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Name of Requestor:
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Email Address:
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Carrier / Adjust. Agency:
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Direct Voice Number:
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Fax Number:
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Billing Email Address:
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Rating Services
Basic Rating
($75 -95) BR
Comprehensive Rating
($115-225+) CR
Report Consistency Analysis
($145 -225+) RA
DEU / Private Rating Review
($145-225+) RR
Almaraz/Guzman Analysis
($225+) AG
Impairment-As-Reported Rating
($75-95) IR
AMA Impairment Analysis -
Texas, Nevada & Utah ($95-195) IA
Optional Rush Services
Regular Turnaround RT
Same Day ($75) SD
1 Business Day ($50) 1
2 Business Days ($40) 2
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Required Service Level:
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Rush Service: SD, 1 or 2
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PDF of Word Format:
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05PDRS or 97PDRS
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Employee Name:
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Claim Number:
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SS # (Last 4 Numbers):
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Employer:
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Occupation:
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Date of Injury:
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Date of Birth:
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Injuries To:
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PTP / QME / AME
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1. Please Print a Copy of request for your records
2. Fax Medical Report to (415) 276-3741
3. Or send Medical Report as Email Attachment to pdrating@pacbell.net
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Basic Rating: Disability Formulas based on the Evaluating Physician’s Reported Impairment
calculations with adjustments under either the 2005PDRS or 97PDRS. Mathematical
Corrections Only. No Tables, Charts or Compliance Comments.
If Medical Report does not comply with AMA criteria or 2005 PDRS, we will provide a
Comprehensive Rating Analysis. One body part / One Medical Report $75 -95
(For Three or more regions / multiple reports $125-175)
Comprehensive Rating Analysis: Verifies impairment ratings comply with AMA criteria & 2005
PDRS. Corrects misapplications of the AMA Guides Rating Criteria and Corrects
miscalculations of Whole Person Impairment. Specifies information needed to be obtained
from evaluating physician to address misapplications. $115-225+ Rating Example
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Report Consistency or DEU / Private Rating Analysis: Addresses deficiencies & inconsistencies
to established procedures: AMA Guides, 97PDRS / 05PDRS, California & WCAB Guidelines.
Findings are checked with the Guides criteria to determine the proper calculation of impairment
and disability - Comparative & Recommended Formulas included. $145-225+
Almaraz/Guzman Impairment Analysis: Provides disability Formulas for both the correct AMA
Guides Rating and the alternative impairment ratings under Almaraz-Guzman. Considers
Duplication among all Impairments within the multiple evaluations for different body organs /
systems. Addresses deficiencies & inconsistencies of the report, the correct rating under the
AMA Guides or the alternative rating to the AMA 5th Edition. $225+
Impairment-As-Reported Rating: Request this rating service when a rating of impairment as
reported in the medical report is needed, but no analysis is required. A rating as reported will be
given with only corrections to mathematical miscalculations of impairment. Formulas abide to
05/97PDRS rating, modifiers & combination guidelines. $75-95
(For 3 or More Regions / Multiple Reports: $125-175+)
AMA Impairment Analysis for Texas, Nevada & Utah: Reported findings are checked with the
appropriate Guides’ Edition rating criteria to determine that proper calculation of impairment has
been made. Includes corrections of WPI miscalculations & misapplications of Guides Rating
Criteria. Also includes annotated corrections and easy-to-follow formulation tables that indicate
proper medical findings for the given WPI present at MMI. $95- 195
AMA Impairment Analysis (Other States)
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