A percentage at the end of a medical report can look more conclusive than the reasoning behind it. Before using that number in a claim evaluation, settlement discussion, or examination of a physician, identify what it measures, which framework produced it, and how it relates to the legal question you need to resolve.
For attorneys, insurance defense firms, and corporate legal departments, the practical task is to separate the medical assessment from its legal consequences. Start with the permanent impairment finding, confirm the governing jurisdictional framework, and trace the physician’s explanation to the reported percentage. That sequence helps you frame targeted clarification requests without assuming that a numerical disagreement establishes a defective report.
What a Permanent Impairment Rating Measures
The American Medical Association’s AMA Guides overview describes a framework for measuring permanent impairment involving long-term loss of a body part or reduction of body function. Read the medical percentage first as an assessment of impairment, not as a stand-alone statement about employability or claim value.
Permanent Loss and Maximum Medical Improvement
Under the AMA framework, physicians assess and document impairment after the patient reaches maximum medical improvement, or MMI. For counsel, the immediate question is whether the report explains the basis for that timing determination. Ask what findings support the conclusion and how the physician accounted for the clinical course described in the records.
Do not turn that inquiry into an assumed universal waiting period. If the report discusses continuing care, seek clarification about how that care relates to the permanence assessment rather than treating its existence as a self-explanatory contradiction.
Suppose a report identifies a lasting shoulder limitation but gives little explanation for its MMI date. A focused request would ask the physician to identify the clinical basis for selecting that date and explain whether the records support it. That is more useful than asking only whether the final percentage should change.
Why Impairment Is Not Disability or Compensation
As Impairment Rating and Disability Determination explains, significant impairment can coexist with little or no disability, while limited impairment can coexist with substantial disability. The concepts are related, but they are not interchangeable.
Consider a hypothetical hand limitation affecting two people with different work demands. One performs precision manual tasks throughout the day; the other performs work that does not depend on the same movements. Ask the physician to explain the medical limitation, and identify separately what questions remain about each person’s work demands.
The AMA identifies compensation determination as a governmental responsibility, not a physician’s responsibility. It also recommends applying jurisdiction-specific legal or non-medical adjustments after the physician completes the standard AMA Guides impairment rating. Keep those stages separate: what medical impairment was assessed, what legal adjustment applies, and what further determinations are needed before discussing benefits.
Identify the Governing Framework Before Comparing Percentages
Do not assume that the newest AMA Guides version governs the matter. The independent training provider Impairment.com explains in About the AMA Guides that use varies by jurisdiction and that some states use earlier editions. The AMA’s guidance on AMA Guides Sixth 2025 likewise directs evaluators to review state and jurisdictional requirements.
Before comparing reports, identify the claim’s governing framework and ask whether both physicians used it. A reference to “the AMA Guides” without an edition leaves an important comparison question unresolved. The following state examples illustrate distinct inquiries, not a national rating formula or a complete survey of workers’ compensation law.
California: Distinguish Whole-Person Impairment From Permanent Disability
California’s Disability Evaluation Unit determines permanent disability ratings by evaluating medical descriptions of physical and mental impairment. Those determinations are used by workers’ compensation administrative law judges, injured workers, and claims administrators to determine permanent disability benefits. This makes the distinction between medical impairment and permanent disability particularly important when reading a California report.
California DWC guidance states that for dates of injury on or after 1/1/13, whole-person impairment is multiplied by 1.4, rounded to the nearest whole number, and then adjusted for occupation and age, as described in its PDRS FAQs for practitioners. That describes a California process, not a universal multiplier or a complete benefits calculation.
Ask which stage each percentage represents. Is the physician reporting whole-person impairment, or is another document presenting the adjusted permanent disability rating?
In a settlement memorandum, label each figure by its source and purpose. Preserve the physician’s medical finding separately from the subsequent rating calculation, and identify unresolved assumptions in the latter. This keeps the discussion focused on the disputed step.
New York and Texas: Check Guideline Scope and Evaluator Qualifications
New York’s guidance illustrates why counsel should identify the scope of the permanency framework; Texas guidance illustrates a distinct qualification inquiry for certifying doctors. Neither question replaces review of the physician’s reasoning, and neither state’s requirements should be projected onto an examination governed by another jurisdiction.
New York Schedule Loss of Use Guideline Scope
New York’s Permanent Impairment Guidelines overview states that the 2018 Schedule Loss of Use Guidelines took effect January 1, 2018. The revised guidelines supersede chapters 1 through 8 of the 2012 guidelines concerning injuries amenable to schedule loss of use, together with inconsistent earlier provisions.
Before comparing two New York percentages, ask whether the injury is being evaluated within the schedule loss of use framework and whether both reports use the relevant guidance. Do not read the revision as establishing one method for every New York permanency determination.
Texas Certifying-Doctor Requirements
Texas guidance on becoming a workers’ compensation health care provider states that certifying doctors conducting MMI and impairment rating examinations must complete DWC-required training, testing, and notification. Qualification verification is therefore a separate review question from whether the report’s findings persuasively support its conclusion.
When preparing questions for a physician expert witness, identify the assigned medical issue and ask which jurisdictional requirements apply to the proposed examination.
Review the Reasoning Behind the Final Number
Once you identify the medical and jurisdictional framework, review the explanation connecting the findings to the percentage. The following questions are practical tools for identifying matters that may need clarification.
