AMA Guides® Newsletter - Issue Archive

Articles

1. Impairment and Disability Compensation Systems in the United States

   Mohammed I. Ranavaya, James B. Talmage

   Pages 1–13

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec01

   Abstract

   Although several states use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) when they evaluate individuals with impairments and disabilities, various disability systems exist in the United States. Disability and compensation systems have arisen to ensure that disadvantaged members of society with a medically determinable impairment, which may lead to a disability, have recourse to compensation from various sources, including state and federal workers’ compensation laws, veterans’ benefits, social welfare programs, and legal avenues. Each of these has differing definitions of disability, entitlement, benefits, procedures of claims application, adjudication, and the roles and relative weights assigned to medical vs administrative deliberations. Workers’ compensation statutes were enacted because of inadequacies of recovery from claims for injured workers under common law. Workers’ compensation is a no-fault system adopted to resolve the dilemmas of tort claims by providing automatic coverage to employees injured during the course of employment; in exchange for coverage, employees forego the right to sue the employer except for wanton neglect. Other workers’ compensation programs in the United States include the Federal Employees Compensation Act; the Federal Employers Liability Act (railroads); the Jones Act (Merchant Marine Act); the Longshore and Harbor Workers’ Compensation Act; the Department of Veterans Affairs; Social Security; and private, long-term disability insurance.
   Show more

2. Clinical Update: Overview of Work-Capacity Restrictions

   Margit L. Bleecker

   Pages 4–5

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec02

   Abstract

   Early return to work is fundamental in the treatment of occupational injuries, but the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) may require temporary or permanent work restrictions. The US Department of Labor Physical Demand Characteristics of work classifies jobs by exertional level (sedentary, light, medium, heavy, and very heavy). The Workplace Functional Ability Guidelines (WFAGs) consist of 21 categories of health impairment and emphasize what the worker can do, ie, the “functional ability.” Musculoskeletal symptoms and signs such as strength, range of motion, or radiographic findings are not good predictors of functional abilities, nor does standardizing the method for work-capacity determination. Measures of physical work performance, even when conducted by highly trained individuals, have low interrater reliability when used for complex tasks. Any discrepancy in expectations between the physician and worker about capabilities and anticipated progress should be resolved. This may be best done if the physician is familiar with the requirements of the job and can offer suggestions about, for example, reducing the stress on an injured body part by using a different model of a tool. Individual differences in motivation, pain tolerance, conditioning, and so on make it difficult to determine work restrictions, but physicians should attempt to return the worker to gainful employment as early as possible.
   Show more

3. Tools & Resources: Impairment and Disability Web Sites

   Pages 5–6

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec03

   Abstract

   Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from those expected by the individual's culture; these inflexible and pervasive patterns reflect issues with cognition, affectivity, interpersonal functioning and impulse control, and lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, defines two specific personality disorders, in addition to an eleventh condition, Personality Disorder Not Otherwise Specified. Cluster A personality disorders include paranoid, schizoid, and schizotypal personalities; of these, Paranoid Personality Disorder probably is most common in the legal arena. Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic personality. Such people may suffer from frantic efforts to avoid perceived abandonment, patterns of unstable and intense interpersonal relationships, an identity disturbance, and impulsivity. Legal issues that involve individuals with cluster B personality disorders often involve determination of causation of the person's problems, assessment of claims of harassment, and assessment of the person's fitness for employment. Cluster C personality disorders include avoidant, dependent, and obsessive-compulsive personality. Two case histories illustrate some of the complexities of assessing impairment in workers with personality disorders, including drug abuse, hospitalizations, and inpatient and outpatient psychotherapy.
   Show more

4. Literature Review

   James B. Talmage

   Pages 11–15

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec04

5. Impairment Tutorial: Personality Disorders in Disability Arena

   David J. Bourne

   Pages 12–13

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec05

6. Quick Reference: Checklist for Upper Extremity Impairment Evaluations

   James B. Talmage

   Pages 14–15

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec06

7. Question and Answer

   James B. Talmage

   Pages 16–16

   DOI: 10.1001/amaguidesnewsletters.1999.NovDec07