Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

47. Workers’ Compensation: An Occupational Perspective…
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Maximal Medical Improvement
Physicians who are treating injured workers with groin pain might on
occasion be asked to comment on maximal medical improvement
(MMI) . MMI is not necessarily related to a prescribed post-hernia repair
time, for example, but rather to that point at which little or no further
improvement is anticipated (more likely than not) and treatment gains
appear to have plateaued. When an injured worker is determined to be
at MMI, a physician might also be asked to provide a permanency rating.
This rating of permanent impairment will help to determine the
amount of benefits for the patient by the workers’ compensation or disability
insurance carrier. For example, usual successful hernia repair
would be expected to result in a 0 % impairment rating. A patient who
reports an absence of pain but for whom there is a recurring groin protrusion
with increased abdominal pressure, and for whom there are some
appropriate lifting restrictions (and surgery declination), would receive
an impairment rating of 10 %. In the case of ongoing pain due to documented
residual nerve entrapment, or in the case of recurrent inguinal
hernias that are only partially reducible despite repeated surgical repair,
it is advised that the American Medical Association’s Guides to the
Evaluation of Permanent Impairment be referenced [ 19 ], as these determinations
are less straightforward.
Conclusion
In summary, there is increasing evidence that groin pain and inguinal
hernias are not usually related to workplace injuries, that disability duration
is often overestimated, and that chronic groin pain and herniorrhaphy
recovery are in part related to psychosocial variables, some of
which are modifiable. Disability and subjective reports of chronic pain
are disproportionally higher among workers’ compensation patients.
Workers’ compensation carriers are generally interested in value. If a
hernia surgeon is able to document improved outcomes and decreased
recurrence rate, there is often an opportunity for a preferred referral
relationship (that is not necessarily related to reimbursement).
Worker’s compensation can be arcane. Although it is described as a
single system, in reality, it is a complex set of often challenging rules
and regulations that vary from state to state. If case-specific questions
arise, a treating physician can consider engaging the carrier medical
director to help clarify.