Understanding the AMA Guides in Workers' Compensation

The American Medical Association's Guides to the Evaluation of Permanent Impairment (or AMA Guides) is mandated for use in many workers' compensation systems. The AMA Guides are now in their sixth edition, and various states are using either the third, fourth, fifth, or sixth edition of the Guides.

In easy-to-follow language, Understanding the AMA Guides in Workers' Compensation brings you up to speed with a review of essential concepts... complete coverage of the 4th, 5th, and 6th Edition of the AMA Guides ...and a focus on the key changes.

Understanding the AMA Guides in Workers' Compensation delivers the concise, jargon-free information you need to prepare any case with confidence - and the courtroom-tested tactics to help you win it. Whether you're new to workers' compensation cases or a long-time practitioner, this expertise-filled resource will be an invaluable time and work-saving tool in every case involving the AMA Guides.

This resource is an arsenal of ready-to-use tools, techniques, and tips to help you build a better case from start to finish, including:

• Expert insight on how physicians should reach impairment ratings - and how to spot mistakes that may compromise up to 80% of all ratings, according to one study
• Case-tested guidelines for using the AMA Guides to prepare client and physician testimony
• Sample proofs that illustrate how permanent impairment can be established for various injuries
• A cross-examination guide that shows how to pick apart an opposing physician's credibility, including word-for-word cross-examinations from real cases
• Dozens of questions to confound opposing witnesses - including case-clinchers like "The Ten Most Difficult Cross-Examination Questions"
• Convenient digests of federal and state statutes and case law decisions that put a wealth of legal background at your fingertips

Understanding the AMA Guides in Workers' Compensation has recently been updated to include:

• Which conditions are not adequately covered in each edition of the AMA Guides
• The level of compliance with the AMA Guides legally required of a rating physician
• When rating physicians may deviate from the Guides and how to justify or challenge such deviations
• Which edition of the AMA Guides is legally required to be used
• How to challenge the adoption of the AMA Guides
• What the courts find or do not find persuasive when ratings made under the AMA Guides are challenged
• How the AMA Guides relate to scheduled awards
• When exactly a claimant is or is not at maximum medical impairment - for example, a claimant with a condition such as reflex sympathetic dystrophy, which may wax and wane over time
• Who is qualified to rate impairment
• Under what conditions can a fact finder apply the Guides on his or her own
• How to deal with conditions, such as pain and mental impairment, for which percentages of impairment are not provided in the AMA Guides
• How to deal with often-litigated situations such as whole-person impairments, range of motion, pain, mental impairments, and apportionment
• How a previous injury should be apportioned when (1) the old injury was not previously rated; (2) the old injury was rated under an earlier edition of the AMA Guides; or (3) an earlier version of the Guides was current at the time of the previous injury