Trace the Medical Assessment to the Reported Percentage
Read the report without treating its final number as the answer to every disputed issue. Can you identify the MMI basis, the rating framework, and the explanation of how the findings support the result? If a step is unclear, ask for the missing connection rather than simply requesting a different conclusion.
Questions for a Focused Clarification Request
- What findings and records support the physician’s MMI conclusion?
- Which edition or jurisdiction-specific guideline was applied, and why?
- How do the examination findings connect to the reported percentage?
- Does the number describe medical impairment or a later legal adjustment?
Examiner interpretation can contribute to variation, as discussed in Impairment Rating and Disability Determination. A numerical difference should prompt investigation of the underlying reasoning, not an automatic preference for the lower or higher result.
Suppose two physicians reach different percentages for the same hypothetical injury. One identifies the applicable method and explains the findings used; the other gives a percentage with little discussion. Ask for the second physician’s reasoning before deciding whether the difference reflects methodology, different findings, or an explanation missing from the report.
When preparing to use IME findings in court, organize the disputed steps rather than displaying only competing totals. Match each proposed examination question to a specific passage, omission, or unresolved medical issue.
California Alternative Ratings Require an Explained Rationale
California’s PDRS FAQs for practitioners describe an alternative rating within the AMA Guides when the physician explains why strict application is inaccurate and justifies the alternative. That is different from an unexplained preference for another percentage. Examine both the stated problem with the strict rating and the rationale supporting the alternative.
A targeted follow-up might ask: What aspect of this patient’s impairment does strict application fail to describe accurately, and how does the alternative address that problem within the Guides? Obtain the physician’s explanation rather than supplying it on the physician’s behalf.
The California guidance states that a judge ultimately evaluates whether the reasoning and rating constitute substantial medical evidence. The FAQs are not exhaustive and may be affected by court decisions and case-specific adjudication. Use them to frame the issue, not as a substitute for reviewing the authorities relevant to your matter.
Conclusion
Locate the Disputed Step Before Choosing a Response
A sound review identifies what the medical percentage measures, confirms the governing framework, and evaluates the supporting reasoning. Keep medical impairment separate from legal adjustments, and address applicable evaluator-qualification questions independently. One number should not stand in for disability, compensation, and medical reasoning at once.
FAQ
Does medical stability mean that treatment cannot affect the condition at all?
No. Impairment Rating and Disability Determination describes permanent impairment as well stabilized and unlikely to change substantially over the next year, with or without treatment. That concerns substantial change, not an absolute promise that no change can occur. Ask the physician to explain any apparent tension between the stability assessment and the treatment discussion.
Are the AMA Guides used outside workers’ compensation?
Yes. The independent training provider Impairment.com describes their use in automobile casualty and personal injury matters in About the AMA Guides. Their use to quantify permanent losses does not establish universal legal acceptance. Identify the framework relevant to the matter rather than assuming workers’ compensation requirements carry over.
Where can attorneys find New York schedule loss of use case studies?
The New York Workers’ Compensation Board provides Impairment Guidelines Training demonstrating SLU principles and objective criteria through case studies. Use these materials to understand application of the framework, not as a substitute for identifying applicable requirements or evaluating the medical evidence in the file.
What should counsel request when a report’s explanation remains unclear?
Ask whether the explanation connects the relevant findings to the applicable method and resolves the disputed issue. Identify the specific passage needing clarification and request the missing reasoning rather than additional pages for their own sake.
How should counsel frame questions before an impairment examination?
Ask the physician to address defined medical issues rather than a desired percentage. Identify the unresolved timing question, relevant records, and methodological issue. This directs the request toward an independent medical assessment while leaving the legal team responsible for determining how that assessment fits the governing claim framework.
Offsite Resources
- AMA Guides® to the Evaluation of Permanent Impairment: an overview — Provides an overview of the AMA Guides and how they are used to evaluate permanent impairment.
- DWC Disability Evaluation Unit — California Division of Workers’ Compensation resources on disability evaluation, impairment ratings, and related processes.
- DWC – I was injured at work – Permanent disability benefits — Explains California workers’ compensation permanent disability benefits and how they may apply after a work-related injury.
- DWC FAQs on the PDRS for practitioners — Answers common practitioner questions about California’s Permanent Disability Rating Schedule (PDRS).
- Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity Overview — Provides an overview of New York guidelines for evaluating permanent impairment and loss of wage-earning capacity.
- Impairment Guidelines Training — Offers training resources for understanding and applying New York’s impairment guidelines.
- Become a Texas workers’ compensation health care provider — Provides information for health care professionals interested in participating in the Texas workers’ compensation system.
- Impairment Rating and Disability Determination: Overview, Impairment Versus Disability, Scope of the Problem and Impairment Rating Overview — Explains the distinction between impairment and disability and provides background on impairment rating and disability determination.
- AMA Guides Sixth 2025: Current medicine for permanent impairment ratings — Provides information about the sixth edition of the AMA Guides and its approach to current medical impairment ratings.
- AMA Guides to the Evaluation of Permanent Impairment — Provides background information about the AMA Guides and their role in evaluating permanent impairment.
- Certifying doctors — Explains requirements and resources for doctors who certify impairment ratings in the Texas workers’ compensation system.
What’s Next?
To discuss an impairment evaluation for your matter, contact MLP IME or call 1-833-465-7463. Share your evaluation needs and the medical questions relevant to your request.
