What Is an Impairment Rating After a Car Accident or Work Injury?

Most people recover well after a car accident or work injury. But some injuries leave lasting effects, and when they do, a case may need an impairment rating: a standardized measurement of how much the injury has permanently affected the body.

Dr. Mark Mulak, founder and clinical director of Cityside Chiropractic, recently earned the Certified Impairment Rater® (CIR®) credential for applying the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. Here is what an impairment rating is, when it matters, and what makes one reliable.

What is an impairment rating?

An impairment rating is a percentage that describes how much an injury has permanently reduced the function of a body part or of the whole person. It is based on a clinical examination, the patient's history, and the medical record.

An impairment rating is not the same as a disability rating. Impairment describes the loss of body function. Disability describes how that loss affects someone's ability to work or do daily activities, which depends on more than the injury itself.

Ratings are usually done once a patient has reached maximum medical improvement, the point where their condition has stabilized and is not expected to change much with more treatment.

The AMA Guides and the CIR® credential

The AMA Guides to the Evaluation of Permanent Impairment are the published standard for impairment ratings. They give evaluators a consistent method, so two qualified examiners looking at the same injury should reach a similar result.

The CIR® credential recognizes demonstrated knowledge in applying the Guides.

The CIR® exam is 100 case-based questions on practical application, with emphasis on the areas that come up most often:

• musculoskeletal injuries

• spinal conditions

• upper-extremity conditions (shoulder, arm, hand)

• lower-extremity conditions (hip, knee, ankle)

Those are the same injuries Cityside sees every day in car accident and workplace cases.

When is an impairment rating needed?

Not every injury case needs one. A rating may come into play when:

• an injury from a car accident or fall leaves lasting symptoms or limited function

• a workers' compensation claim involves permanent effects of a work injury

• an attorney or claims professional needs a standardized measure of permanent injury

• a disability or other medical-legal matter requires a documented assessment

If you are unsure whether your case needs a rating, your attorney is the best person to ask. Cityside works with patients' attorneys on personal injury and workers' compensation cases.

What makes a rating reliable

A reliable impairment rating rests on two things: a careful clinical evaluation and a method anyone can follow.

"An impairment rating should be grounded in a careful clinical evaluation and a transparent, reproducible methodology." — Dr. Mark Mulak

In practice, that means:

• A thorough exam and history. The rating can only be as good as the clinical findings behind it.

• Objective documentation. Measurements, functional testing, and imaging when appropriate give the rating a factual base.

• Each step tied to the Guides. The report should show which section of the Guides was used and how the number was reached.

• A clear explanation. Attorneys and claims professionals should be able to trace the rating and review it step by step.

Dr. Mulak brings about 25 years of personal-injury practice and more than 10,000 motor-vehicle injury evaluations to this work. He is also the author of The Objective Injury Model, a guide for attorneys on objective documentation in motor vehicle injury cases.

Questions about your injury?

Cityside Chiropractic has offices in Providence (480 Broadway) and Cranston (900 Reservoir Avenue). We evaluate and treat car accident, personal injury, and workers' compensation patients, and our staff speaks English and Spanish.

Call (401) 272-5710 to schedule an evaluation. Attorneys can reach Dr. Mulak at drmulak@citysidechiropractic.com.