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AMA GUIDES

SB 899 amended Labor Code §4660 to require that "In determining the percentages of permanent disability, account shall be taken of the nature of the physical injury or disfigurement....the "nature of the physical injury or disfigurement" shall incorporate the descriptions and measurements of physical impairments and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition)."

A publication of the American Medical Association, the Guides admonish that they are not to be used to evaluate work disability, yet that seems to be their predominant use.

"Serious criticisms have been directed at the AMA Guides. First, commentaries have noted that the AMA Guides do not provide a valid, reliable, evidence-based system for the rating of impairments."  Emedicine article.

Despite the inaccuracies and lack of evidence-based medicine underlying parts of the Guides, California's Primary Treating Physicians, Qualified Medical Evaluators and Agreed Medical Evaluators have to use them to rate permanent disability. Caselaw established that, while bound by the four corners of the 5th edition of the Guides, the evaluator is not restricted to using only the tables associated with the industrial condition or body part:

"By using the word "incorporate" and retaining a prima facie standard for the introduction of the PDRS ratings, the Legislature obtained a more consistent set of criteria for medical evaluations while allowing for cases that do not fit neatly into the diagnostic criteria and descriptions laid out in the Guides. The Guides itself recognizes that it cannot anticipate and describe every impairment that may be experienced by injured employees. To accommodate those complex or extraordinary cases, it calls for the physician's exercise of clinical judgment to evaluate the impairment most accurately, even if that is possible only by resorting to comparable conditions described in the Guides. The PDRS has expressly incorporated the entire Guides, thereby allowing impairment in an individual case to be assessed more thoroughly and reliably." Guzman

SB 863 added Labor Code §4660.1 for injuries on or after 1/1/13. It replicated the language from Labor Code §4660 about using the Guides, but added "In enacting the act adding this section, it is not the intent of the Legislature to overrule the holding in Milpitas Unified School District v. Workers’ Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808."

Label Item Links Comments
Labor Code Labor Code §§4660 and 4660.1 mandate the use of the AMA Guides. LC §4660

LC §4660.1
 
Regulations/Rules  
Cases  Milpitas Unified School District v. WCAB (Guzman) (2010) 187 Cal.App.4th 808. Guzman   
Websites Excellent articles on distinction between impairment and disability, etc. with references. Medscape assessment   
Practice Tips Buy from Amazon for huge discount over AMA bookstore

Read the first two chapters.
   
Articles AMA Guides 5th Edition: Almaraz-Guzman II: The Most Accurate Impairment by Steven D. Feinberg, M.D.


Substantial Medical Evidence in an AMA Guides Case by Robert G. Rassp, Esq.
Feinberg on Guzman




Rassp on AMAG & Substantial evidence
Dr. Feinberg's report gave rise to the Guzman case, the only way out of strict application of the tables.

Rassp is the author of The Lawyer's Guide to the AMA Guides and California Workers' Compensation, 2013 Edition
Magazine Articles AMA Guides: Beyond the Tables: Interview with Charles Rondeau, Esq. Rondeau Interview
 
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