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Background Previous studies suggest that many persons with disabilities caused by work do not receive workers' compensation benefits. Methods Data from surveys of persons with disabilities were used to estimate the proportion of disability due to work-related injuries and diseases. Studies examining the proportion of workers with work-related disability who received workers' compensation benefits were reviewed. Legal and other factors explaining the lack of receipt of workers' compensation benefits were examined. Results Many workers with disabilities caused by work do not receive workers' compensation benefits. The obstacles to compensation include increasingly restrictive rules for compensability in many state workers' compensation programs. Conclusions A substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits. The solutions to this problem, such as providing healthcare to workers regardless of the source of injuries or diseases, are complicated and controversial, and will be difficult to implement.

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.

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