Back on April 19, 2004, when Senate Bill 899 became law, the legislature mandated the use of the AMA Guides 5th Edition to evaluate the level of permanent disability in California workers’ compensation cases. The 5th Edition was published by the American Medical Association back in 2001 and is now more than two decades old.

The 6th Edition was published in 2008. There are now updates published electronically such as the 6th Edition 2021, and a 6th Edition 2022. However, until the California legislature changes the labor code, the 5th Edition remains the standard here.

According to a new report on this issue just published by the National Council on Compensation Insurance (NCCI), there are a few states that not only require the use of the AMA Guides, Sixth Edition, in determining impairment ratings but also have provisions in place so users rely on the most recent version after it becomes effective. The statutes are nuanced, but such states include Alaska, Illinois, Louisiana, New Mexico, Tennessee, and Wyoming.

Prior to the AMA Guides, Sixth Edition, going digital in 2021, the last update was in December 2007 (it bore “2008” in its title). The update from the fifth to sixth edition had several major changes impacting impairment ratings,with numerous states ultimately adopting the sixth edition.

With the shift to digital, the AMA has changed the way it will update the AMA Guides going forward. The AMA Guides, Sixth Edition 2021, which became effective July 1, 2021, represents the first update to the AMA Guides since 2007. Going forward, the AMA Guides, Sixth Edition, will be exclusively online and accessible by subscription only. Effective January 1, 2022, the AMA considers the AMA Guides, Sixth Edition 2022, to be the most current version. The AMA expects that the next version will be available online in 2023.

While there were several changes included in the update from the AMA Guides, Sixth Edition 2008, to the AMA Guides, Sixth Edition 2021, the only significant content and methodology changes were for mental and behavioral disorders.These changes, which aimed to provide clarification and updated terminology around mental and behavioral health concepts to improve interrater reliability, included:

– – Updating terminology and methodology from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),6
– – Newer editions of assessment tools and tests, and
– – Elimination of the Global Assessment of Functioning (GAF) from impairment rating methods in Chapter 14 (“Mental and Behavioral Health”).

The AMA Guides, Sixth Edition 2021, adopted the terminology, criteria, and special features of the DSM-5. With the adoption of the DSM-5, the multiaxial system8 is no longer considered in mental health diagnoses.

The 2022 updates were mostly administrative and editorial in nature. Per the AMA’s Summary of Updates, there were no changes to impairment ratings or methodology.As such, if a state were to move from the 2021 to the 2022 edition, there would be no expected impact on WC indemnity costs.

Overall, a state’s adoption of the 2021 updates may impact overall WC system costs, although both the direction and magnitude of the potential impacts are uncertain. The 2022 updates are not expected to impact WC indemnity costs.

Going forward, the AMA Guides, Sixth Edition, is expected to have annual electronic updates. These updates will not impact prior editions of the AMA Guides. The AMA “has created the AMA Guides Editorial Panel as a transparent process in which a broad spectrum of relevant professionals can consider, vet, and determine whether, when, and how the Guides should be improved, enhanced, or revised.” In addition, it will deliver timely enhancements to the AMA Guides that reflect current evidence-based medical practice.

Editorial meetings that are open to the public will be held to discuss proposed changes to the AMA Guides, Sixth Edition. Some topics being considered in future annual content updates are the inclusion of functional patient-reported outcome measures, or PROMs, and changes to how impairment ratings are determined for tinnitus, spinal injuries, and neurological injuries.

NCCI will continue to monitor the annual electronic updates to the AMA Guides, Sixth Edition, and how they may impact WC costs.