Definition of Impairment
Impairment. The American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA’s Guides), 6th Edition, defines impairment as “a loss, loss of use or derangement of any body part, organ system or organ function.” Furthermore, “Impairment percentages or ratings developed by medical specialists are consensus-derived estimates that reflect the severity of the medical condition and the degree to which the impairment decreases an individual’s ability to perform common Activities of Daily Living (ADL), excluding work.” (Emphasis in original) The AMA’s Guides organize ratable organ or body function by chapter e.g., respiratory, cardiovascular, nervous, endocrine etc.
General Requirements for Impairment Ratings
Maximum Medical Improvement (MMI). An impairment rating is to encompass each covered illness that has reached MMI according to the rating physician. MMI means the condition is unlikely to improve substantially with or without medical treatment. A CE may consider conditions that are progressive in nature and worsen over time, such as chronic beryllium disease (CBD), to have reached MMI when the condition is not likely to improve.
An impairment evaluation performed by a qualified physician is the basis for the CE’s determination of impairment benefit entitlement. Therefore, the physician’s impairment rating report is to include narrative text that clearly communicates the physician’s opinion, and that provides a convincingly descriptive rationale in support of the stated impairment rating.
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