The 2008 edition--the first since 2000--has triggered a nationwide debate. Critics believe that it will lead to unfairly low disability awards. Many of us need to understand what the controversy is about.
The American Medical Association recently issued the sixth edition of the "AMA Guides to the Evaluation of Permanent Impairment." The AMA has published guides since 1958. Today, 26 states formally recognize them as sole protocol for impairment measurement. Fifteen states adopt the new editions automatically. The plaintiff bar has assiduously tried, with some success, to convince them to postpone the latest adoption.
Gregory Krohm, the executive director of the International Association of Industrial Accident Boards and Commissions, a trade association representing government agencies charged with the administration of workers' compensation systems, replied to an e-mail about what concerns regulators.
They worry that the new edition could lead to potential disagreements over results. They fear, as the plaintiff bar does, that impairment ratings would be lower. Many view this edition as the regulator's nemesis: a black box.
The editors say, on the other hand, that the new method is clearer and poses less risk of error and conflict. They say, on average, the ratings will come out about the same. Of course, lower does not by itself mean wrong.
As someone who has never been directly involved in a disability determination, I find this edition to be well thought out and exceptionally lucid. I'm not jarred by the contrast with the fifth edition, for I never became inured to using it.
Christopher Brigham is a physician who advised the AMA on the sixth edition. A few years ago, he co-authored an article that reported, according to his audit of thousands of fifth-edition actual impairment ratings, a large majority were erroneous on the high side. He says that, even when done correctly, the fifth edition's ratings don't reflect current medical knowledge, especially how to measure functional capacity.
The steps to apply the new edition are as follows: confirm the medical diagnosis specifically related to the work injury; take a clinical history; do a physical exam; perform objective tests; reference clinical studies; document patient functional history.
For each step, rate the patient on a four-point scale from no objective problem to a very severe problem. Consolidate and translate the findings into a "whole person impairment."
This latest edition gives more weight to functional evidence. Some critics say the edition goes too far and encroaches into the domain of disability rating. A construction worker may not be impaired by a damaged finger tip but a pianist could be out of work for life. That gets very close to making permanent disability findings that are applied in settling on the amount of lifetime benefits.
Some criticism is directed at AMA guides as a whole. The dean of workers' comp research, John Burton, says the sixth edition "is at best a great leap sideways." He has been arguing for more than a decade that the AMA guides are conceptually flawed. They "systematically underpredict the loss of quality of life that workers associate with the various permanent impairments."
Justifiably or not. It will take some time to resolve how the sixth Edition works its way into official use.
PETER ROUSMANIERE is a Vermont-based columnist for Risk & Insurance®.
June 1, 2008
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