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The AMA Guides to the Evaluation of Permanent Impairment is the most widely used basis for determining impairment. They are used in state workers’ compensation systems, federal systems, automobile casualty and personal injury.

They are used in the majority of state workers’ compensation jurisdictions. The Fifth Edition (published in 2000) is the most commonly used Edition. Sixteen states make use of the Fifth Edition (California, Delaware, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Massachusetts, Nevada, New Hampshire, North Dakota, Ohio, Rhode Island, Vermont and Washington).

Ten states use the Sixth Edition which was released at the end of 2007: Alaska, Arizona, Louisiana, Mississippi, Montana, New Mexico, Oklahoma, Pennsylvania, Tennessee and Wyoming. 

Eight states still commonly make use of the Fourth Edition (published in 2000): Alabama, Arkansas, Kansas, Maine, Maryland, South Dakota, Texas, and West Virginia. Two states use the Third Edition, Revised (published in 1990): Colorado and Oregon.  Connecticut does not stipulate which Edition of the Guides to use.

Seven states use their own state specific guidelines (Florida, Illinois, Minnesota, New York, North Carolina, Utah 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 Guides to use and how the Guides are to be utilized. Some states may use their own guidelines for specific problems and use the Guides for other problems. Many states use a statutory schedule for amputations, hearing loss, visual loss, hernias, and disfigurement. Some states may use a statutory schedule and use the Guides for nonscheduled injuries and others do not specify the use of any specific guidelines.

The Guides are also used to rate impairment beyond state workers’ compensation laws. In these other arenas the Fifth Edition, the most current edition, is used. Federal workers' compensation laws cover all federal employees (including postal workers) and citizens of Washington, DC. Federal systems include Federal Employees’ Compensation Act (FECA), Energy Employees Occupational Illness Compensation Program Act, and Longshore and Harbor Workers’ Compensation Act (LHWCA). Under the Federal Employees’ Compensation Act (FECA 5 USC 8107) benefit is given for permanent impairment to specific body parts including extremities, hearing, vision, and loss of specific organs (breast, kidney, larynx, lung, penis, testicle, tongue, ovary, and uterus/cervix and vulva/vagina). Awards are based on a formula of 662/3 percent of monthly wages multiplied by a specified numbers of weeks’ compensation for a specific body part; for the upper extremity this includes arm, hand, and individual digits. Under the Longshore and Harbor Workers’ Compensation Act ratings are performed for “scheduled injuries” (e.g., a scheduled member of the body defined by section 8(c)(1)-(20) of the LHWCA). This includes upper extremity injuries (with the exception of the shoulder), lower extremity injuries, and hearing loss.

The Guides are often used to quantify the extent of injuries resulting from an automobile casualty or personal injury. Insurers may use an impairment rating as one of the factors in determining the reserving or settlement value of a claim. Attorneys may use this to quantify the impact of an injury. With no-fault insurance some states may restrict suits to cases where a specific defined threshold has been met; in these states the Guides play an important role. Florida, for example, has a no-fault system for automobile insurance. Where personal injury protection (PIP) coverage exists, an insured’s claims for pain and suffering are subject to threshold limitations as a basis for recovery outside the automobile no-fault system. The Guides are commonly used in Florida automobile casualty cases to define “significant and permanent loss of an important bodily function.”

Use of the AMA Guides in State Workers Compensation contact us if you have updated information regarding your State):

State

Edition most commonly used

Statute / Code

 Comment

Alabama

4th

AL § 480-5-5-.35

The 4th edition is the "recommended guide" to be used by physicians.

Alaska

6th

AK S. §. 23.30.190

Statutes state new edition to be adopted by board within 90 days of the last day of the month when the new edition is published. The use of the Sixth Edition was required as of March 31, 2008.

Arizona

6th

AZ Rev. S. Ann. § 23-1044;
§
23-1065;
Rule R20-5-113(B) of the Workers' Compensation Practice and Procedure

Use of most recent edition specified by administrative regulation. Guides are used to support medical opinion and in supplementing Arizona’s statutory disability schedule.

