What Is the American Medical Association (AMA) in a Workers’ Compensation Case?

The American Medical Association (AMA) is a national organization that sets medical standards and guidelines for healthcare professionals. In California workers’ compensation cases, the AMA’s Guides to the Evaluation of Permanent Impairment play a major role in determining the level of disability for injured workers. These guidelines help assess how a workplace injury affects a person’s ability to work.

How Does the AMA Affect Workers’ Compensation Cases?

When a worker suffers a permanent injury, their level of impairment must be evaluated. The AMA’s Guides to the Evaluation of Permanent Impairment (AMA Guides) provide a standardized method for doctors to:

• Measure the severity of an injury
• Determine functional limitations
• Assign an impairment rating based on medical evidence

California uses the Fifth Edition of the AMA Guides as part of the Permanent Disability Rating Schedule (PDRS). The impairment rating assigned by a doctor helps calculate the worker’s permanent disability benefits.

Who Uses the AMA Guidelines in a Workers’ Compensation Case?

The AMA Guides are used by:

• Treating physicians – To assess the extent of an injury and assign an impairment rating
• Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs) – To provide independent medical opinions in disputed cases
• Workers’ compensation judges – To determine benefit amounts based on impairment ratings
• Insurance companies – To decide how much compensation a worker should receive

Can an AMA Impairment Rating Be Challenged?

Since the AMA Guides play a major role in determining benefits, disputes can arise if an injured worker or their attorney disagrees with the assigned impairment rating. If there is a disagreement, the worker may request an evaluation by a QME or AME, or challenge the rating through a workers’ compensation hearing.

Need Help With a Workers’ Compensation Claim?

If you believe your impairment rating is too low or your benefits are unfairly reduced, legal guidance can help. The Law Offices of Norman J. Homen has extensive experience handling workers’ compensation claims. Contact us today for a free consultation.