case audit settlement enhancement

25% Valuation of the Injury Claim

The AMA has classified injuries, particularly those seen in auto accidents producing injuries to neck & back (Spine), into “Specific Disorders of the Spine” so that evaluators and adjudicators involved in injury claims could arrive at the same level of understanding and degree of impairment.

Specific Disorders Of The Spine Include:

Unfortunately, it is estimated that only 5% of providers tender a Whole Person Impairment Rating. This cause valuation of the medical injury component to be lost.

In a court ruling in the case Almaraz-Guzman II En Banc Decision, the physician is charged with providing a whole person impairment (WPI) rating utilizing any chapter, table, page or method in the AMA Guides that most accurately reflects the injured 's impairment. The opinion must be substantial evidence. (Almaraz-Guzman II En Banc Decision).

The Audit will assign the Whole Person Impairment rating which is responsible for 25% valuation of the entire medical claim.