If you perform or review impairment ratings, you should be a CIR® — Certified Impairment Rater®

Demonstrate your ability to accurately assess impairment using the AMA Guides to the Evaluation of Permanent Impairment – whether you are a physician, health care provider, attorney, or claims professional. This will enhance your credibility and professional success.

CIR® was created1 in 2006 to establish and maintain professional standards for the knowledge, skills, and abilities required to perform expert impairment evaluations using the Fifth or the Sixth Edition of the Guides.

logo: International Academy of Independent Medical Evaluators (IAIME)

This certification is issued with the International Academy of Independent Medical Evaluators (IAIME), the trusted non-profit organization whose mission is to advance the science, prevention, evaluation, and management of disability.

The Certified Impairment Rater® examination fee is $495. (IAIME members are provided with a significant discount; please contact IAIME for further information.)

Who Should Be Certified?

  • Physicians performing impairment ratings, whether as independent medical evaluators, Qualified Medical Examiners, Agreed Medical Examiners, or treating physicians.
  • Physical therapists who perform impairment assessments.
  • Attorneys (defense and plaintiff) involved in workers’ compensation and/or personal injury cases.
  • Claims professionals, other health care providers, and judges in systems that make use of the AMA Guides.

Learn about the benefits of this certification.

Are You Ready?

Assess your knowledge and skills now with a 10-item mini-assessment at no cost. If you do well, proceed with the CIR® examination with confidence. If not so well, we can assist you with online training and resources. Take action; take either or both mini-assessments now:

Fifth Edition Mini-Assessment – No Cost

Sixth Edition Mini-Assessment – No Cost

What’s in the Test?

The CIR® online assessment reflects the real world. It is an open-book exam that requires you to use the AMA Guides. You will refer to the Guides to obtain information and solve cases. Therefore, it is also a very effective learning tool — you will increase your ability to apply the Guides. Traditional onsite examinations do not provide this learning experience and are associated with significant additional costs, e.g., travel and time away from your practice.

The full examination consists of 100 items, typically taking four (4) hours to complete; however, if you prefer, you can take it in segments – as your schedule permits. It presents a randomized set of questions about specific areas of the Guides, so each examination is different.

The weighting is consistent with the types of ratings performed, i.e., most often musculoskeletal injuries. 15–25% of test items are about the Principles of the Guides, 25–30% on the spine, 20–25% on the upper extremities, and 20–25% on the lower extremities and other areas.

No Risk – Only Benefits

No Risk 100% Unconditional Money Back Guarantee. If, for any reason, the examination does not meet your expectations and/or you do not find this to be an effective learning experience, your fee will be fully refunded. Simply contact us within 30 days of registering, and you will receive a prompt refund.


“The Certified Impairment Rater examination is truly excellent, one of the best tests I have ever taken, and very educational. Kudos to Chris Brigham, MD for providing superb online educational tools on the use of the AMA Guide and for providing an outstanding certification process to distinguish the recipient as a quality AMA Guides evaluator. No one is more respected in the use of the AMA Guides than is Dr. Brigham. Everyone using the AMA Guides should strive to become a Certified Impairment Rater (CIR®).

This certification certainly benefits the recipient; it provides greater credibility and will enhance referrals. It also benefits injured parties and workers’ compensation and legal systems by having more reliable impairment assessments. Physicians performing AMA Guides evaluations should be routinely asked “Are you a Certified Impairment Rater?”.

The web-based, open book process, without time constraints, results in a solid learning experience. Even without the certification component, this is a very worthwhile undertaking.

The online approach also makes so much more sense than being required to travel to an examination testing location where you must also take that organization’s courses. When you consider travel costs and indirect costs of being out of the office, the CIR examination is a fraction of the cost, yet it is a vastly superior process, and certainly much less hassle.

Whether you perform impairment assessments or review the ratings, I strongly encourage you to achieve the goal of being a Certified Impairment Rater.”

—Steven Feinberg, MD, Palo Alto, CA

“The Certified Impairment Rater (CIR) credentialing is a refreshing alternative to demonstrating your competency in using the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition. The CIR examination is high quality, open book, and challenging — reflective of the real world. The fee is less than half the cost of an ABIME certification examination and required training, besides which it can be done from the comfort of your own home and computer, as it is all online (thus saving you the travel cost). Moreover, it is complementary to the ABIME examination. The CIR exam is absolutely highly recommended.”

—Mark D’Souza, MD, Toronto, ON

1. CIR® certification was developed in 2006 by Brigham and Associates, Inc. (www.amaguides.com) under the guidance of Christopher R. Brigham MD, MMS CIME, FIAIME, CIR, Editor of the AMA Guides Newsletter, Senior Contributing Editor of the AMA Guides (Sixth Edition), and Editor of the Guides Casebook and Guides Newsletter. In 2023 it was adopted by the International Academy of Independent Medical Evaluators as a gold standard for evaluating the knowledge and skills required in using the AMA Guides to the Evaluation of Permanent Impairment.