It would have been great if this study had been published ten years ago. Note that I am coming from a workers’ comp background here and have done work across multiple states and Canadan provinces.
Since 2007 there has been far more heat than light generated by discussion of the impact of various editions of the AMA Guides on WC systems around the world. In part the controversies relate to the woeful lack of measurement of the relative generosity of the various editions. Yet everyone knows that there can be major changes across editions. And of course, not all jurisdictions use the Guides, not all use the same edition (as the article correctly noted) and impairment rating as a concept is not even close to universal.
If the AMA ever gets around to generating a new edition, it would be refreshing to see the AMA itself issue a set of studies at the outset that would help policy makers consider changes in ratings. As it is, they just do a bit of hand waving about how it shouldn’t be the only determinant of benefits. They could do much better.
The AMA Guides Guides to the Evaluation of Permanent Impairment where created as a standardized process to equally and hopefully equitably evaluate individual permanent impairment based on a common application of the particular edition utilized. Ontario Auto Insurance and WSIB utilize the 4th Edition. The 5th and 6th editions were created to reduce compensation costs not to improve the process per se. The important factor is that whatever Edition is used everyone accessing the system “should” be treated and evaluated utilizing the same process. It has long been known the purpose and impact on the scoring of each subsequent Edition of the Guides. There have been court decisions, (jurisprudence) in the USA that has determined as much. The potential differences in the scoring outcomes between subsequent Guides Editions have posed legal challenges in various jurisdiction in the USA. Some of the State Legislation requires that the most recent Guides Edition be utilized rendering individuals who had impairments rating and subsequent compensation based on lower Edition with greater benefits than those found impaired today using the 5th and or 6th Editions. The challenges being that this was discriminatory, violating the ADA Americans with Disabilities Act, where it is not legal to discriminate on the grounds of disability. As one trained and qualified to provide Guides Whole Person Impairment Ratings, (WPIR’s), there are other challenges of equal concern regarding the statutory application and use of the Guides regardless of the Edition utilized. First and foremost is the authority of the particular Triers of Fact who can and do interpret methodology that directly impact scores and in turn benefit eligibility. The Triers of Fact are only required to utilize the Guides to “assist” and guide them in rendering decisions regarding rating score disputes. There is a good explanation of this from FSCO Arbitrator, Huberman in the Czombose decision. The training and qualifications of the individuals rating and providing the scores for applicants has no standardization. I took my training in the USA from an organization specifically sanctioned by the AMA to provide Guides training, this is not required in any Canadian jurisdictions as it is in most other US jurisdictions who statutorily utilize the Guides. Utilizing a physician specialist has little to no guarantee, without specific AMA sanctioned Guides training, that one will obtain a proper WPIR score either. It remains imperfect the process of utilizing the Guides to provide a WPIR score. That said I feel it is still the fairest most applicable process to adjudicate benefit eligibility.
It would have been great if this study had been published ten years ago. Note that I am coming from a workers’ comp background here and have done work across multiple states and Canadan provinces.
Since 2007 there has been far more heat than light generated by discussion of the impact of various editions of the AMA Guides on WC systems around the world. In part the controversies relate to the woeful lack of measurement of the relative generosity of the various editions. Yet everyone knows that there can be major changes across editions. And of course, not all jurisdictions use the Guides, not all use the same edition (as the article correctly noted) and impairment rating as a concept is not even close to universal.
If the AMA ever gets around to generating a new edition, it would be refreshing to see the AMA itself issue a set of studies at the outset that would help policy makers consider changes in ratings. As it is, they just do a bit of hand waving about how it shouldn’t be the only determinant of benefits. They could do much better.
The AMA Guides Guides to the Evaluation of Permanent Impairment where created as a standardized process to equally and hopefully equitably evaluate individual permanent impairment based on a common application of the particular edition utilized. Ontario Auto Insurance and WSIB utilize the 4th Edition. The 5th and 6th editions were created to reduce compensation costs not to improve the process per se. The important factor is that whatever Edition is used everyone accessing the system “should” be treated and evaluated utilizing the same process. It has long been known the purpose and impact on the scoring of each subsequent Edition of the Guides. There have been court decisions, (jurisprudence) in the USA that has determined as much. The potential differences in the scoring outcomes between subsequent Guides Editions have posed legal challenges in various jurisdiction in the USA. Some of the State Legislation requires that the most recent Guides Edition be utilized rendering individuals who had impairments rating and subsequent compensation based on lower Edition with greater benefits than those found impaired today using the 5th and or 6th Editions. The challenges being that this was discriminatory, violating the ADA Americans with Disabilities Act, where it is not legal to discriminate on the grounds of disability. As one trained and qualified to provide Guides Whole Person Impairment Ratings, (WPIR’s), there are other challenges of equal concern regarding the statutory application and use of the Guides regardless of the Edition utilized. First and foremost is the authority of the particular Triers of Fact who can and do interpret methodology that directly impact scores and in turn benefit eligibility. The Triers of Fact are only required to utilize the Guides to “assist” and guide them in rendering decisions regarding rating score disputes. There is a good explanation of this from FSCO Arbitrator, Huberman in the Czombose decision. The training and qualifications of the individuals rating and providing the scores for applicants has no standardization. I took my training in the USA from an organization specifically sanctioned by the AMA to provide Guides training, this is not required in any Canadian jurisdictions as it is in most other US jurisdictions who statutorily utilize the Guides. Utilizing a physician specialist has little to no guarantee, without specific AMA sanctioned Guides training, that one will obtain a proper WPIR score either. It remains imperfect the process of utilizing the Guides to provide a WPIR score. That said I feel it is still the fairest most applicable process to adjudicate benefit eligibility.