Use of the Guides in the Workers’ Compensation and Other
Disability Systems
Workers’ Compensation
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.
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