A Scientifically Credible Approach to Impairment Ratings: Florida's History and the World's Future

Impairment ratings are an important issue for claims professionals. In state workers’ compensation systems they drive more than $20 billion of costs. In addition, they are routinely used in other arenas, including federal cases (FECA and Longshore and Harbor Workers Act), automobile casualty, and personal injury claims.

The Sixth Edition of the AMA Guides to the Evaluation of Permanent Impairment, published in 2007, is the new international standard serving as the first step in medically assessing disability. The Sixth Edition introduced a paradigm shift in assessing impairment. An innovative methodology is used to enhance the relevancy of impairment ratings, improve internal consistency, promote greater precision, and simplify the rating process. The approach is based on a modification of the conceptual framework of the International Classification of Functioning, Disability, and Health (ICF). Standardized methodology is applied to each chapter to enhance the relevancy of impairment ratings, improve internal consistency, and promote ease of application to the rating process.

An analytical framework based on the ICF generates five impairment classes that permit the rating of the patient from no impairment to most severe. A diagnosis-based grid has been developed for each organ system that arranges commonly used ICD-9 diagnoses within the five classes according to the consensus-based dominant criterion. Functionally based histories, physical findings and broadly accepted objective clinical test results are integrated where applicable to help physicians determine the grade within the impairment class.