Impairment Use of the AMA Guides

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):