Last week I received a phone call from an attorney regarding Chiropractors performing American Medical Association (AMA) Disability Ratings.  Apparently some insurance companies are using a ploy that Chiropractic impairment ratings are not valid under the law and only medical physicians can render them. Being certified in both 4^th and 5^th Editions of the Guides, I can assure you that nowhere in the laws does this hold true. 

I quote form the 1988 Edition of the Guides:  “The user of the Guides, both physicians and non-physicians alike, must understand the concepts under which the ‘rules’ have been developed and the intended approach for using them to achieve objective, accurate, fair and reproducible evaluations of individuals with medical impairment.”

Section 2.2 of the 5^th Edition states “impairment evaluations are performed by a licensed physician (who) may use information from other sources such as hearing results obtained from audiometry by a certified technician. However, the physician is responsible for performing a medical evaluation that addressed medical impairment in the body or the Guides are to be used by physicians organ system and related systems. (5^th Ed, 18)  Thus, an estimate of impairment is a medical opinion formulated by a licensed physician.” Chiropractors are licensed physicians (Langlitz v. Board of Registration of Chiropractors, 396 Mass. 374, 486 N.E.2d 48) and contributing authors to the AMA Guides.

As Dr. Kaplan so eloquently states, Permanent Impairment is described as that condition which persists after maximum medical rehabilitation has been achieved. Maximal Medical Rehab can be described as the point of maximal recovery after every method of treatment has been employed and a reasonable period of time has elapsed to allow optimal regeneration and other physiological adjustments to occur. No evaluation of permanent impairment is to be attempted until maximal medical, surgical, and rehabilitative treatment has been carried out. A reasonable period of time should be permitted to elapse so that the optimal effect of these procedures on the patient can be determined.

In summary, no permanent impairment can be given unless a patient has reached MMI. The term “Medical” does not refer to a medical doctor either.  It is used in the generic sense of the word and applies to all members of the healing arts.   Medical; pertaining, relating or belonging to the study or practice of medicine, or the science and act of investigating, prevention, cure and alleviation of disease. It is therefore understood that that the word medical here is not intended to describe those actions or qualities that are associated only with MD’s / physicians.

For additional references or law holdings pertaining to the practice of chiropractic medicine and impairments, please contact me.

Dr. George Langlitz III, DC CCSP
Certified Chiropractic Sports Physician
Certified Whiplash Traumatologist
Certified Disability Evaluator
Board Eligible Certified Rehabilitation Doctor
Board Eligible Chiropractic Neurologist
Trained in Accident Collision Reconstruction and Trauma Biomechanics

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