Impairment Tutorial: Consistency in Measurement

Abstract The International Association of Industrial Accident Boards and Commissions (IAIABC) is an organization of medical directors, administrators, and administrative law judges for workers’ compensation systems. It was founded in 1914, and current membership represents 41 US states, the District of Columbia, Puerto Rico, 9 Canadian provinces, and 3 other governments in a forum for education and discussion regarding the various medical, legal, and administrative issues in workers’ compensation systems. In 2001, the IAIABC formed an Occupational Impairment Rating Guide Committee to study the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and to suggest revisions specific to workers’ compensation. The committee's goal is to create a supplement to the AMA Guides for jurisdictions to consider for adoption to clarify and/or to replace methodology in the AMA Guides to make impairment rating more uniform and consistent. The IAIABC Guides has been developed to address impairment of the musculoskeletal system and impairment due to chronic pain with the goal of minimizing or eliminating the need for multiple independent medical evaluations and “dueling doctor depositions.” There are no plans to write supplemental guides for impairment of other body systems, and AMA and IAIABC are engaged in active dialog during the development of the AMA Guides, Sixth Edition.

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Use of the AMA Guides in State Workers' Compensation Systems: 2009 Update

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.marapr02 ◽

2009 ◽

Vol 14 (2) ◽

pp. 13-16

Author(s):

Christopher R. Brigham ◽

Jenny Walker

Keyword(s):

New York ◽

North Carolina ◽

South Carolina ◽

South Dakota ◽

Rhode Island ◽

Workers Compensation ◽

Fourth Edition ◽

Sixth Edition ◽

Specific Guideline ◽

Compensation Systems

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides) is the most widely used basis for determining impairment and is used in state workers’ compensation systems, federal systems, automobile casualty, and personal injury, as well as by the majority of state workers’ compensation jurisdictions. Two tables summarize the edition of the AMA Guides used and provide information by state. The fifth edition (2000) is the most commonly used edition: California, Delaware, Georgia, Hawaii, Kentucky, New Hampshire, Idaho, Indiana, Iowa, Kentucky, Massachusetts, Nevada, North Dakota, Ohio, Vermont, and Washington. Eleven states use the sixth edition (2007): Alaska, Arizona, Louisiana, Mississippi, Montana, New Mexico, Oklahoma, Pennsylvania, Rhode Island, Tennessee, and Wyoming. Eight states still commonly make use of the fourth edition (1993): Alabama, Arkansas, Kansas, Maine, Maryland, South Dakota, Texas, and West Virginia. Two states use the Third Edition, Revised (1990): Colorado and Oregon. Connecticut does not stipulate which edition of the AMA Guides to use. Six states use their own state specific guidelines (Florida, Illinois, Minnesota, New York, North Carolina, and Wisconsin), and six states do not specify a specific guideline (Michigan, Missouri, Nebraska, New Jersey, South Carolina, and Virginia). Statutes may or may not specify which edition of the AMA Guides to use. Some states use their own guidelines for specific problems and use the Guides for other issues.

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State-by-State Use of AMA Guides

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2019.sepoct01 ◽

2019 ◽

Vol 24 (5) ◽

pp. 3-7, 16

Keyword(s):

Expert Testimony ◽

Narrow Range ◽

The United States ◽

Workers Compensation ◽

Federal Employees ◽

Permanent Disability ◽

Sixth Edition ◽

History Of ◽

Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

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International Use of the AMA Guides to the Evaluation of Permanent Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2011.mayjun01 ◽

2011 ◽

Vol 16 (3) ◽

pp. 1-5

Author(s):

Mohammed Ranavaya ◽

Christopher R. Brigham

Keyword(s):

Traffic Accident ◽

Motor Vehicle ◽

The United States ◽

Workers Compensation ◽

Sixth Edition ◽

Compensation Systems ◽

Accident Compensation ◽

Standard Tool ◽

Serious Injury ◽

Almost All

Abstract In the United States, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is used in state and federal workers’ compensation systems and in automobile casualty and personal injury arenas. The AMA Guides is used in similar ways internationally. Most workers’ compensation jurisdictions in Canada use the AMA Guides formally by statute or regulation or accept its use informally as a standard tool to rate impairment. In Australia, the AMA Guides is used in both federal (Australian Commonwealth) and individual states’ (or territories’) compensation schemes; two tables show how almost all states in Australia have legislated various editions of the AMA Guides for use in workers’ compensation and motor traffic accident compensation schemes. New Zealand's Accident Compensation Commission (ACC) previously used the AMA Guides, Fourth Edition; beginning in July 2011 ACC uses the sixth edition. Hong Kong uses the AMA Guides as a reference in evaluating workers’ compensation and motor vehicle claims; Malaysia uses the AMA Guides officially in adjudication; and impairment rating in Asian countries such as Taiwan, Korea, and Singapore are influenced by the philosophy and principles of the AMA Guides. South Africa uses the AMA Guides, Sixth Edition, to determine serious injury, and other editions are used in South Africa's workers’ compensation schemes. Many countries in Europe and the Middle East use the AMA Guides as a reference for determining impairment and in workers’ compensation and social welfare schemes.

