Impairment and Disability: Using the Guides

Abstract

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is a widely used and accepted reference for the evaluation of permanent impairment. Many individuals and entities incorrectly consider the concepts of impairment and disability to be interchangeable, but the AMA Guides defines impairment as the “loss, loss of use, or derangement of any body part, system or function.” In contrast, disability is “an alteration of an individual's capacity to meet personal, social or occupational demands, or statutory or regulatory requirements, because of an impairment.” Thus, impairment evaluation is a medical determination, but evaluation or rating of disability is “a nonmedical assessment of the degree to which an individual does or does not have the capacity to meet personal, social, occupational, or other demands, or to meet statutory or regulatory requirements.” The AMA Guides help estimate the degree to which an individual's capacity to carry out daily activities has been diminished, but the AMA Guides for the most part is based on anatomic impairment, most commonly of the musculoskeletal system. The motivations of the patient, employer, and others often determine whether an impaired person also is disabled, and the AMA Guides clearly emphasizes that “impairment percentages derived according to Guides criteria should not be used to make direct financial awards or direct estimates of disabilities.”