Impairment Rating Insights

2008 ◽  
Vol 13 (4) ◽  
pp. 1-5
Author(s):  
Christopher R. Brigham ◽  
W. Frederick Uehlein ◽  
Craig Uejo ◽  
Leslie Dilbeck
Keyword(s):  
Permanent Disability ◽  
Sixth Edition ◽  
Earning Capacity ◽  
Impairment Ratings ◽  
Disability Rating

Abstract This article addresses a number of issues regarding impairment evaluation and the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, impairment is not synonymous with disability, and, as noted in the sixth and previous editions of the AMA Guides, no direct correlation exists between impairment and work restrictions or loss of earning capacity. An impairment rating does not directly equate to a permanent disability rating and does not solely determine compensation. The AMA Guides creates the opportunity for consistency of impairment ratings among physicians, but impairment ratings must be performed according to standards defined in the AMA Guides. Impairment rating values and methods in the AMA Guides can change between editions based on medical reasons. It is too early to determine the effects of changes in the sixth edition of the AMA Guides pending the accumulation of adequate experience using this edition, until impairment ratings associated with specific diagnoses can be compared, and until an adequate sample of cases can be evaluated and compared using the fifth and sixth editions. Use of the sixth edition may result in some lower impairment ratings, but this edition also expands the number of ratable conditions compared to previous versions. Finally, impairment determination is a medical issue, and more reasonable approaches should be developed to translate impairment into financial rewards.

The AMA Guides in Pennsylvania “Post-Protz”: Act 111 and Case Law Update

2020 ◽  
Vol 25 (3) ◽  
pp. 12-19
Author(s):  
Justin D. Beck ◽  
Judge David B. Torrey
Keyword(s):  
Case Law ◽  
General Assembly ◽  
Disability Benefits ◽  
Permanent Disability ◽  
Sixth Edition ◽  
Legal Questions ◽  
The Supreme Court ◽  
Recent Edition ◽  
Impairment Ratings

Abstract Medical evaluators must understand the context for the impairment assessments they perform. This article exemplifies issues that arise based on the role of impairment ratings and what edition of the AMA Guides to the Impairment of Permanent Impairment (AMA Guides) is used. This discussion also raises interesting legal questions related to retroactivity, applicability of prior precedent, and delegation. On June 20, 2017, the Supreme Court of Pennsylvania handed down its decision, Protz v. WCAB (Derry Area Sch. Dist.), which disallows use of the “most recent edition” of the AMA Guides when determining partial disability entitlement under the Pennsylvania Workers’ Compensation Act. An attempted solution was passed by the Pennsylvania General Assembly and was signed into law Act 111 on October 24, 2018. Although it affirms that the AMA Guides, Sixth Edition, must be used for impairment ratings, the law reduces the threshold for total disability benefits from 50% to 35% impairment. This legislative adjustment benefited injured workers but sparked additional litigation about whether, when, and how the adjustment should be applied (excerpts from the laws and decisions discussed by the authors are included at the end of the article). In using impairment as a threshold for permanent disability benefits, evaluators must distinguish between impairment and disability and determine an appropriate threshold; they also must be aware of the compensation and adjudication process and of the jurisdictions in which they practice.

Impairment Rating in California: Analysis of the Almaraz and Guzman Decision and Impact on the Use of the AMA Guides, Fifth Edition

2009 ◽  
Vol 14 (2) ◽  
pp. 1-13
Author(s):  
Christopher R. Brigham ◽  
W. Frederick Uehlein
Keyword(s):  
School District ◽  
Permanent Disability ◽  
Misleading Information ◽  
Work Impairment ◽  
The Supreme Court ◽  
Impairment Ratings ◽  
Legal Costs ◽  
Case Closure ◽  
Disability Rating ◽  
Human Costs

