In most Australian jurisdictions (states and territories), the American Medical Association Guides (AMA Guides) are the accepted assessment tool for injured workers’ permanent impairment rating. The problem with many AMA Guides (especially the older versions in use such as the AMA Guides 4th ed in Victoria) is that the rated impairment does not take into account the impact the impairment has on the injured worker. What should be measured is disability – that is, how the impairment really affects the injured worker.
The American Medical Association (AMA) has been (and still is) under fire for what experts are calling a reckless assault on injured workers’ care, causing ongoing injury to injured workers by disseminating false and misleading information about the diagnosis of reflex sympathetic dystrophy (RSD) also referred to as complex regional pain syndrome (CRPS Type I).
AMA Guides recklessly disregard RSD/CRPS
In June 2012, we published an article entitled ” WorkCover state the AMA guide does not recognise chronic pain” outlining that [WorkCover states]the AMA guides does not recognise (rate) chronic pain and how does this impact injured workers who, for example suffer from really extremely painful, debilitating complex regional pain syndrome (CRPS), aka as Reflex Sympathetic Dystrophy (RSD).
Under the WorkCover legislation physical injuries must be assessed in accordance with The American Medical Association Guides For The Evaluation Of Permanent Impairment. And that, folks, is the real big problem!
Although these Guides are now in their sixth edition, the WorkCover legislation in Victoria for example requires the fourth edition to be used. They are just about 20 years old and they are banned in civilised countries such as Canada and the USA.
The use of the AMA guide (4th Edition) is based on pseudo science and designed to do only one thing: to stop people — especially the most vulnerable — from being fairly compensated.
For an overview on how the AMA Guides 4th edition rate “pain”, including CRPS/RSD, see our previous article: WorkCover state the AMA guide does not recognise chronic pain
In addition to the flawed AMA 4th Ed as used in Victoria, the states that use the AMA Guides 5th Edition, such as for example NSW, also inflict further insult to such painful injuries.
The (US) Chairman of the Scientific Advisory Committee of the International Research Foundation for RSD/CRPS filed a complaint which was disregarded by the AMA
In 2003, a member of the AMA and Chairman of the Scientific Advisory Committee of the International Research Foundation for RSD/CRPS (Dr. Anthony Kirkpatrick) filed a complaint with the AMA putting the AMA on notice that it was causing ongoing injury to patients by disseminating false and misleading information about the diagnosis of reflex sympathetic dystrophy (RSD) also referred to as complex regional pain syndrome (CRPS Type I).
Dr Kirkpatrick wrote: “The false assertions by the AMA are particularly egregious because RSD/CRPS is a syndrome that must be treated in a timely manner in order to avert exacerbation of symptoms leading to irreversible impairment and suffering. I have personally witnessed patients with RSD/CRPS lose hope and commit suicide following denial of authorization for care by insurance carriers.”
There are countless injured workers who suffer from this debilitating, chronic, neurological syndrome. The syndrome can start after minor trauma, such as one caused for example by a sprained finger, or following minor trauma. But it can also be triggered by surgery or repetitive vibration motion — such as the kind that comes from a jackhammer or weed-cutting tool. While the cause of the disorder remains largely unknown, experts believe it is the result of a malfunction or misfiring in the body’s sympathetic nervous system, the part of the nervous system that regulates involuntary reactions to stress. The injury heals but the pain continues.
As RSD progresses over time, especially without treatment, the syndrome tends to become more unresponsive to treatment. Hence, early diagnosis and treatment are imperative. RSD can remain localised to one region of the body indefinitely. In other cases, it spreads to large segments of the body spontaneously or by trauma leading to permanent deformities and widespread immobility of limbs. At an advanced stage of the illness, all patients develop significant psychiatric problems and narcotic dependency, and are left completely incapacitated. Some commit suicide.
The critical issue that was raised by Dr Kirkpatrick is contained in the AMA GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT, 5th Edition (as is currently in use in NSW)
On page 496, the clinical guidelines state that there “must” be at least eight (8) concurrent, objective signs for RSD in order to make the diagnosis. The AMA clinical guidelines refer to objective diagnostic criteria such as changes in skin temperature, color, sweating, swelling, etc. Dr Kirkpatrick informed the AMA, “…nowhere in the scientific literature will you find such stringent criteria for the diagnosis of RSD/CRPS.” The latter has been corroborated by many renowned pain specialists.
However, despite numerous complaints and pleas for amendment of the AMA Guides, the AMA believes that it is acceptable to publish stringent diagnostic criteria for RSD (in the 5th ed).
Diagnostic information published by the AMA must be unbiased, scientific, evidence-based, and peer-reviewed. Yet, when confronted with its error, the AMA refuses to set the record straight and stand accountable before the public.
The harm cause by the AMA Guides is devastating to countless injured workers
The harm caused by the AMA’s (5th ed) error has been devastating to injured workers with RSD.
An injured nurse was recently denied workcover insurance approval for treatment of her severe RSD of her right arm. A favourite”IME” “occupational phsyician” (well paid) by the workcover insurance company used the AMA’s harsh, but incorrect, diagnostic criteria for RSD to deny approval for treatment and the injured nurse was even accused of “faking” her injuries!
According to the International Research Foundation for RSD/CRPS, Sarah’s battle with RSD began when she was hit with a softball. She says, “I went to therapy and it kind of made me feel like I was kinda crazy but, I knew I wasn’t, but I was like really suicidal.” Sarah’s mother is livid about the AMA’s conduct. “Sarah had only two objective findings to support the diagnosis of RSD. If we would have waited until all eight objective findings were found before reaching a diagnosis of RSD, as published by the AMA, we would have lost a very special young lady and that to me is unthinkable. The fact that these people with the AMA are willing to prolong pain and suffering for these children and parents is deplorable. If a parent was to withhold medical care from their child then they would be charged with a crime; where is the difference?”
