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, while in category III, radiculopathy with objective verification must be present. Since an individual is evaluated after having reached maximal medical improvement (MMI), a previous history of objective findings may not define the current, ratable condition, but it is important in determining the course and whether MMI has been reached. The impairment rating is based on the condition once MMI is reached, not on prior symptoms or signs. If the individual had a radiculopathy caused by a herniated disk or lateral spinal stenosis that responded to conservative treatment
contributing-causal factors of the injured worker's permanent disability once the injured worker is at maximal medical improvement (MMI) or permanent and stationary (P&S). When considering apportionment, the following are three critical portions or provisions of Labor Code Section 4663 as enacted by SB 899 on April 19, 2004: Apportionment of permanent disability shall be based on causation. A physician who prepares a report addressing the issue of permanent disability due to a claimed industrial injury shall in that report address the issue of causation of the
these subjective complaints can result in the rating of impairment for a condition that is not present, has no ob jective findings, or that is unrelated to the alleged injury. A physician may choose to provide an inappropriate diagnostic label. Such mislabeling may have undesirable consequences, including creation of a false self-perception of illness, legitimizing medical intervention, and providing a basis for erroneous rating of impairment. 7 The rating of permanent impairment cannot occur until the patient has achieved maximal medical improvement (MMI); rating
or after maximal medical improvement (MMI) has been established. To qualify for loss of motion segment integrity, measured translation or relative translation on radiographs must be greater than the normal maximal translation documented in the literature. Increased motion at multiple adjacent levels, which is a normal adolescent/young adult pattern of flexion and which is also identified in adult double-jointed individuals, does not qualify for a permanent impairment. Abnormal motion related to pre-existing degenerative disease, congenital/developmental anomalies
the individual is at maximal medical improvement (MMI). Therefore it is essential to determine whether all treatment necessary to achieve MMI has been provided. However, many of the treatments provided for WAD are of questionable efficacy, and not necessary to achieve MMI. Hence the evaluating physician should be familiar with appropriate treatment for WAD. The military has extensive experience managing trauma and has developed a simple, comprehensive, treatment strategy that addresses the biopsychosocial nature of compensable injuries along with the unintended
role may influence when the physician defines maximal medical improvement (MMI). For example, at discharge from care the physician may be inclined to define the patient as ratable, even though it is probable that the patient is not yet at MMI. A treating physician may want to increase a rating, particularly if the impairment number does not appear to reflect a level of perceived disability. A corollary to influences on physicians who rate impairment is the assessment of disability. The assessment of disability is more complex than that of rating impairment, because
causation question formally adjudicated before physicians are asked to assess for maximal medical improvement (MMI) and permanent physical impairment (PPI). For those cases either accepted by a workers' compensation insurer or administratively adjudicated as work compensable, these questions will need to be answered: When is the person at MMI? How should PPI be rated? We offer several clinical scenarios to consider for administratively accepted cases for which an MMI date and PPI rating are requested. Clinical Scenarios Scenario 1: Individuals who are tested
preference is to have evaluations done by rating physicians and in other states by treating physicians) and the skill set of the physician. Maximal Medical Improvement Evaluations are not done until the claimed condition has reached the point of maximal medical improvement (MMI), the point at which a condition has stabilized and is unlikely to change (improve or worsen substantially in the next year, with or without treatment) (6th ed, p 612). The average time from the date of claim to the date of the examination was 21.2 months. It is probable that most of the
has shortness of breath with dyspnea on exertion to ½ flight and a daily, dry cough. His HP was unresponsive to steroids and he is now at maximal medical improvement (MMI). He smoked 1–2 packs of cigarettes per day since he was 21 but quit 2½ years ago when he began having exertional fatigue. His pulmonary function tests (PFTs) show a forced vital capacity (FVC) at 77% of predicted, a forced expiratory volume (FEV 1 ) at 29% of predicted, and a diffusing capacity at 64% of predicted. There were no prior PFTs. The examinee states that he had absolutely no pulmonary
