AMA Guides Overview

The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition (Cocchiarella L, Andersson G, AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, AMA Press, 2001) is the most widely used basis for determining impairment. They are widely used in workers’ compensation, Longshore and Harbor Workers' Act, automobile casualty and personal injury cases to quantify permanent losses associated with injury or illness. Impairment is defined on page 2 as the “loss of, loss of use of, or derangement of any body part, system or function.” The most recent edition is the Fifth Edition published in 2001. The Fifth Edition states on page 2 that “since this edition encompasses the most current criteria and procedures for impairment assessment, it is strongly recommended that physicians use this latest edition, the fifth edition, when rating impairment.” The Fifth Edition of the Guides does have significant shortcomings; however it is the current standard for rating impairment. The Sixth Edition is scheduled to be published in 2007.

The Guides define procedures for obtaining and analyzing clinical data which are then applied to criteria to provide an impairment rating. The evaluation is performed by a physician once the patient is at maximal medical improvement. Most often impairment ratings of specific body parts are converted to a whole person permanent impairment rating; zero percent rating reflects normal functioning and 100 percent rating reflects death. A rating of 90% to 100% whole person permanent impairment reflects very severe organ or body system impairment or requires the individual to be fully dependent on others for self-care, approaching death. The correct whole person permanent impairment ratings average 6% whole person; it is uncommon to see accurate ratings beyond 30% whole person, with the notable exception of multiple or catastrophic injuries, such as a spinal cord or serious head injury.

The Guides are comprised of 18 chapters; the first two chapters explain the use of the Guides, chapters 3 through 17 deal with specific organ systems, and chapter 18 deals with pain. Chapter 15 – Spine, Chapter 16 – The Upper Extremities, and Chapter 17 – The Lower Extremities are the chapters that are most commonly used. These chapters define Principles of Assessment, and describe how to evaluate and rate impairment, using specific criteria.

They are used in most state workers’ compensation jurisdictions, however not all states make use of the current edition. The statutes may or may not specify which edition of the Guides to use and how the Guides are to be utilized. The most widely used edition is the Fifth Edition. Some states do not make use of the Guides; rather they utilize state specific guidelines, i.e. Florida, Illinois, Minnesota, New York, North Carolina, Utah, and Wisconsin. Other 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. Federal workers' compensation laws cover all federal employees (including postal workers) and citizens of Washington, DC. Federal systems include Federal Employees’ Compensation Act (FECA), Federal Employer’s Liability Act (FELA), Jones 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 66⅔ 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:

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 many bodily injury claims.