What is MMI?

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Your patient or injured worker has reached MMI. But what does MMI mean when we’re talking about California workers’ compensation?

MMI is shorthand for Maximum Medical Improvement, defined on pg. 2 of the AMA Guides to the Evaluation of Permanent Impairment 5th Edition as the following:

An impairment is considered permanent when it’s reached Maximal Medical Improvement, meaning it’s well stabilized and unlikely to change substantially in the next year, with or without medical treatment.

The date of MMI is important: it’s the date when a patient is ready for an impairment rating, and for decisions about future care and permanent work restrictions.

How Do You Know if a Patient is MMI?

How can you tell when a work injury has “stabilized” and is “unlikely to change substantially in the next year, with or without medical treatment”?

To find out what goes into determining MMI, keep a few key questions in mind:

1. Is there any on-going medical treatment that will change the injured worker’s functionality?

For instance, imagine a case where a patient has a back injury, and can only lift 25 pounds.

Physical therapy helped improve the patient’s condition in the past, and they still have six more physical therapy visits authorized by the insurance carrier.

In this scenario, the patient may be able to lift more weight after completing all their physical therapy visits.

Why declare a patient MMI if they are in the midst of ongoing treatment that may improve their condition?

2. Is the impairment rating going to change?

Another example: a worker with a shoulder injury is improving their range of motion with physical therapy, but they cannot improve their ability to lift more weight.

Until their range of motion remains the same, they will not be eligible for MMI.

As soon as the claim is filed, MMI becomes the ultimate goal for treatment. Patients obviously want to get bet better after a work injury, but sometimes they continue to have pain. MMI does not mean that the patient is no longer experiencing pain. It’s the doctor’s responsibility to communicate this to the patient, and to everyone involved in the case.

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Increase Your Impairment Rating Accuracy

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Understanding impairment is essential to workers’ compensation cases. Without a working definition of how the AMA Guides approaches impairment, accurate impairment ratings are impossible to assign or review. If you are working in the world of California workers’ compensation then you understand how complex impairment rating can be.

If you don’t have a thorough knowledge of how ratings are assigned in accordance with the AMA Guides then the accuracy of your permanent and stationary reports may be suffering. This leads to delays in patient care as well as extra work for you and your staff. 

Impairment severity, functional limitations and regional impairments… there’s a lot to wade through. Fortunately there’s a simple explanation for all of these moving parts. To learn more about the whole body approach to impairment simply follow RateFast’s easy walkthrough. How does the AMA guides fifth edition approach impairment? There are only 6 facts to keep in mind:

  1. The impairment severity reflects resulting in functional limitations.
  2. Most chapters report impairment as a whole person impairment units.
  3. Upper and lower extremity chapters have a regional impairments to assign additional weighted value to the specific areas of the arms and legs.
  4. Chapter 16, the upper extremities report sub impairment at the levels of digits, hand, and upper extremity.
  5. Chapter 17 the lower extremities report sub impairment at the levels of foot and lower extremity.
  6. Regional impairments of the spine are weighted accordingly to contribution of function.

So let’s say there’s a 52-year-old right-hand dominant labor worker sustained an amputation to his right thumb at the MP joint (40% HI), and the right small finger at the MP joint (10% HI).

Why is there such a big difference in impairment values? Using the organ system and whole body approach to impairment, the thumb is given four times the value as the little finger for functionality importance. Remember, The Guides 5th edition gives relative weights to organs and body systems. A keen understanding is critical to creating and reviewing accurate and reproducible impairment reports

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What is the technical definition of disability?

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Whether you’re a doctor, an attorney, or an insurance adjuster, a precise definition of disability is essential in impairment rating. However, for such an important term its technical definition often goes unexamined.

What You Need to Know About Disability

  1. Disability is an inability to meet social, occupational, personal, or statutory requirements because of impairment.
  2. Disability is different than impairment.
  3. Someone may have disability at home but not at work. Likewise, an individual may have disability at work, but not at home.
  4. A physician may provide an opinion on disability if he/she has expertise and is acquainted with the individual’s work activities and activities of daily living.
  5. An impairment evaluation is only one aspect of determining disability. A disability evaluation includes information about skill, education, job history, adaptability, age, environment requirements and modifications.

Time for an Example

Consider this: a 43 year old man performs sedentary clerical work. He has a permanent impairment from an amputation of the right leg below the knee. He cannot climb stairs in his home. Is he disabled from occupational demands? No. He performs clerical work that doesn’t require him to walk around. Is he disabled from personal demands? Yes! His activities of daily living are affected. Feel free to email us if you have any questions about disability and impairment rating.

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What is the technical definition of ‘Impairment’?

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impair (v.) l, from Old French empeirier, from Latin impeiorare “make worse.” In reference to driving under the influence of alcohol, first recorded 1951 in Canadian English.

Okay…. But what does Impairment mean in the world of Workers’ Compensation?

If you’re a medical professional who examines injured employees, then impairment means “a loss, loss of use, or derangement.” (That’s straight out of the in the AMA Guides 5th Edition, Chapter 1, page 2.)

An injured worker’s impairment is considered permanent when the injury reaches “maximum medical improvement” or “MMI”.

Maximal medical improvement means the patient’s condition is unlikely to change in one year.

The AMA Guides 5th edition refers to impairment as permanent impairment. Permanent impairment requires evaluation of a physician.

Remember, loss, loss of use, or derangement means a change from normal.

So, let’s take this example: imagine a 27-year-old construction worker who has injured her right shoulder. At MMI, you as a doctor, measure the injured shoulder, which flexes to 160°, and then you measure the uninjured shoulder, which comes out to 180°. Does this patient have impairment?

The answer yes, because the employee has lost 20° of use.

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