Nothing like alphabet soup to start your day!

If you don’t see these acronyms in your demand letters then you are leaving a lot of money on the table.

For the legal profession opinions matter.  You present your side of a case and opposing council presents another.  Ultimately, the judge will render their” opinion”.  In healthcare opinions may lead us in the right direction but ultimately we need to know what is causing the problem.  We need proof and we need to document what we find.  Hence the alphabet soup.

So let’s look at these in reverse order.


Whole Person Impairment Rating is the one number you want in your demand letter.  It is of more value than the total cost of damages and is the one number the insurance company will have a tough time ignoring.  To determine the percentage of permanent impairment with a patient or when reviewing a case, I look for each finding and supporting tests to add up ratable diagnoses.

The AMA Guides, 5th and 6th editions give a value to each injury and the loss that comes with it.  Paresthesia, depending on the extent can be rated as high as 13%.  Loss of consciousness, even momentarily, can add to the total when factored in, as can many other findings that are left off the diagnosis list or demand letters.


Alteration Of Motion Segment Integrity is probably the most commonly missed finding that can add 25% to a Whole Person Impairment Rating.  We have long known that ligament damage is a major component of the injuries sustained in an acceleration/deceleration trauma.  The problem has been in documenting this.  A simple flexion/extension X-ray study can demonstrate excessive translation or angular motion.  If one vertebra moves anterior or posterior more than 20% relative to the one above or below there is excessive translation.  If the angular motion at the anterior or posterior longitudinal ligament exceeds 11° there is ligament laxity.


Computerized Radiographic Mensuration Analysis is probably one of the most valuable tools you can have in a personal injury case.  This is the one thing that will establish AOMSI which will in turn provide a 23-28% WPI.  If the patient simply complains of pain the WPI will be as low as 1-3%, and up to 8% with verified neurological findings.  With flexion/extension X-rays, measurements of translation and angular motion are far less reliable than measurements done with computerized analysis.  With a CRMA the measurements are precise and ratable findings are more common than you might think.

Add It Up!

Which would you rather send to the insurance company? A demand letter that says, “My client was injured in an accident.  Your client caused the accident.  Please send a check in any amount you choose.” –or- “My client was injured in an accident caused by your client.  My client has a 25% Whole Person Impairment rating per the AMA Guides.  What are the limits on the policy?”

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