News About the AMA Guides to the Evaluation of Permanent Impairment by Tracy W. Cary

     Northeastern University Law School Dean Emily A. Spieler recently testified before Congress (Subcommittee on Workforce Protections Committee on Education and Labor) concerning the American Medical Association’s (AMA) Guides to Permanent Impairment.

     Doctors in workers’ compensation cases often use the AMA Guides to determine whether an injured worker has an impairment rating after a job-related accident. As Dean Spieler noted, The AMA Guides have been in effect since 1971 and are now in widespread use. Some states even require workers’ compensation programs to use the latest edition of the Guides. The Guides were originally designed to be used by physicians in making a scientific assessment of a worker’s level of impairment—or loss of function—due to a work-related injury. The determination of whether a worker is permanently disabled and entitled to workers compensation is based upon his or her impairment rating, which is then applied to the specific case of a given worker. For example, a worker who loses a hand may not suffer permanent disability if he or she is a teacher, but that same worker would be permanently disabled if he or she works in construction. In 2007, the AMA published the 6th edition of the Guides, and witnesses today will describe how this new edition has dramatically reduced impairment ratings for many types of conditions, without apparent medical evidence, and transparency. The 6th edition has become so controversial that many states, including Iowa, Kentucky and Vermont have decided not to adopt them. It also appears that the 6th edition was developed in near secrecy, without the transparency and consensus which should necessarily accompany the development of standards that will have widespread use by state governments. In addition, it appears that the physicians who developed this latest edition may have ties to insurance companies, and are making a profit training doctors on the use of the 6th edition, which is complicated and very difficult to apply. The National Technology Transfer Advancement Act of 1996 sets forth minimum criteria for the development of voluntary consensus standards: openness; balance of interests; due process protections; and consensus. The process used for developing the 6th edition appears to significantly deviate from these standards and is a focus of testimony before us today. Workers who are wholly dependent on this ‘grand bargain’ when they are injured on the job, are the ones paying the price. The subcommittee invited the AMA to testify today, but unfortunately, it declined.

     It is particularly troubling that doctors with ties to insurance companies would create a book in secret that provides for dramatically reduced impairment ratings for many types of conditions.  I am pleased that Dean Spieler is making Congress aware of this situation.