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A Historical Review of Complex Regional Pain Syndrome in the “Guides Library”

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.novdec01 ◽

2009 ◽

Vol 14 (6) ◽

pp. 1-9

Author(s):

Robert J. Barth

Keyword(s):

Differential Diagnosis ◽

Complex Regional Pain Syndrome ◽

Reflex Sympathetic Dystrophy ◽

International Association ◽

Historical Review ◽

Pain Syndrome ◽

Sixth Edition

Abstract Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.

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Medical and Legal Issues Raised by the Protz Decision Issued by the Pennsylvania Supreme Court

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2017.julaug03 ◽

2017 ◽

Vol 22 (4) ◽

pp. 12-13

Author(s):

LuAnn Haley ◽

Marjorie Eskay-Auerbach

Keyword(s):

Supreme Court ◽

Scientific Evidence ◽

Workers Compensation ◽

Sixth Edition ◽

Complex Concept ◽

The Supreme Court ◽

Compensation Claims ◽

Recent Edition ◽

Impairment Ratings ◽

Definition Of

Abstract Pennsylvania adopted the impairment rating provisions described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in 1996 as an exposure cap for employers seeking predictability and cost control in workers’ compensation claims. In 2017, the Supreme Court of Pennsylvania handed down the Protz decision, which held that requiring physicians to apply the methodology set forth in the most recent edition of the AMA Guides reflected an unconstitutional delegation of legislative power to the American Medical Association. The decision eliminates the impairment-rating evaluation (IRE) mechanism under which claimants were assigned an impairment rating under the most recent edition of the AMA Guides. The AMA Guides periodically are revised to include the most recent scientific evidence regarding impairment ratings, and the AMA Guides, Sixth Edition, acknowledges that impairment is a complex concept that is not yet defined in a way that readily permits an evidence-based definition of assessment. The AMA Guides should not be considered standards frozen in time simply to withstand future scrutiny by the courts; instead, workers’ compensation acts could state that when a new edition of the AMA Guides is published, the legislature shall review and consider adopting the new edition. It appears unlikely that the Protz decision will be followed in other jurisdictions: Challenges to using the AMA Guides in assessing workers’ compensation claims have been attempted in three states, and all attempts failed.

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Proceedings of the Conference on Social Insurance Called by the International Association of Industrial Accident Boards and Commissions, Washington, D.C., December 5 to 9, 1916.

Journal Of The Royal Statistical Society ◽

10.2307/2340740 ◽

1919 ◽

Vol 82 (1) ◽

pp. 92

Author(s):

E. B.

Keyword(s):

Social Insurance ◽

International Association ◽

Industrial Accident

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Income Changes Due to Disability Ratings and Participation in Economic Activities Caused by Industrial Accidents: A Population-Based Study of Data from the Fourth Panel Study of Workers’ Compensation Insurance (PSWCI)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112478 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2478 ◽

Cited By ~ 2

Author(s):

Suk Bae ◽

Sehyun Yun ◽

Ye Lee ◽

Jin-Ha Yoon ◽

Jaehoon Roh ◽

...

Keyword(s):

Repeated Measures ◽

Panel Study ◽

Workers Compensation ◽

Annual Income ◽

Industrial Accident ◽

Negative Consequences ◽

Economic Activities ◽

Industrial Accidents ◽

Average Income ◽

Disability Rating

Industrial accidents cost a huge amount of money, but they also have negative consequences in many respects. We analyzed the data of the first to fourth panel study of workers’ compensation insurance (PSWCI). Repeated measures ANOVA was used to compare the annual income before and after the industrial accident, and a general linear model was used to identify changes in income due to disability ratings and participation in economic activities. The wages before the industrial accident and the annual income varied among the disabilities ratings. In addition, for affected workers, the average income during four years post-accident was lower than the average income before the accident. Regression analysis to see changes in income after the industrial accident showed that the group with a disability rating of 11–14 and no injuries had a suffered a greater income decrease than those with a disability rating of 1–3, and the unemployment group saw a greater decrease in income than the employment group. Workers who were affected by industrial accidents received lower incomes than before the accident, and even considering different disability ratings, there was a greater decrease in income among the unemployed group than in the working group.

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