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October 15, 2002

PA Worker's Compensation and the use of the AMA's "Guide to the Evaluation of Permanent Impairment"

Expressed opinion by Michael A. Kerstetter, PFIW Dauphin County

The Pennsylvania Legislators have voted to use the American Medical Association's "Guide to the Evaluation of Permanent Impairment" for determining a disability rating for injured workers.  This is wrong, unfair and unethical!  Worker's Compensation evaluates disabilities not Impairments, there is a big difference.  The Pennsylvania Legislators know about the unfair evaluation of disability using of the AMA's "Guide to the Evaluation of Permanent Impairment" but yet they continue to allow it's use. 

Here is what the Pennsylvania Worker's Compensation Act 57 says about the AMA's guide and it's use: Section 301

Here are the reasons the AMA's "Guide to the Evaluation of Permanent Impairment" should not be used for evaluating disabilities under the PA Worker's Compensation Act:

1. The AMA itself has warned against the use of it's "Guide to the Evaluation of Permanent Impairment" for evaluating disabilities for worker's compensation.  (AMA's article about using the guide)
2. The first chapter of the most recent fifth edition of the AMA's "Guide to the evaluation of Permanent Impairment" warns against using the guide for evaluating disabilities for worker's compensation.
3. The country's leading expert, Christopher R. Brigham, MD, on the AMA's "Guide to the Evaluation of Permanent Impairment" states this: "The Guides assess impairment, not disability - regrettably they are widely used as a proxy to disability.  The Guides - Fifth Edition explain that they are not to be used as a reflection of the ability or inability to perform work.  This is outlined in Chapter 1 of the Guides."
4. Chief Administrative Law Judge, Robert J. Smith, of the State of West Virginia Office of Judges, has found that the use of the DRE Model as required in the Fourth Edition of the AMA Guides is contrary to the West Virginia workers' compensation statute.

If some official of any importance in Pennsylvania were to look at the way the AMA guide is being used for evaluations it may be found to be contrary to the Pennsylvania worker's compensation statute.  Problem is that in Pennsylvania no one wants to know if injured workers are getting a fair disability evaluation.  A review of this issue has been sent to all Pennsylvania legislators by the Pennsylvania Federation of Injured Workers but there has been no response to date.  The PFIW has also brought up this issue at the Pennsylvania Worker's Compensation Advisory Council meeting on September 19, 2002.  (The information was taken off the record because the meeting was adjourned due to a time issue.  Most of the members present at the Advisory Council stayed for an extended meeting off the record.)

What the Legislators did in Section 303 of the worker's compensation act is to change the disability rating system to an impairment rating system.  If you read the section 303, you can see how the word impairment is slipped in where it should say disability.  When a worker is permanently injured it is referred to as a disability.  This may be in conflict with the PA Worker's Compensation Statute.  Worker's Compensation is supposed to determine the disability an injured worker has due to a work related injury not the impairment.  Why?  It allows the employers/worker's compensation insurance companies to litigate workers compensation claims away to nothing.  Con artists use this technique to rip off unsuspecting people, it is called the bait and switch game.

With all of this evidence against the use of the AMA's "Guide to the Evaluation of Permanent Impairment" and nothing to support the use of the guide, why is it still being used by Pennsylvania Worker's Compensation Bureau?  Thousands of injured workers have been improperly evaluated for their work related disability.  How will these injured workers get a fair disability rating?  This can not be swept under the carpet.  Allowing the AMA's guide to be used has benefited the worker's compensation industry with windfall profits because an injured worker's claim can be terminated based on the inaccurate disability rating created by using the guide.

Where is the help for the injured worker?

When an injured worker is denied worker's compensation or the 500 weeks of partial disability runs out, what happens?  The injured worker still has the disability!  Most injured workers end up on Social Security Disability.  This is a shift of the expense of an injured worker from the employer/worker's compensation insurance company to the Social Security System.  This should outrage everyone since Social Security is in such bad shape. 

Why has the PA Legislators allowed the insurance industry to shift this expense?

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Last modified: 04/29/08