Injured workers (and TAC victims) from all walks of life fall victim to this terrible health care nightmare created by the AMA, and adopted by our workcover legislation.
As stated on the International Research Foundation for RSD/CRPS, “The last thing patients need now is incorrect and seemingly bogus clinical guidelines published by the AMA that are so restrictive that they prevent the diagnosis and treatment of a potentially catastrophic and lethal illness”.
They may never be able to work again and yet they will not ever qualify for even a meager “lump sum”, let alone a common law damages claim.
Related articles and further reading
- International Research Foundation for RSD/CRPS
- WorkCover state the AMA guide does not recognise chronic pain
- AMA Guide 4th Edition evaluation of permanent impairment handbook
- Impairment rating of neuromusculoskeletal conditions: http://emedicine.medscape.com/article/314420-overview
Do you, like Judy, read legal cases or stories involving considerable sums of compensation payouts to injured workers and wonder why it is that you did not receive any such compensation (payout) from workcover, even though you are badly injured and may never work again? If you do, read on as we’ll explain how this “compensation” works in Victoria and hope it all makes some sense.
With the recent rise in workcover, common law and civil claims involving alleged psychiatric injury, knowledge of how psychiatric impairment is assessed is critical to determining whether an injured worker is entitled to a lumpsum or general damages.
The decision of a Medical Panel can only be appealed on very narrow grounds. It is only possible to appeal the decision if the Panel has made legal error.
The Bundaberg District Law Association has warned Queensland’s workers’ compensation system would plunge into deficit with the planned introduction of impairment thresholds. The Association also highlights the undeniable fact that impairment thresholds are arbitrary, unfair and utterly disregard the particular personal circumstances of an injured person.
Referring back to WorkSafe Victoria’s CEO (and high-rise plonker) has recently been demanding that common law rights be slashed and in the wake of the recent cruel NSW workcover reforms, which include an increase in the level of permanent impairment threshold to be entitled for a lumpsum and common law damages, not to mention the current “review” which is going on in QLD,we are really baffled and perplexed as why workcover schemes and their stakeholders continue to push for increased thresholds when there is ample evidence of spectacular failure in other jurisdictions/states.
Without the full and informed consent of the patient, the AMA generally sees no role for an employer in our consultation room.
A very loyal reader and good friend of ours has come across and so kindly shared the User Handbook to the AMA 4th Edition Guide to the Evaluation of Permanent Impairment, which is still used in many states to assess how the whole person impairment is calculated.
AMA Guide 4th Edition evaluation of permanent impairment handbook
Permanent impairment and lumpsum
You may be entitled to a lump sum payment if you are left with a permanent impairment because of your work injury. Unlike a common law damages claim, this is a no fault benefit, so you do not need to establish that your employer has been negligent.
The benefit is calculated in accordance with a formula depending on the level of impairment you are assessed as having. An independent doctor would need to examine you in accordance with a guide published by the American Medical Association (In Victoria and some other Australian states it is the 20 year old 4th edition).
The criteria for entitlement to a lump sum claim are tough and claims can be rejected by WorkSafe. The best rule if you are considering making a lump sum claim is therefore to get legal advice.
As a general rule, you must have suffered 10% physical permanent impairment as assessed by WorkSafe Vic (sometimes 5% for certain injuries like arm, leg, back). Here’s a rough guide:
|30% psychiatric impairment:||$69,540|
Though? Yeah…real tough!
At first glance one would think that we have a what appears to be a reasonable, standard “guide” in place (The AMA guide 4th Edition) to assess the level of permanent impairment for each injured person…
Did you know that the AMA Guides 4th Edition were published in 1993,they are just about 20 years old!
Under the current workers compensation system the kinds of injuries that would be denied compensation include:
- vertebral fractures resulting in up to 25% compression with ongoing pain : 5-8% total body impairment rating!
- spinal fusion requiring multiple surgeries with ongoing pain : up to 14%
- surgically treated disc lesion with ongoing pain: 10%
- pelvic fractures with displacement deformity: 2-10%
- disorders restricting ability to walk up mild gradients and stairs, sit down in deep-chairs, rise to a standing position or walk long distances 1-9%
- brief repetitive or persistent alteration of state of consciousness or awareness 0%-14%
In NSW the new draconian compensation law now also states that lump sum payments are only available for serious permanent injuries, which are defined as greater than 10% WPI.
In Victoria (and most other states) Impairment benefit compensation is determined in accordance with a formula set out by law, dependent of the level of impairment you are assessed as having and the date of your injury. Once the level of impairment is accepted, you cannot negotiate on the amount of compensation that you are entitled to.
To receive any compensation for a psychiatric injury, you need to be assessed as having at least a whopping 30% whole person impairment (primary psychiatric injury).
AMA Guide 4th Edition
This handbook to the AMA “Guides to the Evaluation of Permanent Impairment” 4th Edition is from New Zealand, but they too are based on the AMA 4th Edition & the worksheets & descriptions of how the ‘whole person’ permanent impairment is calculated may just help you to understand the system too!
- can I claim a lumpspum under workcover?
- The current workcover system for impairment rating is not fair at all
- Medical Panel or a judge
- The AMA 4th Edition does not recognise pain
[Post entirely entered by T on behalf of workcovervictim who is suffering from yet another nasty shoulder dislocation… ]
We received an email overnight from an injured worker pointing to a submission as recently made to the Joint Committee into the workers compensation NSW scheme. The submission raises interesting and very important questions, namely that WorkCover states the AMA guide does not recognise (rate) chronic pain and how does this impact injured workers who, for example suffer from -yes, really-debilitating complex regional pain syndrome (CRPS)?