Permanent Impairment Ratings

14 December 2011 / Impairment Rating Specialists / Comments Off on Permanent Impairment Ratings

Under the AMA Guides, p. 19, permanent impairment ratings are only done when the Applicant is at maximum medical improvement (mmi).

P. 601 of the Guides indicates that a patient is at mmi when his medical condition is unlikely to improve during the next year, with or without medical treatment.

What does this mean?  If a patient is not at mmi, he CANNOT receive a whole person impairment rating under the AMA Guides.


1.  Doctor says the patient needs surgery to improve his condition.  He is not at mmi.

2.  Psychiatrist says the patient needs to undergo psychiatric treatment (including antidepressants and psychotherapy) to improve his condition.  The patient is not at mmi.

3.  Patient allegedly has gi symptoms from taking non-steroidal anti-inflammatories.  The patient is not at mmi if the physician has not removed him from the non-steroidal anti-inflammatories as his condition would likely improve if he were taking off the offending medications.

4.  Patient has a sleep disorder contributed to by his obesity/weight.  If the patient has not been put on weight reduction, then he is not at mmi as his condition would likely improve if the obesity/high weight were eliminated.  (Sleep apnea has a tendency to go away when the patient loses weight.)

5.  Patient has hight blood pressure and is not on medication.  The patient is not at mmi because placing him on high blood pressure medication would likely improve his blood pressure and improve his condition.

So, the first question to ask in any situation is, has the patient reached mmi as defined by the Guides.

Frequently, doctors claim a patient is at mmi when one of the following has occurred:  TTD is ending; the doctor does not want to see the patient again; or the doctor just feels like giving the patient a rating despite the fact that the patient has not undergone treatment to improve his condition.

Remember, the reason doctors are supposed to treat patients is to get them better.

So, make sure the patient is at mmi under the Guides before you accept any permanent impairment rating for an Applicant.  Remember, permanent means permanent.  That means that the condition is not likely to go away, with or without further medical treatment.

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