Frequently Asked Questions

Question: Which edition of the AMA Guides to the Evaluation of Permanent Impairment should I use?

The Sixth Edition is the most current standard and the standard for the U.S. federal government and many states and countries. Some states use the Fifth Edition and earlier editions. Visit https://www.amaguides.com/usage-state-by-state-charts/ to view the use of editions by state.

Question: Does subscription to the training resources AMA Guides, Fith, and Sixth Editions – Mastery include the AMA Guides?

Each subscriber is required to have access to the AMA Guides to the Evaluation of Permanent Impairment. You may purchase this at Amazon, as a Hardcover, or on Kindle for the Fifth and Sixth Edition. The AMA Guides, Fifth and Sixth Edition, are now digital. With online access, you can view and search the most current standard.

Question: How do I access the AMA Guides Newsletter?

The AMA Guides® Newsletter, a publication of the American Medical Association, provides you with crucial updates, authoritative guidance, practical information, and rationales for proper use of the AMA Guides in assessing impairment, workability, causation, and other case issues. It is accessible online. With a subscription, you access back issues. This resource is a must to perform quality evaluations.

Question: What books do you recommend that I read to be most effective at performing independent medical and impairment evaluations?

Question: What are the prerequisites for taking the Certified Impairment Rater examination?

It would be best if you had a solid understanding of using the AMA Guides, Fifth and Sixth Editions, which can be obtained through the online training at www.emedicolegal.com, other courses, or experience. We recommend taking the mini-assessment (no charge, ten items) to determine if you are ready. You do not have to take specific training.

The examination is open to all, including allopathic, osteopathic, and chiropractic physicians, physical and occupational therapists, nurses, attorneys, fact finders, and claims professionals.

Question: How do the learning experiences AMA Guides, Fifth and Sixth Editions – Mastery courses with www.emedicolegal.com compare to other offerings, e.g., in-person courses?

It is your most cost-effective and efficient solution to learning the AMA. With the annual and monthly subscriptions, you have 24/7 access. You can take the training and return as needed. The training is provided by the Senior Editor of the AMA Guides (Sixth Edition) and editor of the Guides Newsletter and Guides Casebook.

You have access to resources not provided by others, including video content (physical examination procedures), study material, case exercises, quizzes, and subscriber-only monthly Question and Answer sessions with Dr. Brigham.

The monthly subscription fee is less than the typical fee for a single-day course, and the annual subscription fee is typically less than a single IME fee. You do not have the added expenses of travel and loss revenue being away from the office (or away from family), saving thousands of dollars.

Question: How do I proceed with the training for AMA Guides, Fifth Edition – Mastery at www.emedicolegal.com?

At the start of the training, please take the pre-test. Then, you should start the modules by watching the presentations, studying the material provided below the video presentations, and using the hyperlinks to the relevant content from AMa Guides and Guides Newsletters, starting with those for Chapters 1 and 2, which are the foundations for AMA Guides. Afterward, go through the case exercises and quizzes provided at the end of each section.

After completing these learning experiences, take the post-test provided in the last section of the training. After successful completion and passing, you will then immediately receive your certificate of training as a .pdf document.

You are welcome to join our webinar Question / Answer discussions on the Fifth Editions. These are held on the second Tuesday of every month at 4 p.m. ET.  All the monthly and yearly subscribers will have access to the webinars, valid till their subscription period.

Question:  How do I proceed with the training for AMA Guides, Sixth Edition – Mastery at www.emedicolegal.com?

At the start of the training, please take the pre-test. Then, You should start the modules by watching the presentations, studying the material provided below the video presentations, and using the hyperlinks to the relevant content from AMa Guides and Guides Newsletters, starting with those for Chapters 1 and 2, which are the foundations for AMA Guides. Afterward, go through the case exercises and quizzes provided at the end of each section.

After completing these learning experiences, take the post-test provided in the last section of the training. After successful completion and passing, you will then immediately receive your certificate of training as a .pdf document.

You are welcome to join our webinar Question / Answer discussions on the Fifth Editions. These are held on the second Tuesday of every month at 11 a.m. ET.  All the monthly and yearly subscribers will have access to the webinars, valid till their subscription period.

Question: How do I obtain a Certification of Training?

