What is Almaraz/Guzman?

If you have read our pages on shoulders, knees, carpal tunnel, or hearing loss, you have run into the same problem: the strict AMA rating sometimes produces a number that does not describe what happened to a person.

Almaraz/Guzman is the doctrine that addresses it.

What it holds

In Almaraz/Guzman II (2009, WCAB en banc), affirmed by the Court of Appeal in Milpitas Unified School District v. WCAB (Guzman) (2010), California established that:

A physician may depart from a strict, mechanical application of the AMA Guides where the strict rating does not accurately reflect the injured worker's impairment.

The court's reasoning: the statute's instruction to "incorporate" the Guides does not require mechanical application without regard to accuracy — and the Guides themselves prescribe the exercise of clinical judgment. As the court put it, the Guides "should be applied 'as intended' by its authors," and that application "must take into account the instructions on its use, which clearly prescribe the exercise of clinical judgment."

The limit — "the four corners"

A physician may use any chapter, table, or method within the AMA Guides. A physician may not go outside the four corners of the AMA Guides.

Which means the argument is not "the Guides are unfair." It is: the Guides contain a better tool for this impairment than the one the strict method points to, and here is why.

Examples of what that looks like in practice:

A reverse total shoulder replacement — a procedure not addressed in the Guides, which deliberately trades motion for stability, so rating it on motion alone understates it.

A carpal tunnel case where the strict method caps at 3% whole person despite severe functional loss.

A severe tinnitus case with preserved audiometric thresholds, where the strict method gives nothing.

A knee or shoulder where the mechanically indicated method plainly misses the actual loss.

What it requires — and this is where cases fail

The physician has to do the work.

A valid Almaraz/Guzman opinion must:

• Give the strict rating first, and state it
• Explain why the strict rating does not accurately capture the impairment
• Identify the alternative method inside the Guides and state which chapter, table, or figure
• Explain why that alternative is more accurate for this worker

The party seeking to rebut the scheduled rating must present substantial evidence — meaning the opinion sets out facts and reasoning justifying the departure.

An "obviously inapplicable section" cannot support rebuttal, and a bare assertion that the strict rating "does not reflect the applicant's true impairment" will be rejected. This is where most Almaraz/Guzman opinions die.

Which means it has to be planned before the examination, in the letter to the evaluator — not requested afterward when the report comes back low.

Two things it is not

It is not a way around apportionment. Apportionment under § 4663 is a separate analysis, and only reporting physicians determine it — there is no such thing as "vocational apportionment" after Nunes. How apportionment works.

And it is not a guarantee. We are going to be straight about this: it is an argument, and it is contested. A site telling you your rating "should be higher under Guzman" as though that were settled is not being honest with you. What is true is that where the strict rating plainly fails, there is a recognized route to a more accurate one — and it has to be built deliberately.