AMA Guides® Newsletter - Issue Archive

Articles

1. Flawed Approaches to Determining the “Most Accurate Impairment Rating”: The California Experience

   Christopher R. Brigham, James B. Talmage, Marjorie Eskay-Auerbach

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.2017.JulAug01

   Abstract

   Socioeconomic factors influence all aspects of workers’ compensation, personal injury, and disability systems, but the best financial interest of certain stakeholders may not be aligned with the ultimate best interests of those who are injured or ill. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was introduced in California in 2005 to improve the reliability of permanent disability award ratings, which previously were based primarily on subjective factors. The result was a reduction in the dollar value of disability rewards, and, in response, certain stakeholders took steps to reduce this impact, including instructing physicians to ignore instructions in the AMA Guides. The AMA Guides, Sixth Edition, addresses many of the potential misapplications of the criteria in the fifth edition. Despite efforts to improve the validity and reliability of impairment assessment, some stakeholders continue to resist use of the more current edition. In California, impairment currently is rated by agreed medical evaluators; this should be changed to ensure that evaluations are performed by unbiased physicians who are educated with respect to evidence-based medicine and causation. Injured workers must be fairly and appropriately compensated for losses associated with an injury, but not at the cost of inappropriate inflation of impairment and disability ratings because the latter contribute to needless disability and impede living a productive and joyous life.
   Show more

2. The AMA Guides, Fifth Edition—the California Experience

   Steven Feinberg, Kenneth Kingdon, Robert Rassp

   Pages 6–11, 16

   DOI: 10.1001/amaguidesnewsletters.2017.JulAug02

   Abstract

   Over the past thirteen years, physicians have experienced a learning curve regarding how to use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) with a “California flavor.” Physicians are mandated by law to provide the court with the “most accurate” ratings that apply in a given case based on permanent objective medical evidence and the education, skills, knowledge, and experience of the physician. Two cases, commonly known as Almaraz–Guzman, profoundly changed how California interprets and uses the AMA Guides, Fifth Edition. Under Almaraz–Guzman, the evaluating physician is tasked with first providing a whole person impairment using a “standard” AMA Guides impairment rating. If the physician believes that this rating “is not the most accurate” and does not adequately reflect the extend of the disability, an alternative rating “within the four corners” of the AMA Guides can be provided based on “reasonable medical probability.” In many cases, this has resulted in the use of tables, charts, methods, measurements, and descriptions from chapters and text materials that were not originally intended to apply to other parts of the body. The AMA Guides tells us that when there is no clear impairment rating, rating by analogy or use of other impairments that create a similar effect on ADLs should be considered, and the opinion must reach the level of substantial evidence.
   Show more

3. Medical and Legal Issues Raised by the Protz Decision Issued by the Pennsylvania Supreme Court

   LuAnn Haley, Marjorie Eskay-Auerbach

   Pages 12–13

   DOI: 10.1001/amaguidesnewsletters.2017.JulAug03

   Abstract

   Pennsylvania adopted the impairment rating provisions described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in 1996 as an exposure cap for employers seeking predictability and cost control in workers’ compensation claims. In 2017, the Supreme Court of Pennsylvania handed down the Protz decision, which held that requiring physicians to apply the methodology set forth in the most recent edition of the AMA Guides reflected an unconstitutional delegation of legislative power to the American Medical Association. The decision eliminates the impairment-rating evaluation (IRE) mechanism under which claimants were assigned an impairment rating under the most recent edition of the AMA Guides. The AMA Guides periodically are revised to include the most recent scientific evidence regarding impairment ratings, and the AMA Guides, Sixth Edition, acknowledges that impairment is a complex concept that is not yet defined in a way that readily permits an evidence-based definition of assessment. The AMA Guides should not be considered standards frozen in time simply to withstand future scrutiny by the courts; instead, workers’ compensation acts could state that when a new edition of the AMA Guides is published, the legislature shall review and consider adopting the new edition. It appears unlikely that the Protz decision will be followed in other jurisdictions: Challenges to using the AMA Guides in assessing workers’ compensation claims have been attempted in three states, and all attempts failed.
   Show more

4. Q&A: Apportionment of Musculoskeletal Impairment to Preexisting Metastatic Disease

   Christopher R. Brigham, James B. Talmage

   Pages 14–15

   DOI: 10.1001/amaguidesnewsletters.2017.JulAug04