July 3, 2021

AMA Updates Impairment Rating Guidelines for the First Time Since 2008

The American Medical Association (AMA) recently approved updates to their Guides to the Evaluation of Permanent Injury, 6th Edition, the first update to these guidelines since 2008, which are effective as of July 1, 2021.

Over 40 states utilize some version of the AMA’s impairment guidelines as the accepted authority to assess and rate permanent loss of function, and physicians use these guides to assess a patient’s impairment and document findings. Impairment rating reports appropriately produced using the AMA guidelines are considered a gold standard for documenting permanent impairment in insurance and legal proceedings.

As these guides are key to rating and establishing impairment across healthcare and in workers’ comp, understanding changes to these guides is important for workers’ comp stakeholders.

However, it is important to note that these updates may not lead to immediate change across the nation. Currently 16 states require use of the 6th edition, 11 states require use of the 5th edition, and seven states require use of the 4th edition, which was published in 1993. While there is clear precedent in using the AMA’s impairment guidelines, this new update may be utilized in a patchwork fashion across the nation, based on regulatory activity conducted on a state-by-state basis.

A majority of the guideline changes focus on mental and behavioral conditions. This 2021 update adopts the Diagnostics and Statistics Manual of Mental Disorders version five (DSM-V), while the previous 2008 guides utilized the DSM-IV-TR, an older version of the DSM.

Because evidence-based medicine and science related to the evaluation of permanent impairment associated with mental and behavioral disorders has advanced significantly since 2008, these new updates have been anticipated since 2019, where a combination of patient lawsuits and advocacy efforts from groups like the American Psychiatric Association and American Psychological Association pushed for change.

A major difference between the DSM-V and DSM-IV-TR includes the removal of a highly criticized assessment known as the Global Assessment of Functioning (GAF).

Many professionals considered the assessment to be flawed and arbitrary, and the DSM-V removed this assessment in 2013, but because the AMA’s guidelines previously focused on the DSM-IVTR, this assessment was still utilized as a necessary component for measuring psychological impairment for several years.

Now that this assessment has been removed, the averaging of final impairment ratings is likely to change on a case-by-case basis, as other, more up-to-date assessments are utilized.

In addition to this change, new psychological tests and batteries for standard neuropsychological assessment will be used for impairment ratings. Furthermore, the DSM-V removed the word “malingering” (the exaggeration or feigning of illness to escape duty or work) altogether, while also addressing the complexities of patient motivation when it comes to recovery.

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