Comp Impact of AMA Updates on Mental Injuries 'Uncertain': NCCI

Wednesday, September 14, 2022 | 0

Several changes made in 2021 to the 6th edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment that affect workers’ compensation claims will have an “uncertain” effect on the diagnosis and disability determination for mental injury claims, according to an analysis released Monday by the National Council on Compensation Insurance.

The Boca Raton, Florida-based ratings agency examined the AMA Guides, 6th edition 2021, updates — the first since 2008 — finding that “the only significant content and methodology changes were for mental and behavioral disorders.”

States that accept mental injury claims in workers’ comp often require a diagnosis of a psych condition for compensability. And experts have said that claims costs related to ailments such as post-traumatic stress disorder, accepted on presumption in more than a dozen states for first responders, are undetermined. Psych claims have also become a major topic of discussion in recent years.

Overall, in the states using the 6th edition of the AMA Guides to determine impairment, NCCI said, “the direction and magnitude of the cost impact” to the workers’ comp impairment and disability ratings for mental injuries is “unclear at this time.”

More than a dozen states use the 6th edition of the AMA Guides, including Arizona, Oklahoma and Pennsylvania. Statutes in Alaska, Illinois, Louisiana, New Mexico, Tennessee and Wyoming specifically mandate the use of the most recent version of the 6th edition.

NCCI said it is also uncertain whether changes to income replacement costs following a psych injury would be offset by other indemnity changes.

Business Insurance is a sister publication of WorkCompCentral. More stories are here.