For some doctors, the world of impairment ratings creates fear and anxiety.Or, on the other end of the spectrum, an adrenaline surge, and battle-ready emotions. Little is taught in most chiropractic colleges on impairment ratings and how they impact the life of a patient and reflect on the competence of the DC caring for the injured patient. This series of blogs will not only help you get in the game but will give you the tools to stay at the top of your game for years to come.
Before we get too deep, let’s clarify the difference between Impairment and Disability and possible continued residual symptoms. Maximum Medical Improvement (MMI) has a factor in determining the permanent impairment itself. MMI is the date from which further recovery or deterioration is not anticipated, although over time (years) there may be some expected change. MMI is the condition or state where the patient is stabilized and the condition unlikely to change substantially in the next year with or without treatment. This could be determined months or years after the initial date of injury. 1
It is only from this MMI date that the permanent impairment rating can be determined in accordance with the AMA Guides to the Evaluation of Permanent Impairment (5th or 6th Edition). Key principles of permanent impairment are that the impairment is stable, static, or plateaued. Permanent impairment does not preclude the patient from receiving ongoing treatment after MMI. It is a clinical decision based on the doctor’s analysis. You can only rate the current impairment.You cannot speculate and attempt to rate any future impairment that might change years down the road. You can only rate the impairment that exists today after the condition has reached MMI.
Disability is an alteration of an individual’s capacity to meet personal, social, or occupational demands or statutory or regulatory requirements because of an impairment.2Impairment does not equal disability. An impaired individual may not have a disability. Disability involves many intangibles. Functional demands and motivation are both links between impairment and disability. You must take the person into account for disability regarding their mental and social adaptation, their occupation and how they as a person are impacted. Impairment assessment is a necessary first step for determining disability.
Ongoing symptoms or residuals are subjective but can certainly be valid and should be described. A person may have no ratable impairment and no disability, but they can have ongoing residuals. Permanent Impairment can only be just that. You cannot create an impairment rating unless it is at MMI and it is permanent in the definition of the AMA Guides. Impairment percentages derived from the Guides criteria should not be used as a direct estimate for disability. However, impairment percentages do estimate the extent of the impairment on whole person functioning whether physical or mental and account for basic activities of daily living, not including work.3Check back for Part 2 of this series so you can understand how to stay in the game.
Permanent Impairment Ratings: