The AMA Guides to the Evaluation of Permanent Impairment

The current American Medical Association (AMA) Guides, 6^th edition, were published in late 2007 and there has not been an update since then. Almost every medical assessor uses these guides when evaluating a patient’s level of injury.

Categories of the Body

There is a guide for each section of the body, such as the upper body, lower body, spine and hip, the sight system, and other parts. These are then broken down into subsections to deal with specific parts, such as arms, elbows, wrist, hands, and fingers. These external parts are classified under the upper body guide. Each subpart, such as a hand, deals with parts of fingers that have been injured, or toes on a foot.

The ICF model for Evaluations

When this edition was published, the International Classification of Function, Disability, and Health (ICF) was included to regulate how evaluations would be done, like the disability reviews are conducted for most people who claim disability. It aimed to also give consistency among all medical reviewers, although there has been some discord in the early days.

The ICF gives a method of interviewing the patient for the following determination of severity in losing one’s lifestyle and working capabilities:

• Impairments – related to significant loss of activity, bodily functions,
• Activity, or lack of – conducting daily activities, such as walking around the home, managing cooking capabilities, cleaning, or other typically normal activities,
• Participation or Engagement (Social) – living with others (or not), engaging in social events, such as family get-togethers,
• Changes in Body Functions – ease (or not) of going to the bathroom, digesting food and liquids properly, ability for self-care,
• Body Structure – changes in structure of the body and not being able to move in certain ways anymore.

Scheduled Impairments

Scheduled impairments are applied to specific body parts that affect the worker’s ability to return to work. The highest impairment award, 77 percent, would go to the worker who is unable to return to the work he did previously, due to partial or total loss of a body part. The other two levels are the 50 percent range and the 55 percent.

Unscheduled Impairments

There can be impairments to two or more parts of the body which are in different evaluation categories. There can also be one main category defined in the initial report, with a second one in a different part of the body, which becomes an unscheduled impairment rating.

In some cases, where the AMA Guide does not give a satisfactory method of evaluation, the injury can be made an unscheduled impairment. Arizona has the state code A.R.S. §23-1065(B), that specifically deals with unscheduled impairments.

Total Disability or Permanent Impairment

In extreme cases of disability or permanent impairment, for which there might also be an award provided, aside from the monthly benefit, those injuries are:

• Loss of use or separation of both hands,
• Loss of use or separation of both feet,
• Loss of separation of one hand and foot,
• Brain injury resulting in lack of comprehension, cognitive awareness, lack of decision process, and
• Injury to the spine, possible result is permanent and total paralysis of significant parts of the body (legs, arms, torso, etc.).

If you need help for handling your injury case, call a worker’s compensation attorney for first help. You are due to everything you should have in the case of permanent bodily function loss.