Legal Update: An Alternative for Rating Impairment in Injured Workers

The International Association of Industrial Accident Boards and Commissions (IAIABC) is an organization of medical directors, administrators, and administrative jaw judges for workers' compensation systems. It was founded in 1914, shortly after the first workers' compensation laws were enacted in the United States. Its current membership represents 41 US states, the District of Columbia, Puerto Rico, 9 Canadian provinces, and 3 other governments. The IAIABC exists to provide a forum for education on and discussion of the various medical, legal, and administrative issues in workers' compensation systems.The IAIABC has recognized a number of problems inherent in the process whereby physicians rate permanent impairment in injured workers using the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (currently in its fifth edition). The current AMA Guides is supposed to provide a uniform methodology for rating permanent impairment; however, multiple physicians evaluating the same patient, and each claiming to rate impairment “according to the AMA Guides,” frequently assign ratings that vary excessively. When an injured worker receives vastly divergent impairment ratings from different physicians, the result is often patient anger, litigation, and increased cost of claim closure.In 2001 the IAIABC formed an Occupational Impairment Rating Guide Committee to study the AMA Guides and suggest revisions specific to workers' compensation. Fifteen physicians experienced in both workers' compensation issues and impairment rating and 2 PhDs have worked as a committee on this project. The current working iteration has been posted on the IAIABC Web site (www.iaiabc.org). The committee's goal is to create a supplement to the AMA Guides for jurisdictions to consider for adoption. The supplement would in some cases clarify and in others replace the methodology of the AMA Guides to make impairment rating more uniform and consistent.The IAIABC Guides has been developed to address impairment of the musculoskeletal system and impairment due to chronic pain. There is no current plan to write supplemental guides for impairment of the other body systems as the committee feels that the AMA Guides is adequate to rate these much less common injuries and illnesses.The committee's goal is to describe commonly occurring injury scenarios in mutually exclusive impairment rating categories so that it will be very clear into which rating category an injured worker's problem should be placed. If all physicians who see an injured worker are forced to agree that, based on the medical information, there is only one answer to the impairment rating question, claims should be resolved more promptly.The basic IAIABC Guides methodology has been supplemented with additional rating schedules, or “addons,” to adjust for objectively verifiable case severity and complications. For those jurisdictions that require it, a methodology for apportionment has also been developed. An example of an additional schedule is that for patients with back injuries who have believable complaints and symptoms but no objective findings. According to the AMA Guides, these patients qualify for a diagnosis-related estimates (DRE) rating of Category I, or 0% impairment. Plaintiffs' attorneys will frequently send these patients for evaluation to physicians who may report findings not seen by other physicians, and who thus rate these patients with DRE Category II, or 5% impairment. Under the IAIABC system, these cases would receive a 3% impairment rating based on the presence of symptoms (back pain) that persist for more than 6 months. Every physician who sees these patients would agree that the pain has been present for 6 months and that no other major findings are present;thus, each physician would rate these patients as having a 3% impairment. The need for multiple independent medical evaluations and “dueling doctor depositions” Is thus eliminated.The IAIABC Guides has not been adopted by any jurisdiction, nor has it been tested to determine with certainty the extent to which it would reduce litigation and thus cost. It is very similar to the guidelines from the state of Utah. Utah's modification of the AMA Guides has proved very successful in decreasing the frequency of workers' compensation litigation.The AMA has begun the process for producing a sixth edition of its Guides. As the AMA and the IAIABC are engaged in active dialog during the development process, some of the IAIABC Guides principles may be incorporated into the sixth edition of the AMA product.

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