Abstract The Sate of California Workers’ Compensation Appeals Board (WCAB) in a February 3, 2009, decision in the consolidated cases of Almaraz vs SCIF et al. and Guzman vs Milpitas Unified School District (Almaraz/Guzman) concluded that the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, portion of the 2005 Permanent Disability Rating Schedule is rebuttable. The effects of this decision are significant for California and could catalyze challenges regarding use of the AMA Guides in other jurisdictions. Unavoidable consequences of this decision include increased confusion in the assessment of permanent impairment and disability, far more litigation, increased medical and legal costs, and delayed case closure. The consequence of the WCAB's interpretation is significant financial and human costs, including inaccurate expectations by employees regarding the amount of benefits they may reasonably expect, delays in obtaining these benefits, and perceptions of being significantly permanently disabled. Further, the WCAB decision confuses the concepts of “work impairment” and “disability” and presents misleading information about the AMA Guides and its role in assessing impairment. The WCAB decision will be appealed to the Supreme Court, and it likely will be overturned. In the interim, stakeholders must continue to ensure that impairment ratings and resulting disability ratings are accurate. The article reports on and comments in depth regarding the WCAB Decision and highlights errors in the decision.

State-by-State Use of AMA Guides

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.

Spine Impairment Evaluation: Sixth Edition Approaches

2009 ◽  
Vol 14 (1) ◽  
pp. 1-5
Author(s):  
Craig Uejo ◽  
Marjorie Eskay-Auerbach ◽  
Christopher R. Brigham
Keyword(s):  
Functional Status ◽  
Spinal Injury ◽  
Current Medical ◽  
Clinical Testing ◽  
Medical Evidence ◽  
Sixth Edition ◽  
Whole Person ◽  
Rating Process ◽  
Impairment Ratings ◽  
Class Assignment

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

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

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.

Errata

2008 ◽  
Vol 13 (2) ◽  
pp. 5-5
Keyword(s):  
Psychotic Disorders ◽  
Pain Syndrome ◽  
Vestibular Disorders ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Neurologic Disorders ◽  
Upper And Lower Extremities ◽  
Impairment Ratings ◽  
Extensive List ◽  
Mental And Behavioral Disorders

Abstract Although most chapters in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, instruct evaluators to perform impairment ratings by first assigning a diagnosis-based class and then assigning a grade within that class, Chapter 13, The Central and Peripheral Nervous System, continues to use a methodology similar to that of the fifth edition. The latter was criticized for duplicating materials that were presented in other chapters and for producing different ratings, so the revision of Chapter 13 attempts to maintain consistency between this chapter and those that address mental and behavioral disorders, loss of function in upper and lower extremities, loss of bowel control, and bladder and sexual function. A table titled Summary of Chapters Used to Rate Various Neurologic Disorders directs physicians to the relevant chapters (ie, instead of Chapter 13) to consult in rating neurologic disorders; the extensive list of conditions that should be addressed in other chapters includes but is not limited to radiculopathy, plexus injuries and other plexopathies, focal neuropathy, complex regional pain syndrome, visual and vestibular disorders, and a range of primary mood, anxiety, and psychotic disorders. The article comments in detail on sections of this chapter, identifies changes in the sixth edition, and provide guidance regarding use of the new edition, resulting in less duplication and greater consistency.

Sixth Edition: the New Standard

2008 ◽  
Vol 13 (1) ◽  
pp. 1-12
Author(s):  
Christopher R. Brigham ◽  
Robert D. Rondinelli ◽  
Elizabeth Genovese ◽  
Craig Uejo ◽  
Marjorie Eskay-Auerbach
Keyword(s):  
Review Process ◽  
Peer Review Process ◽  
World Health ◽  
International Classification Of Functioning ◽  
Revision Process ◽  
Sixth Edition ◽  
Impairment Ratings ◽  
Health Organization ◽  
Impairment Severity