Arkansas

4th

Workers' Compensation Commission Rule 099.34 - Impairment Rating Guide

Excludes any sections that refer to pain and exclusive of straight leg raising tests or range of motion tests when making physical or anatomical impairment ratings to the spine.

California

5th

CA Code of Reg. Title 8, Ch. 4.5 Sub Ch. 1 Art. 7

California Permanent Disability Rating Schedule, an impairment-based rating system which is based on the 5th edition and modifies ratings based on adjustments for Future Earning Capacity, occupational demands and age. 5th adopted as of January 1, 2005. California Workers' Compensation Appeals Board issued a decision February 2009 in the consolidated cases of Almaraz v. SCIF, et al. and Guzman v. Milpitas Unified School District  that the AMA Guides were rebuttable.

Colorado

3rd revised

Colo. Rev. Stat. § 8-42-101

Legislation maintains the use of the 3rd edition revised.

Connecticut

4th, 5th & 6th

 

The physician who is doing a rating must use an “objective” standard. The state recommends use of the AMA Guides but specifically does not require use of a specific edition.

Delaware

5th

Title 19, Ch. 23

Not required by statute but are strongly favored including in case law.

District of Columbia

6th

DC Statute §32-1508

The most recent edition is mandated by statute.

Florida

State specific

1996 Florida Uniform Permanent Impairment Rating Schedule

 

Title XXXI, Chapter 440


69L-7.604

State specific guide, however incorporated some principles from the 4th edition. Not anticipating use of AMA Guides.

Georgia

5th

GA Code Ann. § 34-9-263(d) (Ch. 9 Art. 37)

5th edition adopted as of July 1, 2001.

Hawaii

5th

 

Uses latest edition but has not moved to 6th edition yet. Also uses a schedule and rules for rating nonscheduled disability.

Idaho

5th

 

Uses the 5th edition as medical evidence, neither regulation nor state require it

Illinois

State specific

820 ILCS § 305/1

State schedule used for certain cases, no reference in statutes or regulations to the Guides.

Indiana

5th

IN Code 22-3-3-10

Guides use not required, however latest edition of Guides often used to evaluate nonscheduled impairment.

Iowa

5th

IA Code, §876-2.4(85);

Adopted for determining permanent partial disabilities under Iowa Code section 85.34(2)"a" to "s".  "Nothing in this rule shall be construed to prevent the presentations of other medical opinions or other material evidence for the purpose of establishing that the degree of permanent disability to which the claimant would be entitled would be more or less than the entitlement indicated in the Fifth Edition of the AMA guides."  Deferred going to the 6th edition.

Kansas

4th

KS Stat. § 44-510d,
KS Stat. § 44-510e

Not known if later edition will be used in the future.

Kentucky

5th

KY Rev. Stat. § 342.0011 (35);

House Bill 333

States latest available edition; however, House Bill 333 passed March 2009 retains use of Fifth Edition until July 2010.

Louisiana

6th

LA Rev. Stat. Ann. § 23:1221.(4)(q)

Statute mandates that most recent version of the Guides should be utilized.

Maine

4th

WCB Rules & Regulations Rule 90-351. ME Title 39-A, 153 § 8

4th edition specified. No plans to use 5th edition at this time.

Maryland

4th

MD Title 14.09.04.01

Changing to the 5th edition is not planned at this time.

Massachusetts

5th

MA Gen. Law Title XXI Ch. 152, § 36

Edition not specified. Incorporates Guides by statute, requiring its use when certain criteria are met for permanent conditions.

Michigan

Not Specified

Worker's Disability Compensation Act of 1969 $418.361

Scheduled amputations and total permanent disabilities are listed in law.

Minnesota

State specific

Stat. Ch. 176.101

State specific schedule of permanent partial disabilities used.

Mississippi

6th

Fee Schedule: IV Impairment Rating 'A'

"In determining the extent of permanent impairment attributable to a compensable injury, the provider shall base this determination on the most current edition of the Guides ... which is in effect at the time the service is rendered."

Missouri

Not Specified

Ch. 287 Rev. Stat.

