Newest version of AMA Guides closes worker's claim

In Arizona, a physician should rate an injured worker's impairment using the AMA Guides most recently published before the worker's impairment.

Case name: Gutierrez v. Industrial Commission of Arizona, No. CV-10-0285-PR (Ariz. 04/21/11).

Ruling: The Arizona Supreme Court held that a worker's claim should be closed since the most recent edition of the American Medical Association's Guides did not provide a permanent impairment rating for resolved radiculopathy.

What it means: In Arizona, a physician should rate an injured worker's impairment using the AMA Guides most recently published before the worker's impairment.

Summary: A worker injured his back while working for a framing company. His claim for workers' compensation was accepted, and he underwent medical treatment. His treating physician later released him to return to work with physical restrictions. The company's insurer concluded that the worker was not permanently impaired and closed the claim.

The worker challenged the determination of no impairment. The worker's treating orthopedic surgeon relied on the fifth edition of the AMA Guides and rated the worker's resolved radiculopathy as a 5 percent permanent impairment. The insurer's doctor relied on the sixth edition, which provided no impairment rating for a resolved radiculopathy. The Arizona Supreme Court held that the worker's claim should be closed.

A rule provides that a physician should rate an injured worker's impairment using the standards in the "most recent edition" of the AMA Guides. The court said that the words "most recent" show that an evolving standard was intended. If use of the fifth edition was intended, the rule would likely have identified that edition by number. Historical practice also suggested that the newest version at the time of the impairment rating should be used. The court explained that its interpretation led to the more sensible result and allowed consideration of medical advancement.

The court also pointed out that use of the AMA Guides in rating impairment is discretionary.

Read more at the WorkersComp Forum homepage.

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