• 1. FUNDAMENTAL PRINCIPLES
  • Origins of Scheduled Awards
  • Development of the AMA Guides
  • The Crucial Distinction Between Impairment and Disability
  • Using the AMA Guides for Direct Financial Awards to Claimants
  • Adopting the AMA Guides
  • Failure to Follow the AMA Guides
  • The Importance of Using the Correct Edition
  • The AAOS Manual
  • Comparing the AMA Guides to Scheduled Awards
  • The Whole-Person Concept, Rounding Off, and the Combined Values Chart
  • Injuries Not Covered by the AMA Guides
  • The AMA Guides and Appeals
• 2. USE OF THE AMA GUIDES FOR MEDICAL EVALUATIONS
  • When to Evaluate Permanent Impairment
  • The Process of Evaluating Impairment
  • The Evaluator's Qualifications
• 3. CHALLENGES TO THE ADOPTION AND USE OF THE AMA GUIDES
  • Are the AMA Guides Valid and Reliable?
  • Are the AMA Guides Comprehensive?
  • Constitutional and Other Legal Challenges
• 4. AMA GUIDES, FOURTH EDITION
  • Key Points in the AMA Guides
  • The 15 Most Important Changes in the AMA Guides
• 5. AMA GUIDES, FIFTH EDITION
  • Chapter 1: Philosophy, Purpose, and Appropriate Use of the AMA Guides
  • Chapter 2: Practical Application of the AMA Guides
  • Chapters 3–14: Other Systems
  • Chapter 15: Spine
  • Chapter 16: The Upper Extremities
  • Chapter 17: The Lower Extremities
  • Chapter 18: Pain
  • Exhibit 5-1 Difficult Cross-Examination Questions Under the Fifth Edition of the AMA Guides
• 6. AMA GUIDES, SIXTH EDITION
  • Key Points for Counsel
  • Preface to the Sixth Edition
  • Methodology of the Sixth Edition
  • Chapter 1: Conceptual Foundations and Philosophy
  • Chapter 2: Practical Application of the Guides
  • Chapter 3: Pain-Related Impairment
  • Chapter 4: The Cardiovascular System
  • Chapter 5: The Pulmonary System
  • Chapter 6: The Digestive System
  • Chapter 7: The Urinary and Reproductive Systems
  • Chapter 8: The Skin
  • Chapter 9: The Hematopoietic System
  • Chapter 10: The Endocrine System
  • Chapter 11: Ear, Nose, and Throat and Related Structures
  • Chapter 12: The Visual System
  • Chapter 13: The Central and Peripheral Nervous System
  • Chapter 14: Mental and Behavioral Disorders
  • Chapter 15: The Upper Extremities
  • Chapter 16: The Lower Extremities
  • Chapter 17: The Spine and Pelvis
  • Exhibit 6-1 Difficult Cross-Examination Questions Under the Sixth Edition of the AMA Guides
• 7. DIRECT EXAMINATION: USING THE AMA GUIDES TO PROVE PERMANENT IMPAIRMENT
  • Knowing What Must Be Proven
  • Laying the Foundation with the Claimant's Testimony
  • Exhibit 7-1 Sample Trial Sheet
  • Preparing the Rating Physician to Testify
• 8. FOURTH EDITION CROSS-EXAMINATION GUIDE
  • Were the AMA Guides Used?
  • Which Edition Was Used?
  • Examples of Specific Changes Between Editions
  • Training and the AMA Guides
  • The General Principles Behind the AMA Guides
  • When to Rate Permanent Impairment
  • The Physician's Report
  • The Whole-Person Rating Concept
  • Pain
  • Mental and Psychiatric Impairments
  • Focusing on All of the Impairments
• 9. SAMPLE CROSS-EXAMINATIONS UNDER THE FIFTH EDITION
  • Misreferences to the AMA Guides
  • Use of the AMA Guides to Assess Permanent Partial Disability
  • Examiners' Roles and Responsibilities
  • Examiners' Ethical Obligations
  • Upper Extremity Impairment Evaluation Protocol
  • Different Ratings Under Different Editions
  • Failure to Rate Pain
  • Combination versus Addition
  • Spinal Impairment
  • Radiculopathy Ratings
  • Whiplash
  • Carpal Tunnel Syndrome
  • Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
  • Tendinitis
  • Muscle Atrophy
• 10. SAMPLE CROSS-EXAMINATIONS UNDER THE SIXTH EDITION
  • Reading and Understanding Chapters 1 and 2 and the Glossary as Required
  • Challenging the Validity of the AMA Guides Past and Present
  • Cultural Differences
  • Required Components of Impairment Evaluation Reports
  • Accuracy of Diagnosis
  • Prejudice Against the Treating Physician
  • Rating Unlisted Diagnoses by Analogy
  • Using a Functional Assessment, Allowed by the AMA Guides, That Does Not Have Instructions on How to Score or Convert Score to Grade Modifier
  • Failure to Review Actual Clinical Studies
  • Spying on Examinee
  • Following Chapter-Specific Instructions
  • Apportionment
  • Understanding the Definition of Maximum Medical Improvement
• 11. SAMPLE PROOFS
  • Lower Back Injury
  • Herniated L4–L5 Disk Injury
  • Bilateral Upper Extremity Injury
  • Ulnar Nerve Injury
  • Back Injury
  • DRE versus ROM Model in Spine Impairment
  • Carpal Tunnel Syndrome and de Quervain's Tendinitis
  • Mental Impairment Under the Fourth Edition
  • Rating CRPS-1 Under the Fifth Edition and Deviating from the Guides' Requirement to Do So
  • Lumbosacral Spine Impairment Under the DRE Method of the Fourth Edition
• 12. JUDICIAL INTERPRETATION OF THE AMA GUIDES
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Minnesota
  • Mississippi
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • West Virginia
  • Wisconsin
  • Wyoming
  • Federal Cases
• Appendix A. THE GUIDES IN WORKERs' COMPENSATION STATUTES AND REGULATIONS
• Appendix B - OMPAIRMENT CASE LAW DECISIONS