Recommendations to guide revision of the Guides to the Evaluation of Permanent Impairment. American Medical Association.

The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.

Legal solutions for the problems of special populations at risk.

Some populations of workers face competitive disadvantages in the labor market and increased risks at work. This paper discusses three areas of law that are relevant to the occupational health concerns of these subgroups of workers. First, laws against discrimination in employment on the basis of race, sex, age, and disability are described. Second, laws that provide universal protection for all workers, including regulatory laws (e.g., OSHA) and social insurance programs (e.g., workers' compensation) are evaluated in terms of the extent to which they provide effective protection for vulnerable populations. Third, the nature of legal protections for people at specific increased risk for disease is assessed. Appendices provide specific summaries of relevant laws.