Answers to Frequently Asked Questions about Impairment Ratings

From answering questions about what is an impairment rating, to how they should be documented, we’ve got you covered.

What is an impairment rating?

According to the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA Guides), “Impairment ratings reflect the severity of the medical condition and the degrees to which the impairment decreases an individual’s ability to perform common activities of daily living, excluding work.” In most cases, the rating is determined by evaluating loss of range of motion, loss of motor function/strength and loss of sensation. The evaluation can extend to all areas of physical and cognitive functioning. These ratings determine disability payments/benefits to injured or ill individuals.

What is the difference between permanent impairment and total disability?

The terms disability and impairment are sometimes used interchangeably, but when it comes to benefits, they mean very different things. Disability refers to limits and restrictions on a person’s ability to complete tasks, while impairment refers to the issue affecting the neurology or physical condition of the person. It is imperative that we use the correct language when talking about impairment because sometimes the two are mutually exclusive.

How should impairment be documented?

Impairment is documented using the AMA Guides to the Evaluation of Permanent Impairment, unless otherwise required. Documentation should include the use of current evidence and consensus-based science that provides a fair and consistent impairment measure. There must be an impairment and the injured party should be at maximum medical improvement with no additional beneficial treatment available.

Who should perform and evaluate impairment?

Impairment should ideally be evaluated by a board certified and active practice physician who maintains a license in the state of jurisdiction whenever possible. Impairment should only be evaluated by a provider familiar with the AMA Guides to the Evaluation of Permanent Impairment used for the claim’s jurisdiction in question, unless otherwise required.

Why are impairment ratings performed?

Impairment ratings are often used as one of the factors in determining the settlement value of a claim. There are several indications for an Independent Medical Exam for the purposes of determining permanent impairment:

  • Treating physician does not perform impairment ratings
  • Treating physician did not follow state specific regulatory guidelines for impairment rating calculation
  • Impairment rating was not supported by objective findings
  • Impairment rating does not correlate to documented injury (too high or too low)

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