Workers Compensation Ama Guides

6th Edition of AMA Guides Impacts Workers' Compensation Practice

The Workers' Compensation Statute relies on the AMA Guides to the Evaluation of Permanent Impairment to determine permanent partial disability.

The statute refers to the latest edition of the AMA Guides, and the American Medical Association has published a new edition every four or five years.

The book is supposed to determine functional impairment to the body as a whole for every type of loss, from back injuries to amputations.

According to statute, the Executive Director of the Office of Workers' Claims certifies the latest edition and its effective date.

Recently, the American Medical Association published the 6th Edition of the AMA Guides and the Acting Executive Director, Phillip Harmon, certified that the 6th Edition would become effective on April 1, 2008. However, the newly appointed Executive Director, Dwight T. Lovan, has amended the certification so that the 6th Edition becomes effective July 1, 2008 and all claims filed prior to that date will be governed by the previous, 5th Edition of the AMA Guides.

This was so that lawyers and doctors would have time to read and learn to use the new Guide.

The Legislature took this up during its session, passing HB 199 which required that the 5th Edition be used until the 6th Edition can be studied.

The Senate amended the statute to include a sunset date the 6th Edition will come into use during the summer of 2009, and the Executive Director of the Office of Workers' Claims must make a report by January 2009. At that time the legislature will perhaps revisit the issue.

At a recent seminar on the new Guides, it became clear that the 6th Edition will require a great deal of effort to learn and use. The patient/claimant is to fill out a questionnaire and the doctor is to rate the injury using grids which apply to the injury and the severity of impact on the claimant's abilities to function. The book has some obvious mistakes and discrepancies in it, some of which are being addressed by the AMA.

Overall, the new guide makes it so difficult to determine a permanent impairment rating that most treating doctors will not want to take the time to do this for their patients. Already, many doctors refuse to do these evaluations because of the time and difficulty involved under the 5th Edition.

The 6th Edition encourages the use of non-treating examiners, and in psychiatric cases, states that the treating psychiatrist should avoid evaluating the patient?s impairment. The cost of a full evaluation by an independent doctor is more than the treating doctor usually charges, and in many cases will be more than the case is worth based on the impairment rating.

Most states which use the A.M.A. Guides at all tie their statutes to a particular edition, either the 4th Edition or the 5th Edition.

There may be a constitutional complaint that the determination of workers' compensation benefits cannot be delegated to a non-governmental entity such as the A.M.A. For the time being, however, workers' compensation can be practiced using the familiar 5th Edition of the A.M.A. Guides.