Subscribers to online training on the AMA Guides to the Evaluation of Permanent Impairment will receive Certification of Training at no additional cost. For the Fifth Edition, complete all of the steps at https://www.impairment.com/trainingcertificate5/. For the Sixth Edition, complete all the steps at https://www.impairment.com/trainingcertificate6/. This involves completing the learning experiences at fifthedition.com or www.6thedition.com, as explained at the links above. Complete the mini-assessment and the application form, as explained at the links above. Upon completing all of these steps, you will receive a Certificate of Training as a .pdf.

We highly encourage you to become a Certified Impairment Rater, as explained at www.certifiedrater.com. This distinguishes you from others who lack this credential. It is also a great learning experience.

Question: Do subscriptions to AMA Guides, Fith, and Sixth Editions – Mastery courses at www.emedicolegal.com provide Category I AMA credits?

No; however, you can claim Category II credits. There are a myriad of resources to obtain Category I AMA credits; therefore, this is rarely an issue.

Question: How do I bill for an impairment rating, and what should I charge?

If the evaluation is requested by an attorney, insurer, third-party administrator, employer, or governmental entity, you will typically bill that client unless they ask that you bill someone else. If you are billing someone else, it is essential to obtain approval in advance. Workers’ compensation systems or independent medical evaluation companies may have a fee schedule; otherwise, your fee may be based on the time involved or other factors, such as the case complexity, number of body parts, issues, and amount of medical records. The value of the examiner’s time varies, depending on the uniqueness of knowledge, skills and experience, specialty and training, and geographical location.

Impairment rating performed by the treating physician is usually considered an extension of the treatment process (office visit, medical records review, diagnostic studies, current physical findings, and a written report). Treating physicians who perform the examination can bill this work using CPT code 9455; CPT code 99456 applies if a non-treating physician performed the work (the code is used for each 30-minute increment). Payment for these codes is dependent on the complexity of the case, the time required in the evaluation and report writing, and the value of the examiner’s time.

Do I need a professional (e.g., medical or chiropractic) license to perform impairment ratings?

The need for licensure depends on jurisdiction and context. It is important to disclose to your examinee the scope of an evaluation and that you are not establishing a physician-patient relationship.

In performing independent medical evaluations (IMEs), it is typically viewed that you do not form a doctor-patient relationship; however, the American Medical Association, in their Code of Medical Ethics Opinion 1.2.6, states there is a limited patient-physician relationship. However, IMEs often involve other issues, such as appropriateness of care and recommendations, that may not be dealt with in performing an impairment rating. Therefore, the need for licensure may be less in this more limited role.

State workers’ compensation systems may require evaluators to be licensed in that state; however, others may state the evaluations are performed by a licensed physician, e.g., you could be licensed in another state. The US Department of Labor requires for their evaluations a valid medical license and board certification in the field of expertise (e.g., toxicology, pulmonary, neurology, occupational medicine, etc.)

Physician opinions are often challenged by opposing counsel; therefore, the lack of a medical license could result in challenges.

Any qualified individual may review an impairment rating and provide an opinion on its correctness. These impairment rating reviewers include non-physicians, e.g., claims professionals, attorneys, and nurses.

It is highly recommended that you have credentials documenting your expertise in using the AMA Guides, e.g., Certified Impairment Rater.

If an overseas medical doctor gets the certificate, will he or she be permitted to work as an impairment rater in the U.S. without a USMLE certificate?

The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners that physicians with a medical degree and international medical graduates must pass after successful completion of medical training to receive their medical license and begin practicing medicine. Federal and state workers’ compensation jurisdictions typically require physicians to have an active medical license to perform an independent medical or impairment assessment, even though they do not establish a traditional physician-patient relationship. Therefore, without a USMLE certificate and subsequent medical licensure, it is probable that they could not perform a direct examination in most jurisdictions. Physician opinions are often challenged by opposing counsel; the lack of a medical license would raise serious questions about medical qualifications. Any qualified individual may review an impairment rating and provide an opinion on the correctness of the rating. These impairment rating reviewers include non-physicians, e.g., claims professionals, attorneys, and nurses. Therefore, the short answer is no in the traditional role of evaluating a patient; however, yes if reviewing impairment ratings.