Refer A Rating

OPTIONS FOR
REFERRING A RATING

You can either complete the fields below or download a referral form and submit to: ratings@bradfordbarthel.com.

Alternatively, you can use US Mail or fax:
Bradford & Barthel AMA Analysis & Rating Service
2518 River Plaza Drive
Sacramento, CA 95833
(916) 973-1592 fax

B&B AMA Analysis & Rating Department
AMA Analysis & Rating Referral Form - General
SIBTF Referrals Only - Click Here

SIBTF Referrals Only - Click here

Phone
This field is for validation purposes and should be left unchanged.
Referred By:
Billing Information
Company/Firm*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Rating Requested For*
Email*
Phone*
Injured Worker Information
Worker's Name*
Claim Number*
Occupation/Group Number*
Employer's Name*
Birth Date*
MM slash DD slash YYYY
Injury Date*
MM slash DD slash YYYY
Age at DOI
Return Rating Via*
- e-mail
- Fax Number
Fax Number*
Options*
- Option 1
  RATING ONLY: Rating based on the doctor’s WPI assessments.
  Apportionment applied. Corrections applied consistent with DEU practices: errors reading values from Figures and Tables in the Guides; math errors; combining errors.
  - 1 rating string, up to 20 pages = $125
  - 2 or more rating strings, and/or more than 20 pages to review = $350/hour
- Option 2 - $350/hour
  RATING WITH ANNOTATION: Rating based on the doctor’s WPI assessments.
  Corrections applied consistent with DEU practice: errors reading values from Figures and Tables in the Guides; math errors; combining errors. Apportionment applied.
  ANNOTATION: a brief discussion of potential issues with the doctor’s assessment of WPI, based on our review of documented clinical findings from the doctor’s report. This Annotation service reports potential areas of WPI inflation (or potential understatement of WPI) without the time and expense of a full analysis.
  (e.g. “the documentation in the report does not appear to support the use of the ROM Method for the lumbar spine”; “the use of Gait Derangement for the knee would not apply if the instructions on page 529 of the Guides are followed”.
  ONE set of ratings strings will be provided based on the doctor's recommendations consistent with DEU practices.
- Option 3 - $350/hour
  FULL ANALYSIS: Review of doctors’ reports, DEU Ratings, Deposition preparation, Almaraz/Guzman Analysis, etc. Full, in-depth analysis of reporting; critical review of the Guides instructions and the doctor’s report documentation.
  Detailed review and discussion of each impairment assessment offered by the doctor. Medical report supporting documentation of clinical findings correlated with instructions, Figures, and Tables in the Guides; applicable instructions from the Guides referenced.
  TWO Sets of Ratings Provided: 1) based on the doctor’s recommendations; 2) our recommendations based on our critical review.
- Option 4 - $350/hour
  Lifetime Benefits Projections (COLA) or Commutations
  Specify in 'special notes' below
  Unless otherwise specified, rater will provide effective date of commutation as 30 days from ratings analysis.
AWE/TTD:*
PD%:*
Date PD Begins:*
Applicant’s Gender (for life expectancy):*
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Prior rating done?
- Yes
Rush Service (1-2 business days) add 50% to fee
- Yes
Priority Service (3 business days) add 25% to fee
- Yes
When is return needed:
Additional Information
Additional Document Upload (job description, medical reports from the doctor in question, ratings from DEU/claims/AA, physical examination report, etc.)
Drop files here or

Max. file size: 50 MB, Max. files: 10.
Consent*
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PO Box 348450
Sacramento, California 95834
(916) 569-0790
contactus@bradfordbarthel.com

Refer A Rating

OPTIONS FOR REFERRING A RATING

SIBTF Referrals Only - Click here

Billing Information

Injured Worker Information

Section Break

OPTIONS FOR
REFERRING A RATING