Guides / Reading med-legals
Guide · 5 min read

How to Read a Med-Legal Report Like a Rater

The five numbers in every P&S and med-legal report that become the money — WPI per part, apportionment, occupation, age, completeness — plus the red flags raters catch that everyone else misses.

A med-legal report is thirty pages of history and examination wrapped around five numbers. Raters read those five first and judge the rest by whether it supports them. Here is that reading order — the same one built into the reserve workflow.

The five numbers

1 · WPI per body part — and the AMA Guides table it came from. A bare percentage with no table citation is the report’s weakest joint. 2 · Apportionment — the §4663 split and, critically, the reasoning; “degeneration, 20%” without the how-and-why is vulnerable, and the apportionment guide shows what each point is worth. 3 · The job description — it selects the occupational variant, and a “light duties” description of a heavy job quietly moves thousands. 4 · Age at injury — trivial to verify, occasionally wrong. 5 · Completeness — every claimed part addressed, or expressly deferred.

The red flags

Ratings without tables. Apportionment without reasoning. Grip-loss ratings where the Guides don’t support them. Add-ons — pain over the 3% cap, or psych/sleep add-ons on a post-2013 physical injury where §4660.1(c) limits them. And internal inconsistency: a “moderate” history examined into a “minimal” impairment, or vice versa.

Then check the arithmetic

Everything after the five numbers is deterministic: the calculator turns them into the string, the percentage, and the dollars — and the decoder verifies any string already in the file, step by step against the schedule. Disagreements about the medicine go back through supplementals and depositions (the AME/QME machinery); disagreements about the math should not survive five minutes. Informational use only; not legal or medical advice.

FAQ

What should I look for in a med-legal report?
Five things set the money: WPI for each body part (with the AMA Guides tables used), apportionment percentages and their reasoning, the job description (it selects the occupational variant), age at injury, and whether every claimed part was actually addressed. Everything else is context.
What are the common red flags in med-legal reports?
WPI stated without the Guides table behind it; apportionment asserted without the “how and why” reasoning substantial evidence requires; a job description that doesn’t match the actual duties; claimed body parts that silently vanish; and add-ons (pain, sleep, psych) applied where the 2013+ rules limit them.
How do I check the rating math in a report?
Run the WPI, occupation, age, and apportionment through a rating calculator — the string, percentage, and dollars follow mechanically. If a rating string is already in the file, paste it into a decoder and verify every step against the schedule tables.
Who is this checklist for?
Everyone who touches the report: adjusters setting reserves, attorneys on both sides valuing the case, and injured workers checking their own number. The math is the one part of the report that has a single right answer.
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