Use of the Guides in the Workers’ Compensation and Other Disability Systems
There is increased use of the Guides to translate objective clinical findings into a percentage of the whole person. Typically this number is used to measure the residual deficit, a loss--a number that is then converted to a monetary award to the injured party. The scheme is most commonly used in various workers’ compensation systems in the United States and abroad.
In the United States, 44 states, 2 commonwealths, and federal employee compensation systems (in about 90+% of US jurisdictions) either mandate or recommend using the Guides to measure impairment in workers’ compensation cases, the Guides is often used to assess damages in personal injury claims under federal statutes and state common law.
Fundamental Principles of the Guides
1. Concepts and philosophy in this chapter are the fundamental rules of the Guides; they shall preempt anything in subsequent chapters that conflicts with or compromises these principles.
2. No impairment may exceed 100% whole person impairment. No impairment arising from a member or organ of the body may exceed the amputation value of that member.
3. All regional impairments in the same organ or body system shall be combined as prescribed by the rule, at the same level first and further combined with the other regional impairments at the whole person level.
4. Impairments must be rated in accordance with the chapter relevant to the organ or system where the injury primarily arose or where the greatest dysfunction consistent with objectively documented pathology remains.
5. Only permanent impairment may be rated according to the Guides, and only after Maximum Medical Improvement (MMI) status is certified.
6. A licensed physician must perform impairment evaluations. Chiropractic doctors, if authorized by the appropriate jurisdictional authority to perform rating under the Guides, should restrict rating to the spine.
7. A valid impairment evaluation report based on the Guides must contain the 3-step approach
8. The evaluating physician must use knowledge, skill, and ability generally accepted by the medical scientific community when evaluating an individual, to arrive at the correct impairment rating according to the Guides.
9. The Guides is based on objective criteria. The physician must use all clinical knowledge, skill, and abilities in determining whether the measurements, test results, or written historical information are consistent and concordant with the pathology being evaluated. If such findings, or an impairment estimate based on these findings, conflict with established medical principles, they cannot be used to justify an impairment rating.
10. Range of motion and strength measurement techniques should be assessed carefully in the presence of apparent self-inhibition secondary to pain or fear.
11. The Guides does not permit the rating of future impairment.
12. If the Guides provides more than one method to rate a particular impairment or condition, the method producing the higher rating must be used.
13. Subjective complaints alone are generally not ratable under the Guides.
14. Round all fractional impairment ratings, whether intermediate or final, to the nearest whole number.