ALBERT & MACKENZIE, LLP - RATING SERVICE REQUESTADJUSTER INFORMATIONCompany:Address:City/State/Zip:Name:Email:Phone:Fax Number:CASE INFORMATION Applicants Name:Claim Number:Occupation:Employer's Name:Birthdate:Date of Injury:Age at DOI:BASIC RATING - $149/flat feeThe basic service is recommended for those parties that are looking for a quick assessment of permanent disability exposure of a single medical-legal report. As part of the basic rating service, a report summarizing the following will be provided for your claim: A formal rating per the AMA guides, 5th edition, and permanent disability rating schedule, as applicable to the date of injury. An adjustment for the rating after apportionment identified by the evaluator. A limited annotation of any discrepancies with the report and AMA guides, 5th edition in the determination of impairment. The corresponding monetary value of any permanent disability, as applicable to the date of injury. COMPREHENSIVE RATING - $199/hourOur comprehensive service provides an in-depth assessment of medical legal or treating physician reports, to identify current and prospective exposure on claims, based on an evaluators diagnosis and findings. In addition to the basic service, we provide: A detailed explanation of an evaluators findings, actual and/or prospective ratings, and a supporting explanation based on the AMA guides, fifth edition, Identify any discrepancies involving ratings using an alternative section under the AMA guides, A legal assessment of whether the actual rating would be controlling at a hearing before the WCAB. Recommendations to combat any deficiencies in the report. RETURN RATING VIA:EmailFaxBILLING METHOD:E-Billing (provide info below)Paper Billing (provide info below)E-Billing Website Address:Paper Billing Mailing Address:Submit Rating RequestThis field should be left blank