The biggest problem in the medical legal system with injuries and compensation was two-fold in nature:

  1. How to set up a standard system to determine if permanent body damage has occurred with an injury.
  2. How to objectively determine the effect that this injury would have on a person’s ability to perform their basic activities of life without pain, discomfort, or suffering.

This monumental task was accomplished in 1970s when the AMA published the first Guides to the Evaluation of Permanent Impairment, which could be easily renamed the “Guides to the Evaluation of Permanent Injury” because that is exactly what impairment is: a condition that injures the person’s ability to function.

This book is the “Kelley Blue Book” of body damage; every doctor treating injuries and every attorney representing injury cases should be very familiar with it. They should readily be able to use it to represent to anyone that you have a permanent injury, and the level of negative effect on a person’s life this injury is agreed to have.

The word “objective” means anything that can be verified by others. The chair you may be sitting on can be verified to exist by others, but how you feel in it cannot.

When we look at the AMA Permanent Injury Guides I think the stated purpose of this book says it all: “The primary purpose of the guides is to rate impairment to assist adjudicators and others in determining the financial compensation to be awarded to individuals who, as a result of injury or illness, have suffered measurable physical and/or psychological loss.”

These books are made so that anyone can look up the identified injuries to any body part, and see what the agreed upon negative consequence are as communicated in the form of a impairment rating.

Let’s say you have excessive motion of the spinal segment from a ligament injury that is ratable. If you look up an injury and the book states that the injury can cause a negative consequence to 25% of your activities of daily living – reported as a 25% whole person impairment – it means 25% of your daily activities may be negatively influenced by this injury.

While this is not a perfect system, it does prove that the condition exists, it will negatively impact your life, and it is a worldwide agreement.

The key to this is that it is not the treating doctor stating this – IT IS THE AMERICAN MEDICAL ASSOCIATION!

Any injury doctor or injury attorney that is not fluent in impairment rating and the AMA’s permanent injury assessment is way out of touch and can seriously reduce your compensation benefits, causing you to possibly be responsible for very large unpaid medical bills.

Once again, Spinal Kinetics put a very good short video on the AMA guides called Spinal Ligament Injuries –Was the AMA Wrong?

Mark Blane, a well-known San Diego personal injury attorney, states this about the AMA Guides in his book How to Effectively Document Your Patient’s Personal Injury Case from A to Z: “… your biggest piece of medical evidence in terms of allowing your patient’s lawyer to argue or substantiate appropriate case settlement value is, besides your actual documented injuries, is whether your patient has a medically documented impairment to a function of a body part or parts.”

He also states the following about the spinal ligament injuries: “This is probably the worse soft tissue injury diagnosis you could have from an accident. Essentially, it is a ligament instability injury. It affects the neck and lower back (the mid back is protected by the rib cage).”

He goes on to say, “This could occur in a rear-end collision that damages ligaments of the spine. Such damage can affect your vertebra’s proper range of motion. Blood can stagnate and cause poor blood supply in the spine, which can lead to degenerative conditions such as bone degeneration and early arthritis. You could also experience continual pain long after the accident. Post-accident, you should make sure to seek medical attention and the advice of a knowledgeable injury attorney. Some doctors and injury lawyers routinely miss these medical diagnoses.”

This book can be purchased on

The essential point is this: you should always work with a doctor that knows how to find and diagnose this condition.

In fact, I believe that this injury (the spinal ligament injury) is so important, so well documented in how you find it, that any doctor that misses this injury should be found guilty of malpractice. Especially if the patient can be shown to have suffered avoidable consequences as a result!

Why work with any doctor or lawyer that does not clearly understand your injuries?

Time To Start Feeling Better?