Flawed Promises: A Critical Evaluation of the American Medical Association’s Guides to the Evaluation of Permanent Impairment
Harvard Law Review, Vol. 103, p. 964, 1990
14 Pages Posted: 16 May 2010 Last revised: 8 Aug 2010
Date Written: 1990
Since the 1980s, the American Medical Association’s Guides to the Evaluation of Permanent Impairment has come to play a dominant role in numerous compensation programs, especially workers’ compensation. Disability payments under many state workers’ compensation systems now heavily rely on impairment evaluations made according to the AMA Guides. This review-essay, which examines the third edition of the AMA Guides, shows that the Guides is not the objective, medical evaluative system that it purports to be and that has been so appealing to legislators. Instead, like any impairment rating scheme, it relies on important normative judgments that, in the case of the Guides, are often hidden or poorly explained. Not all the problems associated with the Guides stem from the book’s own flaws. Medically or scientifically authored ratings schemes can offer useful insights into the nature and measurement of various losses. Judges, lawyers, and legislatures have often misunderstood the relationship between impairment rating systems and different aspects of disability. Legal systems should make use of the Guides only in specific and defensible ways as described in this review-essay.
Keywords: disability, impairment, impairment ratings, workers' compensation
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