Many physicians were not formally trained in the evaluation and management of disability and must understand the language of disability, how disability is evaluated, what to expect from a medical evaluation, and how to communicate effectively to achieve the best outcomes. The very language of disability is complex and often is misunderstood. For example, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines impairment as “a significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder, or disease.” In contrast, disability is variously defined by the administrative or legal system with jurisdiction, and the AMA Guides broadly defines disability as “activity limitations and/or participation restrictions in an individual with a health condition, disorder, or disease.” Another useful concept is “needless disability” or days away from work that are not medically necessary; workless populations experience a two- to threefold increased risk of poor general health, including higher rates of cardiovascular disease, lung cancer, and respiratory infections, among other problems that contribute to an excess mortality of 20% among individuals in this group. Physicians help establish but are not the final arbiters of disability determinations; their role is to provide accurate, complete, and clear information that allows others to determine the presence, extent, and compensability of disability.

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