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MMI-Maximum Medical Improvement

This is when there is little to no more improvement anticipated. Essentially if
improvement is expected to be less than 10% improvement over the next six months, the
claimant has reached MMI.
IR-Impairment Rating also called PPI or permanent partial impairment
This rating is given at the end of treatment for any condition that is permanent. It should
be expressed as a percentage to the extremity and taken out to the body as a whole. In
Arkansas we still use the AMA Guidelines to Permanent Impairment Fourth Edition.
Some accounts such as the US Dept. of Labor will require the Fifth Edition. When
providing this information, be sure to include the page number, table and edition used.
In the extremities range of motion can be used, but this is not acceptable in Arkansas with
regard to the spine. All spinal ratings must be on objective findings to the disc rather than
range of motion.
TTD-Temporary Total Disability
This is usually referred to the compensation the claimant receives if they are unable to
return to work for a period of time during treatment.
PPD-Partial Permanent Disability
This is usually referred to the compensation received as a result of the impairment rating.
It is compensation for the permanent change to the body as a result of the injury or
PTD-Permanent Total Disability
This is the pay received by a claimant when their disability is permanent and the claimant
is unable to return to work. It is often used in a settlement.
IME-Independent Medical Evaluation
This examination is performed by a physician who has not previously seen the claimant
and none of his/her associates has been involved in the treatment of the individual. It is
typically used when a conflicting opinion has been given or if treatment seems
questionable. Please note that if you want to treat the patient you should not perform an
IME, but rather a Second Opinion. Any IME must include diagnosis, prognosis, and
causality as it relates to the injury or accident, impairment, functional ability or
limitations, whether the claimant has reached MMI and if not, when it is anticipated. Any
further treatment recommendations should be made known as well.

Needed with each and every visit:

1. Work Note-A work status form of some kind is needed after each visit. It does
not matter if the recommended work duties have changed or not. The best work
note provides written recommendations regarding sitting, standing, lifting,
pushing, pulling and makes notes for any special instructions such as wearing a
splint or brace. Can not do rather than can do. Employer to figure out the
2. Estimated length of disability-At the initial visit we need some kind of idea as to
how long treatment is expected to last. We understand this may change upon each
visit, but a general idea is needed. At each appointment the length statement
regarding disability is more about the reduction or elimination from work i.e. light
duty for four more weeks.
3. Treatment plan-what is the treatment plan and how long is it expected to last. If
you know what the next step will be, be sure to let us know this as well. i.e. we
will try an ESI at L5-S1 and if this does not resolve her complaints we may
consider a facet injection
4. MMI-Is the claimant at MMI? If not, let us know when it is expected (if known).
If yes, then provide us with the rating at the appointment if able.
5. Copies- As case managers we will request copies of prescriptions for medications,
therapy, return appointment date if applicable
6. Office Dictation-a fast turn around on dictation allows us to obtain authorization
for tests or procedures. It also helps us to close our file for those claimants who
have reached the end of their healing time.
For any questions or clarification, feel free to contact either of us. We are here to help
your practice succeed!
Victoria Powell, RN, CCM, ALNC, CNLCP, CEAS
VP Medical Consulting, LLC