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.

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