In Dr. Ray's Blog

AMA Guides® to the Evaluation of Permanent Impairment


For over 50 years, the AMA Guides® to the Evaluation of Permanent Impairment (AMA Guides®) have been the trusted authoritative source that physicians, patients, and regulators rely on for fair and consistent impairment rating information and tools. The AMA Guides® provide physicians with certainty that they are following the most current best practice and also play a key role in supporting fair and timely resolution of impairment-related claims, enabling patients to easily navigate on an administrative process that can  be burdensome at a time when they need to focus on their health and wellness.

The AMA Guides® provide a reliable, repeatable measurement framework for permanent impairment in patients that have suffered an injury or illness that has resulted in long-term loss of a body part or reduction of body function. Once a patient has reached Maximum Medical Improvement, physicians and authorized practitioners use the AMA Guides® to assess a patient’s impairment and document findings in an report. A properly completed impairment rating report produced using the most current AMA Guides® content is the gold standard for measuring permanent impairment.

Impairment ratings and impairment rating reports produced using the AMA Guides® are used extensively in the United States and abroad as a critical input to determining fair compensation for patients with work related injuries . Importantly, this determination of appropriate compensation is the realm of state legislation and regulation, not medicine. As such, development of compensation models is beyond the scope of the AMA Guides®; each jurisdiction makes its own determination of appropriate compensation formulas.

Curated through a transparent, stakeholder-driven panel process, the AMA Guides® represent the best medical practice. The AMA strongly recommends that states consistently adopt this best practice to quantify impairment, and apply compensation formulas and/or jurisdiction-specific adjustments only after a standard AMA Guides® impairment rating has been completed.

Recent Developments

In 2019, based on extensive industry feedback from physicians, state and specialty medical societies, regulators, and other industry stakeholders, the AMA initiated a program to update and modernize the AMA Guides®.

Key elements of that program include:

  • The AMA has convened diverse experts with deep expertise across a broad range of medical topics to serve as the AMA Guides® Editorial Panel (the Guides Panel). This group includes physicians, allied health professionals and regulatory and legal advisors with a shared objective:
    • Serve patients, physicians, government entities and related stakeholders by incorporating the best available information, science, evidence-based medicine, and tools within the AMA Guides® to the Evaluation of Permanent Impairment in order to enable fair and consistent evaluations.
  • The Guides Panel will utilize a transparent, stakeholder-driven process based on published criteria to evaluate proposals for changes to the AMA Guides®. This approach is designed to promote updates to the AMA Guides® that are rooted in evidence-based medicine whenever possible, and that represent the best available medical science.

The AMA is committed to reducing physician burden. With that in mind, the AMA Guides® will be delivered in a format that reduces the workload on the practitioner, while guiding the process to mitigate the risk of administrative error or oversight. Providing the AMA Guides in this form will increase quality and consistency while reducing the effort required to produce an impairment rating report.


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