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, was published in December 2007 and is the result of efforts to enhance the relevance of impairment ratings, improve internal consistency, promote precision, and simplify the rating process. The revision process was designed to address shortcomings and issues in previous editions and featured an open, well-defined, and tiered peer review process. The principles underlying the AMA Guides have not changed, but the sixth edition uses a modified conceptual framework based on the International Classification of Functioning, Disability, and Health (ICF), a comprehensive model of disablement developed by the World Health Organization. The ICF classifies domains that describe body functions and structures, activities, and participation; because an individual's functioning and disability occur in a context, the ICF includes a list of environmental factors to consider. The ICF classification uses five impairment classes that, in the sixth edition, were developed into diagnosis-based grids for each organ system. The grids use commonly accepted consensus-based criteria to classify most diagnoses into five classes of impairment severity (normal to very severe). A figure presents the structure of a typical diagnosis-based grid, which includes ranges of impairment ratings and greater clarity about choosing a discreet numerical value that reflects the impairment.

Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

Spinal Alteration of Motion Segment Integrity Using the Sixth Edition

2019 ◽  
Vol 24 (3) ◽  
pp. 10-13
Author(s):  
Patrick R. Luers
Keyword(s):  
Angular Motion ◽  
Resonance Imaging ◽  
Key Factors ◽  
Sixth Edition ◽  
Motion Segment ◽  
Flexion Extension ◽  
Technical Factors ◽  
Impairment Ratings ◽  
The Individual

Abstract Spinal impairment evaluation includes determination of the presence or absence of alteration of motion segment integrity (AOMSI). The diagnosis-related estimate (DRE) method is the principal methodology used to evaluate spinal AOMSI impairment in the fourth and fifth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In the AMA Guides, Sixth Edition, impairment ratings are calculated using the diagnosis-based impairment (DBI) method that uses five impairment classes determined by diagnoses and specific criteria, adjusted by consideration of non-key factors and grade modifiers. This article includes a correction of numbers in the AMA Guides, Sixth Edition, Figure 17-6. The following factors must be considered to determine if AOMSI is present: 1) flexion/extension radiographs are performed when the individual is at maximum medical improvement and are technically adequate; 2) the proper methodology is used in obtaining measurements of translation and angular motion; 3) normal translation and angular-motion thresholds consistent with the literature are used in determining AOMSI. Imaging modalities such as videofluoroscopy, digital fluoroscopy, and upright/motion magnetic resonance imaging cannot be used to establish an AOMSI permanent impairment using the AMA Guides. A number of technical factors can affect the image quality associated with measurements of AOMSI, including film centering, artifacts, poor edge resolution, endplate normal variations and spurring, and use of analog rather than digital radiography.

Case Study: Carpal Tunnel Syndrome

2004 ◽  
Vol 9 (5) ◽  
pp. 4-10
Keyword(s):  
Grip Strength ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Permanent Disability ◽  
Left Hand ◽  
Whole Person ◽  
Tunnel Syndrome ◽  
Impairment Ratings ◽  
The Individual

Abstract This Case Study involves a 49-year-old, right-handed laborer whose impairment rating was performed by two surgeons in California following right- and left-hand endoscopic carpal tunnel release surgeries. He was evaluated by both physicians as permanent and stationary with 30% disability according to one rater and 19% by the second rater. Both raters used grip strength measurements tested using a dynamometer by the first evaluating physician and also discussed by the second evaluator. Both evaluators assessed permanent disability. The authors of this Case Study now pause to ask about problems associated with these reports and how the case should be rated; readers are encouraged to perform their own assessments before continuing with the answers and discussion that appear several pages later in this issue of The Guides Newsletter. The authors note that neither report met standards defined in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): both histories are inadequate (eg, results of any sensory testing), as is the clinical discussion. Further, the AMA Guides indicates that it is inappropriate to rate the individual based on weakness of grip strength. In this, as in other aspects of the initial ratings, the evaluators should have followed the AMA Guides more closely, citing appropriate text and tables both for the conduct of the tests and arriving at appropriate impairment ratings. Doing so, in this instance, would result in a rating of 2% whole person permanent impairment.

Sign in / Sign up

Export Citation Format

Share Document