MAXIMUM MEDICAL IMPROVEMENT, IMPAIRMENT RATINGS, AND DISABILITY AWARDS

Eventually the medical treatment phase of your workers’ compensation case, your doctor will make a determination of maximum medical improvement and determine if you are permanently impaired and to what extent.  The determinations the doctor makes have great weight and the importance of the basics of maximum medical improvement and impairment rating are discussed below.

“MAXIMUM MEDICAL IMPROVEMENT”

This is a phrase with both medical and legal significance. From a medical standpoint, it means the curative medical treatment has ended, and the injured worker is “as good as he is going to get.” There may be a dispute about this status if there are other physicians still treating the injured worker for other problems. For example, an orthopedic surgeon may release a patient from care while the neurologist is still actively treating. And in other cases, there may be disagreement between an “authorized treating physician” and findings following an “independent medical evaluation.” These types of disputes may have to be resolved at a hearing, where your workers’ compensation attorney will argue the case for additional treatment, but the Commission is very accommodating to any reasonable recommended procedure or treatment. Once all physicians and/or the Commission agree the injured worker has reached MMI, the next step in the process is to determine if and to what degree there is any “permanent partial disability.”

IMPAIRMENT RATING / DISABILITY AWARD

At the same time a doctor determines an injured worker is reaching maximum medical improvement, they will start determining if there is any “permanent partial impairment.” By its description, this term means there will be lifelong effects from the injury, and now, the degree or percentage must be measured. In many cases, the treating physician will do range of motion and limitation testing in the examining room. In more serious cases, a formal “Functional Capacities Evaluation” (FCE) may be required. In either situation, the doctor will ultimately consult the American Medical Association’s Guide to the Evaluation of Permanent Disability book and assign a percentage of impairment to a particular body part. For example, a typical impairment rating following a microdiskectomy back surgery is 10-15% PPI to the spine. A fusion procedure might result in a 20-25% PPI rating. In some cases, physicians make a “whole person” rating, but the Commission will convert that rating to the spine.

It is important to remember that “impairment ratings” are determined by doctors. They consider such factors as restrictions in range of motion, ability to stand or bend, weight limitations, and even pain restrictions (although you get nothing for pain and suffering under workers’ compensation law).

The Commission, on the other hand, has a much more expansive review and will consider such ratings only as part of a larger analysis before determining a “disability award.” In their role, they also look at an injured worker’s age, education, prior work history, work restrictions, and need for future medical treatment. As a result, a “disability award” will often be a higher “percentage” than the initial impairment rating and may include future care such as continuing prescription medication or other procedures. Any “prosthetic devices” implanted, such as plates, screws, rods, artificial disks or joints, are covered for the lifetime of the injured employee.

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