What Is an Impairment Rating?
If an individual is injured in an accident or at work, they receive medical care and hopefully will not sustain any kind of long-term impairment. After appropriate medical treatment, the individual reaches what is called Maximum Medical Improvement (MMI). MMI refers to the point in a patient’s treatment where their medical condition has stabilized and is unlikely to improve significantly with further medical intervention. It does not necessarily mean that the patient has fully recovered, but rather that their condition has reached a plateau where no substantial change, better or worse, is expected despite ongoing care. At the point of MMI and Impairment Rating can be obtained. Impairment ratings are given as a percentage to evaluate how the person is doing when compared to pre-injury state.
An impairment rating is provided as a percentage used to quantify the extent of an injured worker’s permanent physical or functional limitations resulting from an injury. Impairment ratings are used to describe the degree to which an individual’s normal bodily functions have been altered. Impairment Ratings are typically based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment. The Impairment Ratings make up an important component of most worker’s compensation claims, as well as personal injury cases.
What are impairment ratings used for?
Healthcare payors often use impairment ratings to calculate payouts for disability benefits or workers’ compensation. A higher impairment rating typically results in larger compensation amounts. The calculation of an impairment rating takes into consideration factors such as: occupation, age, and state-specific laws.
What is the role of impairment ratings in compensation?
Impairment ratings play a crucial role in determining the compensation an individual may be entitled to after an injury. These ratings measure the degree of permanent impairment following an accident or illness and directly impact insurance or workers’ compensation claims.
Why are accurate Impairment Ratings important?
Impairment ratings can greatly affect the amount of money paid to rehabilitate an injured worker, or the amount with which a claim is settled. Settlement amounts are based on a formula that includes the impairment rating. Both the payor and the claimant strive to make sure the compensation is fair and equitable. Permanent partial disability injuries account for approximately 50% of all workers compensation costs, with impairment ratings playing a key role in most states. Because of this, inaccurate impairment ratings can have a significant impact on workers compensation costs. Currently it is estimated that impairment ratings can vary between 4% and 11%. That can make a significant difference in insurance claim settlement costs.
How do I get an accurate impairment or disability rating?
This is where BICMD comes in! Our Best In Class Doctors offer a completely unbiased and accurate evaluation for any type of impairment or disability claim. We can provide permanent-impairment assessment on the basis of a medical file review. You will receive our impartial expert assessment of maximal medical improvement (MMI) and the permanent impairment rating. This process includes clinical analysis by an expert that are documented and consistent with jurisdictional and system requirements.
What does a BICMD unbiased review of disability or impairment include?
We provide you with an emailed summary and a detailed written report. If there is not adequate data, we can advise you on how to obtain it by requesting specific information from the treating physician or we offer an independent medical evaluation. BICMD is also experienced in translating impairment ratings into state-specific disability ratings and in assessing Global Assessment of Functioning.
BICMD will also provide you with:
- Chronological summary
- Timeline of treatment
- Clinical summary
- Clinical analysis and discussion, including specific issues requested
- Impairment analysis with detailed explanation of the rating process
- Impairment rating analysis to give to the treating physician for agreement.
Guide to Impairment Ratings – FAQs
What is an Impairment Rating?
An Impairment Rating (IR) quantifies the extent of a person’s permanent loss of bodily function following an injury or illness. It reflects a medical determination of the degree to which an individual’s body structure or function has been permanently altered, based on evidence-based criteria, most commonly from the AMA Guides to the Evaluation of Permanent Impairment.
How is Impairment Different from Disability?
- Impairment: A medical concept; a significant deviation, loss, or loss of use of any body structure or function.
- Disability: A broader social concept; it refers to limitations or restrictions in daily activities or participation in the workforce.
Someone may have an impairment but not be disabled — for example, a desk worker with a minor knee injury — while another person with minimal impairment may be significantly disabled, such as a concert pianist with a finger injury.
Why Are Impairment Ratings Important in Workers’ Compensation?
Impairment ratings are central to workers’ compensation systems. They often determine whether an injured worker qualifies for permanent benefits, the amount of compensation, and how long payments are made. In some jurisdictions, ratings above or below a defined threshold can even mean the difference between limited benefits and lifetime awards.
How Accurate Are Impairment Ratings?
Unfortunately, impairment ratings are frequently inaccurate. Studies show a 78% disagreement rate among ratings, with differences often exceeding 10% Whole Person Impairment (WPI) even among skilled evaluators. Errors typically arise from lack of physician training, incorrect clinical assessments, biases, or premature ratings before Maximum Medical Improvement (MMI).
How Can Employers, Insurers, and Attorneys Ensure Accurate Impairment Ratings?
- Use skilled, unbiased evaluators with no financial interest in ongoing care.
- Require use of the latest edition of the AMA Guides (currently the 2023 Sixth Edition) unless jurisdiction mandates otherwise.
- Request objective sensor-based testing where appropriate.
- Conduct internal reviews early and throughout the case to anticipate potential disputes.
What Edition of the AMA Guides Should Be Used?
Jurisdictions vary. Some use the edition in effect at the date of injury, while others use the edition in effect at the time of evaluation. The AMA Guides Sixth Edition (2023 Update) is considered the most evidence-based and current standard.
What is Maximum Medical Improvement (MMI), and Why Does it Matter?
MMI is the point at which a patient’s condition has stabilized and is unlikely to change significantly with additional medical treatment. Impairment Ratings must only be assigned after MMI — premature ratings are unreliable.
Can Impairment Ratings Be Challenged?
Yes. If an impairment rating is believed to be inaccurate, stakeholders can:
- Request a second opinion or independent medical evaluation
- Engage a qualified expert for reassessment
- Strategically dispute the rating through litigation
- Implement proactive quality assurance measures
How Are the AMA Guides Evolving?
The AMA has transitioned to a digitally-updated platform with an Editorial Panel that continuously reviews proposals to update the Guides annually. This ensures the Guides remain aligned with current medical science.
Why Partner with an Organization like Best In Class MD (BICMD) for Impairment Ratings?
BICMD offers:
- Access to a national network of board-certified, unbiased experts
- Expertise in Expert Medical Opinions (EMOs), Independent Medical Exams (IMEs), and Impairment Ratings (IRs)
- Consistent application of the latest AMA Guides standards
- A proactive focus on quality assurance and defensibility
Through BICMD, stakeholders can trust that impairment ratings are accurate, fair, and defensible — minimizing costly disputes and ensuring injured workers receive appropriate benefits.
Impairment ratings, audio by Dr. Chris Brigham, Editor – AMA Impairment Ratings Guide
