Guidelines for the assessment of permanent impairment Version 3

Pain1.35 The tables in the AMA 4 Guides require the pain associated with a particular neurologicalimpairment to be assessed. Because of the difficulties of objective measurement, medical assessorsshould make no separate allowance for permanent impairment due to pain, and Chapter 15 ofthe AMA 4 Guides should not be used. However, each chapter of the AMA 4 Guides includes anallowance for associated pain in the impairment percentages.Rounding Up or Down1.36 The AMA 4 Guides (p 9) permit (but do not require) that a final whole person impairment may berounded to the nearest percentage ending in 0 or 5. This could cause inconsistency between twootherwise identical assessments. For this reason medical assessors must not round whole personimpairment values at any point of the assessment process. During the impairment calculationprocess however, fractional values might occur when evaluating the regional impairment (e.g.an upper extremity impairment value of 13.25%) and this should be rounded (in this case to13%). Whole person impairment values can only be integers (not fractions).Consistency1.37 Tests of consistency, such as using a goniometer to measure range of motion, are good but imperfectindicators of workers’ efforts. The medical assessor must utilise the entire gamut of clinical skill andjudgement in assessing whether or not the results of measurements or tests are plausible and relateto the impairment being evaluated. If, in spite of an observation or test result, the medical evidenceappears not to verify that an impairment of a certain magnitude exists, the medical assessor shouldmodify the impairment estimate accordingly, describing the modification and outlining the reasons inthe impairment evaluation report.1.38 Where there are inconsistencies between the medical assessor’s clinical findings and informationobtained through medical records and/or observations of non-clinical activities, the medical assessoris encouraged to bring these inconsistencies to the attention of the worker. For example,inconsistency demonstrated between range of shoulder motion when undressing and range of activeshoulder movement during the physical examination. The worker will then have an opportunity toconfirm the history and/or respond to the inconsistent observations to ensure accuracy andprocedural fairness.Assessment of Children1.39 The determination of the degree of permanent impairment in children may be impossible in someinstances, due to the natural growth and development of the child (examples are injuries to growthplates of bones or brain damage). In some cases the effects of the injury may not be consideredWCT Guidelines 1 October 2011 7