Impairment Use of the AMA Guides

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The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition 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 most state workers’ compensation jurisdictions, however not all states make use of the current edition. Twenty six states make use of the Fifth Edition (Alaska, Arizona, California, Delaware, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington and Wyoming.

Ten states still commonly make use of the Fourth Edition (Alabama, Arkansas, Connecticut, Kansas, Maine, Maryland, Mississippi, South Dakota, Texas, and West Virginia), and two states use the Third Edition, Revised (Colorado and Oregon). 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 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. Florida Statutes §627.737(2) (1995) state:

(2) In any action of tort brought against the owner, registrant, operator, or occupant of a motor vehicle with respect to which security has been provided as required by ss. 627.730-627.7405, or against any person or organization legally responsible for her or his acts or omissions, a plaintiff may recover damages in tort for pain, suffering, mental anguish, and inconvenience because of bodily injury, sickness, or disease arising out of the ownership, maintenance, operation, or use of such motor vehicle only in the event that the injury or disease consists in whole or in part of:

(a) Significant and permanent loss of an important bodily function.
(b) Permanent injury within a reasonable degree of medical probability, other than
scarring or disfigurement.
(c) Significant and permanent scarring or disfigurement.
(d) Death.

The Guides are commonly used in Florida automobile casualty cases to define “significant and permanent loss of an important bodily function.” Therefore, ratings are subject to challenge.

Guides ratings are an important aspect of workers compensation systems and many bodily injury claims.

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	5th	AK S. §. 23.30.190(d)	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.
Arizona	5th	AZ Rev. S. Ann. § 23-1044; § 23-1065; Rule R20-5-113(B) of the Workers' Compensation Practice and Procedure	Edition not specified by statute. Guides are used to support medical opinion and in supplementing Arizona’s statutory disability schedule.
Arkansas	4th	Workers' Compensation Rule 34	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	Schedule for Rating Permanent Disability, 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.
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.
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 Fourth. Not anticipating use of AMA Guides.
Georgia	5th	GA Code Ann. § 34-9-263(d)	5th edition adopted as of July 1, 2001.
Hawaii	5th	DLIR Regulations § 12-10-21(a); HI Rev. Stat. §386-32	Adopted the 5th edition in 2003. Also use 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); IA Code §§ 85.34(2) "a" to "s"	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 guides 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 AMA guide."
Kansas	4th	KS Stat. § 44-510d, KS Stat. § 44-510e	Not known if 5th edition will be used in the future.
Kentucky	5th	KY Rev. Stat. § 342.0011 (35);	Specifies latest available edition, 5th edition as of March 1, 2001.
Louisiana	5th	LA Rev. Stat. Ann. § 23:1221.(4)(q)	Statute mandates that most recent version of the Guides should be utilized.
Maine	4th	ME Title 39-A, 153 § 8	4th edition specified. No plans to use 5th 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	4th	Medical Cost Containment Rules	Proposing use of "most current edition" effective Aug. 1, 2007
Missouri	Not Specified	Ch. 287 Rev. Stat.	No guide for nonscheduled injuries, but ratings from Guides may be used.
Montana	5th	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 specified with specific exceptions where RSA 281-A:32, II is more favorable to the claimant.
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	5th	NM Stat. Ann. § 52-1-24	Most recent edition specified.
New York	State specific	Medical Guidelines	Uses own Medical 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 Fifth Edition of the Guides.
Ohio	5th	OH Rev. Code § 4123	Statute specifies most current edition.
Oklahoma	5th	OK Stat. Title 85-22-3	Specifies "latest publication". "Paragraph 3 of Section 22 of this title, relating to scheduled member injury or loss; and impairment, including pain or loss of strength, may be awarded with respect to those injuries or areas of the body not specifically covered by said guides"
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	5th	34 Pa. Code § 123.105.	Most recent edition specified, and effective for all ratings on and after August 1, 2001
Rhode Island	5th	RI Gen. Laws § 28-29-2	Most recent edition specified
South Carolina	Not Specified	SC Reg. Sec. 67-1101	Hearing impairment is based on the American Academy of Otolaryngology "Guide for Evaluation of Hearing Handicap", which is based on the Guides.
South Dakota	4th	SD Codified Law 62-1-1.2	Fourth Edition required by statute. Not known when and if 5th edition will be used
Tennessee	5th	TN Code Ann. § 50-6-102	Most recent edition specified (in the event of a release of a new edition of the publication in a given year, the new edition shall be deemed to be the most recent edition on January 1 of the year following its release) 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	5th	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	Requires use of the most recent 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	5th	WY Stat § 27-14-405(g)	Most recent edition specified