabled. A year later, I completed the ride. Impairment ≠ disability.

Let’s talk about how often impairment ratings are inaccurate. I asked attendees to estimate: 40%, 50%, even 60%. That aligns with my experience. It varies by jurisdiction. In California, error rates are high. In Hawaii, where I practiced for 13 years, they were low—around 10%. But most ratings are too high, not low, often due to methodological errors.

Why does this happen? Key reasons include:

  • Lack of physician training
  • Bias (especially from treating physicians)
  • Misuse of the Guides, especially the 5th Edition
  • Use of range of motion when not reproducible
  • Combining multiple unrelated diagnoses

It’s crucial to use the correct edition of the Guides. The most current is the 2024 version of the Sixth Edition, available on the AMA Guides Digital platform.

We reviewed 21 red flags in impairment ratings. These include:

  • Reports by biased or unqualified physicians
  • Using vague or incorrect terminology
  • Inadequate documentation
  • Mathematical errors
  • Unvalidated rating methods
  • Improper application of the Guides

We also emphasized evaluating the evaluator:

  • Are they trained or certified?
  • Are they practicing within their scope?
  • Is the report professional and well-structured?
  • Is there objective and reproducible data?

A particularly helpful tool is the Red Flags Checklist, which outlines each red flag, why it matters, and what action to take. Feel free to share this widely—it’s intended to improve practices across the board.

We previewed what’s coming in Part Two on July 9:

  • Detailed report review using a structured checklist
  • Application of AI tools to critique reports
  • Case studies and examples
  • Legal and procedural considerations for challenging flawed reports

We’ve also developed AI-supported tools, including hybrid reviews combining machine and expert analysis. Early results are promising—pulling out red flags, inconsistencies, and providing critique summaries.

In closing, please provide your feedback using the link provided. Review the tools, explore the AMA Guides Mastery platform (with free access for 24 hours), and try out ImpairmentCheck and Report Screening.

Questions? You can contact us at support@cbrigham.com. And don’t forget to register separately for Part Two on July 9.

Thank you for joining us today. I’m speaking from our home in Maine—and if I were still in Hawaii, I’d end with “mahalo.”