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Christopher R. Brigham
,
W. Frederick Uehlein
,
Craig Uejo
, and
Leslie Dilbeck

Abstract

This article addresses a number of issues regarding impairment evaluation and the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, impairment is not synonymous with disability, and, as noted in the sixth and previous editions of the AMA Guides, no direct correlation exists between impairment and work restrictions or loss of earning capacity. An impairment rating does not directly equate to a permanent disability rating and does not solely determine compensation. The AMA Guides creates the opportunity for consistency of impairment ratings among physicians, but impairment ratings must be performed according to standards defined in the AMA Guides. Impairment rating values and methods in the AMA Guides can change between editions based on medical reasons. It is too early to determine the effects of changes in the sixth edition of the AMA Guides pending the accumulation of adequate experience using this edition, until impairment ratings associated with specific diagnoses can be compared, and until an adequate sample of cases can be evaluated and compared using the fifth and sixth editions. Use of the sixth edition may result in some lower impairment ratings, but this edition also expands the number of ratable conditions compared to previous versions. Finally, impairment determination is a medical issue, and more reasonable approaches should be developed to translate impairment into financial rewards.

in AMA Guides® Newsletter
Christopher R. Brigham
,
Craig Uejo
,
Leslie Dilbeck
, and
W. Frederick Uehlein

Abstract

The goal of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is “to provide a standardized, objective approach to evaluating medical impairment,” resulting in reliable, reproducible impairment ratings with high levels of interrater consistency. The authors reviewed 6233 impairment ratings that took place between July 2006 and January 2010 that reflected 11991 ratable diagnoses and found poor interrater reliability (78% disagreement rate). A previous study conducted in 2005 was published in The Guides Newsletter (May/June and July/August 2006 issues) and evaluated 2100 cases for impairment rating review and found that 80% of ratings resulted in different outcomes when reviewed by an expert reviewer. The current study found an average difference of 10.0% whole person permanent impairment (WPI) between the original WPI ratings calculated with the fifth edition and the revised ratings after expert review; the 2005 study found a similar difference, 9.9% WPI. The reasons for poor interrater reliability with fifth edition ratings are many and include inaccurate clinical and causation analysis, failure to use the AMA Guides appropriately, and bias. The error rate in this study was lowest for patients in Hawaii, where the AMA Guides, Fifth Edition, has been used since 2001, only a relatively small number of authors who have been trained in the use of the AMA Guides perform the evaluations, there is no systematic coaching by attorneys about how to use the AMA Guides, and impairment ratings are routinely reviewed to determine their accuracy.

in AMA Guides® Newsletter
Christopher R. Brigham
,
Marjorie Eskay Auerbach
,
James B. Talmage
,
Robert Barth
,
Craig Uejo
,
Mark Melhorn
, and
Leslie Dilbeck

Abstract

The application of the processes defined in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) should result in reliable impairment ratings, ie, reproducible impairment ratings when the AMA Guides is applied appropriately. This article reviews some of the causes of erroneous impairment ratings based on misapplication of the fifth edition. The first two chapters of the AMA Guides provide the principles of assessing impairment, a key of which is that physicians must be independent and unbiased. Treating physicians cannot be unbiased because they inherently have a patient advocacy role, and they may use approaches that will increase the patient's impairment rating. Clinical and causation errors are common in evaluations; the greatest source of error is examiner inexperience. Evaluations should take place only when the patient is at maximum medical improvement, and evaluators must distinguish between impairment related to the alleged injury and that due to other injury, degenerative disease, or illness, not self-reports. A box shows common causes of erroneous impairment ratings based on the fifth edition. Both the rating physician and the party requesting the rating should recognize the high likelihood of error and should become knowledgeable about the AMA Guides, and the evaluating physician should have had formal training regarding use of the AMA Guides and should possess demonstrated competency in assessing impairment.

in AMA Guides® Newsletter