Edition timeline
Still in use in some jurisdictions, and by New Zealand’s ACC through the User Handbook to AMA4.
California’s standard under Labor Code § 4660(b)(1). Diagnosis-based, with the DRE and ROM spine methods.
Impairment classes and grades, whole-person calculation, functional focus aligned with the WHO ICF. Pennsylvania adopted the 2nd printing (2009); Tennessee and Montana followed.
Revised upper limb, lower limb, spine and nervous-system content. Training offered by ACOEM and the AMA.
4 editions are still live somewhere in North America at once, which is why the edition question has to be answered per jurisdiction before a rating is worth anything. The marked entry is the current revision of the most recently published edition.
- 4th Edition (1993): still used in some jurisdictions and by New Zealand's ACC (User Handbook to AMA4)
- 5th Edition (2000): California's standard under LC 4660(b)(1); taught through courses like AAMVI's 5th Edition Impairment Rating
- 6th Edition (2008): standardized methodology; adopted by PA (2nd printing 2009), TN, MT and others
- 6th 2023 / 2025 updates: revised upper limb, lower limb, spine, and nervous system content; training offered by ACOEM and AMA
5th vs 6th — the real difference
The 6th replaced much of the 5th's diagnosis-based approach with impairment classes and grades, a consistent whole-person impairment calculation, and a stronger functional focus aligned with the WHO ICF. The DRE vs ROM distinction remains central to spine rating in both.
Which states use what
Verify the edition per state before rating — this is the highest-error-risk fact in impairment rating. Of the 10 jurisdictions profiled in this hub, 1 works to the 5th, 2 require the 6th, 4 leave the edition to the agency, and 2 use their own schedule instead.
California: 5th. Pennsylvania: 6th (2nd printing 2009). Tennessee: 6th (approved training). Montana: 6th statutory. Florida: its own 1996 schedule. New York: its own SLU guidelines. Texas: commissioner-adopted edition. Always verify the current edition per state — this is the highest-error-risk fact in impairment rating.
The companion treatises
- AMA Guides to the Evaluation of Disease and Injury Causation (2nd ed., 2014): work-relatedness, methodology, apportionment, report writing
- AMA Guide to the Evaluation of Functional Ability: requesting and interpreting FCEs
- AMA Guides to the Evaluation of Work Ability and Return to Work
Training landscape
AMA Guides training platforms offer ~200 modules; ACOEM and state-approved providers (TN list) offer edition-specific courses; ABIME CIME and AADEP CEDIR certify the examiners. This hub maps those courses to free guides.
