Criticisms of the Use of the AMA Guidelines in Illinois Workers’ Compensation Claims

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According to the Illinois Workers' Compensation Commission, about 200,000 people in Illinois experience a work-related accident each year. Many of these injured workers turn to workers' compensation to receive benefits.

Last June, major reforms to the Illinois workers' compensation system were passed in an effort to reduce costs. This September several provisions, including the adoption of the AMA (American Medical Association) impairment guidelines, take effect.

Illinois' adoption of the AMA impairment guidelines is probably one of the lesser publicized and less understood aspects of the wider workers' compensation reform measure. The issue, however, is an important one and deserving of further attention.

What are the AMA Guidelines?

The AMA Guides to the Evaluation of Permanent Impairment (AMA guidelines) are used by several state workers' compensation systems as a way to determine impairment and quantify the seriousness of injuries.

In situations where an employee returns to work, but has restrictions or limitations, they are considered to have a permanent partial disability. Previously, factors such as the nature of the injury and accident, job description and an employee's complaints were considered in the analysis of whether the worker had a permanent partial disability. Now, for injuries that occur after September 1 st 2011, the AMA guidelines will be used by an arbitrator in determining whether an employee has a permanent partial disability.

Criticisms of the AMA Guidelines

One major criticism of Illinois' adoption of the AMA guidelines is that they were designed to determine impairment, and impairment is not the same as disability. The Chicago Tribune provided the example of the AMA guidelines giving a four percent impairment rating to a man who is 55 and has a torn biceps. Someone working at a desk job may be able to perform all their job duties with such a rating. Someone like a construction worker, however, may actually be work disabled. Thus, a minor impairment may result in someone being completely unable to do their job, and disabled for the purpose of workers' compensation.

Another major concern is the frequency of errors in determining impairment ratings. For instance, when almost 6,000 cases (most from California) were reviewed, 80 percent of ratings were found to be incorrectly applied, according to a 2010 AMA guides newsletter. These incorrect assessments can often cause injured workers to receive far less compensation than they need and deserve.

Errors are most frequently caused by lack of knowledge or inexperience of the examiner; something that seems quite likely as Illinois begins using the AMA guidelines for the first time. The conditions most prone to errors were spinal injuries, shoulder injuries and carpal tunnel syndrome.

Another criticism of the AMA guidelines is the likelihood that awards for injured workers will be significantly reduced and not adequately provide them with the financial support they require. For instance, in Nevada, a state that uses the AMA guidelines, back injuries necessitating fusion surgeries were frequently only given a 13 percent disability rating. In Illinois (prior to the implementation of the AMA guidelines) 25-35 percent was the typical disability award. In other words, monetary awards for major back injuries could potentially be cut in half after Illinois adopts the AMA guidelines.

Although it may be some time before the impact of the AMA guidelines is felt by injured workers in Illinois, the implementation of the guidelines certainly seems to make the environment for workers' compensation claims more challenging. This makes it all the more important that injured workers have a knowledgeable Illinois workers' compensation attorney to advocate on their behalf.