When they assess impairment, examiners must determine what “loss, loss of use, or derangement of any body part, organ system, or organ function,” occurred, according to the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. At the same time, the AMA Guides cautions examiners to avoid “double dipping,” or rating the same impairment twice: “Related but separate conditions are rated separately[,] and impairment ratings are combined unless criteria for the second impairment are included in the primary impairment.” For example, it is not appropriate for an examiner who is rating spinal impairment using a Diagnosis-related estimate (DRE) category to award an additional 3% whole person impairment (WPI) beyond the baseline rating for the category because of limitation in activities of daily living (ADLs), presumably at least in part because of residual pain, and then to award a further impairment rating for pain based on Chapter 18. Rather, the AMA Guides notes that “the impairment ratings in the body organ system chapters make allowance for any accompanying pain.” Duplicative and, therefore, erroneously inflated ratings sometimes are performed by physicians who are less experienced in using the AMAGuides or those who, due to patient advocacy or other reason, want to maximize ratings.

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