Most people have probably never heard of the American Medical Association’s impairment ratings. As part of the Illinois workers’ compensation reforms of 2011, these ratings are now used by physicians and considered by courts and arbitrators when evaluating workers’ compensation claims.
Unfortunately, the AMA guidelines often negatively impact the claims of injured workers, particularly those with permanent partial disabilities. An attorney, however, can present other evidence to refute the AMA impairment ratings and help an injured worker receive the compensation they need and deserve.
The Illinois Workers’ Compensation Act explains how the AMA guidelines are to be used. Section 820 ILCS 305/8.1b, “Determination of permanent partial disability,” provides that, “For accidental injuries that occur on or after September 1, 2011, … The most current edition of the American Medical Association’s ‘Guides to the Evaluation of Permanent Impairment’ shall be used by the physician in determining the level of impairment.”
A major problem with the AMA guidelines is that they attempt to define impairment instead of disability. Therefore, a worker may only be rated as having a minor impairment according to the AMA guidelines but may be disabled for the purposes of doing his or her job.
For example, a worker with a torn bicep would likely have a low impairment rating under the AMA guidelines because the individual can still perform basic functions like eating, walking and getting dressed. Despite a low impairment rating, such an injury may be completely disabling for someone doing heavy construction.
Additionally, research has shown that impairment ratings are often incorrectly assessed and applied because of examiners’ lack of knowledge or inexperience. For example, a 2010 AMA guides newsletter reported that 80 percent of ratings given across almost 6,000 cases, a majority in California, were misapplied. Errors were most frequent in spinal injuries, shoulder injuries and carpal tunnel syndrome.
Insurance carriers may use the AMA guidelines to attempt to lessen the award for an injured worker. The impairment ratings, however, are only one factor that is considered. Other factors include a person’s age, occupation, future earning capacity and medical records.
Experienced workers’ compensation attorneys know how to refute evidence based on the AMA ratings. Lawyers may present evidence from medical experts and treating physicians to help ensure injured workers receive the maximum amount of compensation for their claims.