No guide for nonscheduled injuries, but ratings from Guides may be used.

Montana

6th

MT Code Ann. §39-71-711(b)

Current edition specified.

Nebraska

Not Specified

NE Stat. § 48-121

Guides not specified, however commonly used as a predicate for disability.

Nevada

5th

NV Rev. Stat. 616C.110

5th edition used as of October 2003.

New Hampshire

5th

NH Rev. Stat. Ann. § 281-A:32; Labor rules 508.01(d)

Most recent edition was previously specified, however legislation in July 2008 removed this requirement and specified ratings are to be performed by the 5th edition with the exception of workers who achieved MMI between January 1 and June 25, 2008 who will be evaluated by the 6th edition.

New Jersey

Not Specified

NJ Stat. Ann. § 34:15-12

Permanent disability is based upon the objective medical evidence of a disability as well as the injured worker’s testimony.

New Mexico

6th

NM Stat. Ann. § 52-1-24

Most recent edition specified.

New York

State specific

Medical Guidelines

Uses own Disability Guidelines, not anticipating use of Guides

North Carolina

State specific

NC Stat. 97, WCA 97-31

Use on guides presented in the NC Workers Compensation Rating Guide.

North Dakota

5th

ND Cent Code § 65-05-12-2

Guides are modified to be consistent with ND law, to resolve issues of practice and interpretation, and to address areas not sufficiently covered by the guides. Subject to rules adopted under this subsection, impairments must be evaluated under the 5th edition of the Guides.

Ohio

5th

OH Rev. Code § 4123

Statute does not specify Edition.

Oklahoma

6th

OK Stat. Title 85-3.19

Specifies "latest publication".

Oregon

3rd Revised

OR Admin. Rules Ch. 436, Div. 035

Utilizes 3rd edition Revised, re-affirmed 1/1/06. The DRE model does not fit their concept of impairment.

Pennsylvania

6th

34 Pa. Code § 123.105.

Most recent edition specified.

Rhode Island

5th

RI Gen. Laws § 28-29-2

Fifth Edition specified

South Carolina

Not Specified

SC Reg. Sec. 67-1101

"The method for determining hearing impairment is based on the American Academy of Otolaryngology "Guide for Evaluation of Hearing Handicap", copyright 1979, which is based upon the American Medical Association's "Guides to the Evaluation of Permanent Impairment", copyright 1977. "

South Dakota

4th

SD Codified Law 62-1-1.2

4th edition required by statute. Not known when and if later will be used

Tennessee

6th

TN Code Ann. § 50-6-102 and 50-6-204

Most recent edition specified - 6th Edition adopted January 1, 2008 - or "in cases not covered by the AMA Guides an impairment rating by any appropriate method used and accepted by the medical community."

Texas

4th

TX Lab. Code Ann. § 408.124

As of 10/15/01, 4th edition required

Utah

State Specific

Rule 612-7-3 Method for Rating

Utah's Impairment Guides

For rating all impairments, which are not expressly listed in Section 34A-2-412, the Commission adopts Utah’s 2006 Impairment Guides as published by the Commission for all ratings of impairments on or after January 1, 2006. For those conditions or exclusions not found in Utah’s 2006 Impairment Guides, the Guides are to be used.

Vermont

5th

VT Stat. Ann. Tit. 21, § 648

Legislation specifies continued use of 5th Edition vs. moving to the 6th Edition.

Virginia

Not Specified

VI § 65.2-503

Guides most often used as source of impairment rating. No specific guide mentioned in statute or regulation.

Washington

5th

WAC 296-23-381

WAC 296-20-220

State specific guidelines for certain conditions, 5th edition used for loss of function of extremities, partial loss of vision or hearing.

West Virginia

4th

WV Title §85-20-3

Code specifies 4th Edition.

Wisconsin

State specific

WI Adm. Code 80.32, 80.33;
WI Stat. Ch. 102

Not anticipating use of Guides. State specific schedules provided for rating.

Wyoming

6th

WY Stat § 27-14-405(g)

Most recent edition specified