Understanding the AMA Guides to Impairment

California’s disability evaluation guidelines previously evaluated levels of impairment to injured workers.  The state now uses the American Medical Association (AMA)’s Guide to the Evaluation of Permanent Impairment.  The AMA periodically issues new editions of the Guides at pace with advances in diagnoses, philosophy, and medical treatment.  In cases that involve the user of the AMA Guides, QMEs determine what medical reports constitute substantial medical evidence based on their evaluation.  There reports are presented to the WCAB (Workers’ Compensation Appeals Board) and all of the workers’ compensation judges to determine the level of impairment.  Several important legislation changes have influenced this process.  The passing of SB (Senate Bill) 899 put into action significant changes to the state’s workers’ compensation system.  The summary of SB 899 provides an overview of these changes.

Section 4660 PD Rating Schedule states that the “nature of the physical injury or disfigurement” shall incorporate the AMA Guides for both description and percentage of impairment.  The permanent disability rating ranging from 0% to 100% correlates to an employee’s diminished future earning capacity.  This “diminished future earning capacity” replaces the previous clause of “diminished ability to complete.”

Understanding the AMA Guides is central to a QME’s work in determining level of impairment based on the permanent disability rating schedule.  Course author Steven Feinberg, MD has written Guide to the Guides: Evaluator’s Resource Algorithm to the AMA Guides which provides an excellent overview of the principles found in the Guides.  As always the course materials can be read and reviewed for free before taking the course test for 12 hours of QME credits.