MMI and Grover Meds
From Pinnacol's Medical Director
Medical care for the work related illness or injury involves concepts foreign to traditional medical training. Occupational medicine in Colorado has some unique terminology: Maximum Medical Improvement (MMI) and Grover Meds. Unless you take care of workers injured or ill these two terms do not arise. If you do, they become an essential component of the lexicon
The AMA Guides 3rd Edition, Revised, does not address the term MMI. The Guides refer to permanency. The Level II Curriculum offers the following: “Maximum medical improvement exists when the underlying condition causing the disability has become stable and no further treatment is reasonably expected to improve the condition. MMI does not preclude medical maintenance or alteration of the medical condition with the passage of time. Continuing treatment to sustain the patient’s current level of functioning can be prescribed but should be documented by the physician in the final report.”
The 6th Edition on page 26 offers further information on MMI: “Maximum Medical Improvement refers to a status where patients are as good as they are going to be from the medical and surgical treatment available to them. It can also be conceptualized as a date from which further recovery or deterioration is not anticipated, although over time (beyond 12 months) there may be some expected change. “Thus, MMI represents a point in time in the recovery process after an injury when further formal medical or surgical intervention cannot be expected to improve the underlying impairment. Therefore, MMI is not predicated on the elimination of symptoms and/or subjective complaints. Also, MMI can be determined if the recovery has reached the stage where symptoms can be expected to remain stable with the passage of time , or can be managed with palliative measures that do not alter the underlying impairment substantially, within medical probability.”
On page 24, the 6th Edition notes: “Impairment should not be considered until a reasonable time has passed for the healing or recovery to occur. This will depend on the nature of the underlying pathology, as the optimal duration for recovery may vary considerably from days to months.”
Thus, MMI is predicated on stability of the condition. Pain is not the deciding factor. The ability to improve function with medical or surgical interventions and stability of the injury or illness defines the presence or absence of MMI.
If an injured or ill worker requires medical care for maintenance of MMI, then Grover Meds comes into effect.
The ruling came down in 1988 in Grover v. Indus. Comm’n, supra, 759 P.2d at 711-12 "[i]f at the hearing on the final award of permanent disability there is substantial evidence of such need for future treatment," the employer may be ordered to pay the costs of future medical treatment.
In the Impairment Rating Tips offered by the Division of Workers’ Compensation (DOWC) in January 2011, the DOWC addressed Grover Meds with:
“Grover Meds” and Impairment: If continuing treatment or medications are ordered in a case post-MMI (“Grover Meds”), and that treatment was not being given prior to the onset of the work-related injury or condition, there may be a reasonable assumption that there has been a permanent change in a body part under the definition of impairment in the AMA Guides, 3rd Edition (rev.). Therefore, it is incumbent on the physician to perform a full assessment for impairment at the time MMI is determined. This should not be interpreted to say that all persons receiving Grover Meds necessarily qualify for an impairment rating. If the rating physician provides an assessment of zero or no impairment, yet orders post-MMI treatment, this should be reconciled and justified in the physician’s closing report.
The court has noted that the patient may obtain future medical benefits only to maintain MMI or prevent deterioration of the condition. The injured worker (claimant) is therefore entitled to Grover-type medical benefits where there is substantial evidence in the record to support a determination that future medical treatment will be reasonable and necessary “to relieve a claimant from the effects of an [industrial] injury” or prevent further deterioration of the claimant's condition. Such evidence may take the form of a prescription or recommendation for a course of medical treatment necessary to relieve a claimant from the effects of the injury or to prevent further deterioration. Once an injured worker (claimant) establishes the probable need for future medical treatment he “is entitled to a general award of future medical benefits, subject to the employer's right to contest compensability, reasonableness, or necessity.”
To enable Grover Meds, the documentation must be substantial; the continuing care cannot be set as simply an afterthought. Be thorough in your documentation, as your patient's well-being depends on adhering to the law.