Many states follow the AMA Guides to Evaluation of Permanent Impairment to determine what an employer owes an employee injured on the job. Missouri workers' compensation judges, by contrast, often reject the opinions of experts who rely upon them.

There is a difference between impairment and disability. Many judges have been quick to point out that AMA impairment ratings do not take into account subjective complaints of pain.1 AMA also allows asignment of impairment for pre-existing asymptomatic conditions.2

Missouri law mandates that objective findings shall prevail over inconsistent subjective findings, noting the importance of conditions that can be verified by appropriate tests or diagnostic procedures.3 Missouri, however, did not adopt AMA Guides, unlike other states.4

Some administrative law judges have been sharply critical of AMA. An AMA rating was deemed to have "little probative value" in one case, in which the Commission considered the opinion of a family doctor well-known for his liberal ratings more credible than the treating orthopedist who provided an AMA rating.5 Another judge considered use of an AMA rating "inconsistent" with the requirements of 287.190.3. 6 Other judges have been sharply critical of AMA guides.7 In a recent January 2009 Commission decision, Steed v Air-Serve Group, Inc.8 a judge sharply criticized opinions on both sides as "not credible" when both experts relied upon AMA Guides as a basis to assess disability.

The administrative law judges are not bound by a disability rating, whether it is based on AMA on or some nonuniform-pull-a-number out of the air method. 9 Parties in some simple cases can proceed to a hearing and final award without obtaining any expert opinion on disability, which may have some merit. Obtaining a rating may taint other opinions10 or may set a minimum value to discuss settlement. There is nothing inherently evil about an AMA impairment rating, as suggested by some of the opinions. It is possible a judge can always consider an AMA rating a reasonable assessment of disability11 or for parties to consider an AMA impairment rating equivalent to a disability rating.12

Medical experts play an important part to determine treatment plans, causation, diagnosis, and work restrictions. The argument could certainly be made whether expert ratings benefits anyone in the worker's compensation system when supplemental rating reports add a layer of expense, delay, and can skew reasonable expectations of both parties, particularly when a judge can ignore them. Some legal advisors years ago refused to consider approving any settlement with a pro se without a rating, and then "advised' the claimant to ignore the rating. Ratings are currently a part of the system, and by statutory definition, required in any complete medical report. Many doctors won't provide ratings or use AMA ratings. AMA ratings provide a good starting point to objectively assess residual functional capacity to determine what an employer owes for any permanent disability.

1. Landers v New Prime, DOLIR 3-10-09 (dissent), Caton v Roadway Express, DOLIR 11-14-01; Nolan v Flat River Glass Co., DOLIR 5-21-01.
2. Ford v Auto Terminal, DOLIR 9-27-02.
3. 287.190.6(2)
4. Conrad v Jack Cooper, DOLIR 2-8-08; Looney v Automatic Systems, DOLIR 1-5-04.
5. Alamo v Denny's, DOLIR 11-24-03.
6. Becherer v David Shermann Corp., DOLIR 1-3-07.
7. Whit v Warren County Concrete, DOLIR 10-26-05. See also McCulloch v Tasco Construction, 5-7-08 (criticizing the expert for using an outdated 2nd edition)
8. Steed v Air-Serve Group, DOLIR 1-27-09
9. Patchin v National Supermarkets, 738 S.W.2d 166 (Mo. App. 1987).
10. Wilson v Golden Business Forms, DOLIR 1-3-07. (criticizing the expert's general credibility due to a modest rating).
11. Roberts v Nestle Food, DOLIR 10-16-06
12 Smith v Cleveland Health Care, DOLIR 11-10-98.