Permanent Impairment Ratings – Follow the Guides

For some doctors, the world of impairment ratings creates fear and anxiety.Or, on the other end of the spectrum, an adrenaline surge, and battle-ready emotions. Little is taught in most chiropractic colleges on impairment ratings and how they impact the life of a patient and reflect on the competence of the DC caring for the injured patient. This series of blogs will not only help you get in the game but will give you the tools to stay at the top of your game for years to come. If you have not read part 1, take a look so you understand how and why you should get in the impairment ratings game. Read on to lean how to follow the Guides to success.

The AMA Guides only apply to permanent impairment as they attempt to assign a percent of permanent impairment for the persons’ whole body. The purpose is to convert a human pathology or disease into a number and then convert that number into a monetary award. The Guides provide rules to evaluate patients with injuries or illnesses to translate this evaluation into an impairment number to assist legal and other compensation systems in the calculation of that monetary award. This internationally accepted methodology published by the AMA Guides is accepted in most all states’ court systems, as well as countries across the world. Some states workers compensation statutes recognize the 5th Edition while others have upgraded to the 6th Edition and some accept both. There is a difference in state regulatory rules governing workers compensation that are specific as to which Edition they accept, whereas most all states allow both Editions for personal injury cases. Chiropractors can perform impairment ratings using the AMA Guides.

One area in both of The Guides that is quite easy to ascertain a whole person impairment rating is the AOMSI method. This is applicable to most DC’s caring for personal injury cases resulting from an automobile collision affecting the cervical spine.  Using modernized software with your digital x-ray or plain film cervical spine flexion/extension lateral views you can have the software automatically measure the potential for anterolisthesis or retrolisthesis of one vertebra over another and make a determination for a potential ratable impairment. This permanent impairment can range from 4% to 25% if the difference is 3.5mm depending on the 5th or 6th Edition.

The value of AOMSI is the most reliable and standardized method of determining if spine ligamentous laxity or injury is evident, separate from the disc. The patient may not have enough laxity with measurable translation or angulation to qualify for the impairment rating, but even if it is 2mm compared to the 3.5mm for the rating qualification, (5th Edition) they still have objective measurable evidence of abnormality and injury to the ligaments. Thus, the translation measurement length has merit in the radiology report to prove injury,but it may not be severe enough to warrant the permanent impairment rating. The findings could be ratable, abnormal, or normal measurements. The images are worth their weight in gold to provide evidence of ligamentous injury. An MRI does not show this injury as the flexion and extension views are required by the Guides for plain film (digital) images. Itis important to note that more than one segmental level in the spinal region could have a ratable impairment measurement. Some patients may have 3 or 4 vertebral motor units that might add more of a percentage to their impairment. Multiple spinal segment motor units could be ratable and anther motor unit is abnormal adding a combined value of permanent impairment to the whole person. How to determine the AOMSI measurements will be described in the next blog.

For a patient suffering from personal injury, especially if they are about to enter a legal battle, an impairment rating can be the key to not only determining a monetary award but also to helping devise a recovery plan. If they understand their injury and what the recovery plan is, compliance goes up and confidence in the DC is achieved. Now that you know the importance of impairment ratings and how much they can help patients, it is time to get in the game. In a future blog, we will take things a step farther and take a closer look at how to deliver an effective impairment rating report.

Part 3 of this series will look at delivering an effective radiology-based impairment ratings report. Make sure to catch up on Part 1 of this series before moving and stay tuned for more great information to keep you at the top of your permanent impairment ratings game.


  1. TheAMA Guides 5th Edition, pages 2 and 601.
  2. TheAMA Guides 5th Edition, page 8.
  3. TheAMA Guides 5th Edition, page 13.

Permanent Impairment Ratings:

  1. Get in the Game
  2. Follow the Guides
  3. The Delivery
  4. The Final Report

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