Maximum medical improvement (MMI) is a milestone at which an injured worker is stabilized and has no room for improvement. MMI is important when collecting workers’ compensation benefits because reaching it may mean the end of compensation.
Workers who reach MMI have a few options: return to work and no longer receive benefits, transfer to permanent disability, or dispute the MMI categorization.
Learn everything you need to know about maximum medical improvement in workers’ compensation, including how the insurance company determines this point and what additional options may be available for continued benefits.
Definition of Maximum Medical Improvement (MMI)
Maximum medical improvement (MMI) describes the point at which an injured worker has reached maximum improvement. MMI doesn’t mean that the worker’s condition is fully healed. Instead, it means that further improvement, even with treatment, is unlikely. It also doesn’t mean the patient’s condition can’t or won’t worsen.
Many long-term injuries may prevent a worker from returning to work in the same or, in some cases, in any position.
MMI occurs when further medical treatment or rehabilitation is unlikely to improve the condition, not necessarily when the employee is healed enough to return to work.
Significance of MMI in Workers’ Comp Cases
Maximum medical improvement is a crucial milestone in workers’ compensation filings because it may mean the worker is no longer eligible for temporary disability payments. To continue receiving payments through workers’ compensation, the injured worker may need to seek permanent disability.
Both permanent partial and total disability are available to workers whose conditions prevent them from working.
Permanent partial disability refers to an employee whose injury prevents them from completing their typical duties but allows them to work. This is usually the result of a permanent impairment that may require ongoing medical care and prevents them from ever completing their initial work responsibilities.
Permanent total disability refers to an employee with an injury that prevents them from working in any position. If the treating physician determines the injured employee cannot safely return to any line of work, they may be eligible for permanent total disability payments.
Determining MMI
Workers’ compensation has specific policies to determine when an injured worker has reached maximum medical improvement. Here’s everything you need to know about determining maximum medical improvement.
The Role of the Treating Physician
The treating physician decides when a patient’s condition has reached maximum medical improvement (MMI). The attending physician gives the injured worker a disability rating.
They may provide the worker with a list of work restrictions, which determine the type of work or work tasks they can complete in their current condition.
The treating physician makes this determination using various information, including a medical evaluation, tracked progress, and treatment outcomes. They then report this information to the workers’ comp insurance company, which recategorizes eligible benefits.
Independent Medical Examinations (IMEs)
An independent medical examination (IME) may provide further information about a patient’s status. The workers’ compensation company may request an IME to confirm the worker’s MMI and disability percentage. The injured worker also has a right to a second opinion if they disagree with the MMI assessment.
Factors Considered in Determining MMI
Physicians may determine that an injured employee has reached MMI based on the following factors:
- Medical Diagnosis: The medical diagnosis can impact the likelihood of an employee reaching maximum medical improvement.
- Healing Process: How well or quickly the worker can heal is also considered when determining the likely success of further treatment.
- Treatment Effectiveness: How well previous treatments have worked may determine a worker’s disability rating or likelihood of improvement.
- Ability to Return to Work: The doctor will consider how a medical condition may affect a worker’s ability to return to work, either now or in the future.
- Capability to Perform Similar Job Duties: An impairment rating may be determined by evaluating a worker’s ability to perform the same or similar job duties.
A functional capacity evaluation is a series of tests that measure an employee’s physical abilities and work restrictions. It can help providers calculate an accurate impairment rating and determine whether an employee has fully recovered. It can also help providers identify permanent injuries that may also contribute to reaching MMI.
For example, a permanent injury is unlikely to heal from additional medical treatment, which could result in an MMI determination. MMI is usually determined once further improvement is unlikely. At this point, permanent total or permanent disability benefits may be considered instead.
What Happens When You Have Reached Maximum Medical Improvement
Reaching maximum medical improvement (MMI) triggers a change or stop in workers’ compensation benefits. Here are a few options that workers may have after reaching MMI.
End of Temporary Disability Benefits
Once workers reach maximum medical improvement, they may no longer receive temporary disability benefits, either temporary total disability (TTD) or temporary partial disability (TPD).
Workers’ compensation considers the employee medically stable at this point. However, reaching MMI doesn’t always mean full recovery or that the worker isn’t permanently restricted. Additionally, the worker may disagree that they have reached MMI, which deserves a second opinion.
Permanent Disability Evaluation
If a patient can no longer work after reaching MMI, they may undergo a permanent disability evaluation. During this, a medical provider completes a full assessment to determine the injury’s severity and impairment level. An evaluation may include reviewing the worker’s medical history, physical assessments, and diagnostic tests.
The results of this assessment are based on percentages, which refer to the level of disability rating. A 100% rating means total disability. A rating below 100% is a partial impairment rating with partial disability. The assigned percentage determines the medical benefits and compensation for the workers’ comp claim.
Settlement Negotiations
Settlement negotiations may be important when calculating permanent disability. A provider should consider the worker’s medical condition and how it impacts their ability to work. However, even a partial disagreement on disability percentage can make a difference regarding fair compensation.
Workers’ comp pays based on the worker’s average weekly wage and level of disability, making this rating important. If an injury worsens over time, the employee should be entitled to additional benefits.
Some insurance providers may try to get an injured worker to sign off on a lump sum settlement, which prevents them from receiving further compensation, even if they require additional medical treatment. Work with a lawyer before accepting a lump sum payment to evaluate your legal options.
A workers’ compensation attorney can also help negotiate a fair settlement, ensuring the insurance carrier comprehensively evaluates the employee’s condition, work restrictions, treatment plan, and disability percentage.
Disputing an MMI Determination
A maximum medical improvement determination may not always be accurate or reflect the worker’s ability to earn an income. Disputing an MMI requests a review of the determination.
Here are a few things that may occur during an MMI dispute.
Seeking a Second Opinion
If you disagree with your maximum medical improvement determination, you can receive a second opinion from a different qualified medical provider. Before seeking a second opinion, contacting a workers’ compensation attorney is usually best.
Each state has its laws regarding MMI disputes, and ensuring you follow your state’s policies increases the chances of a successful outcome.
Filing a Petition for Benefits
With new evidence, injured workers can file a petition for continued benefits. This may require a new disability rating or proof of the potential for continued improvement. A petition for a dispute can be used when the employer’s insurance carrier only accepts partial liability for an injury caused while at work.
A workers’ compensation attorney experienced in your state helps ensure future claims or disputes are correctly filed and with the appropriate evidence. A petition may require presenting your case to an administrative law judge. Work with an experienced law firm to ensure you receive a fair settlement that appropriately covers your medical bills and lost wages.
How a Workers’ Comp Attorney Can Help Injured Workers
Navigating workers’ compensation isn’t always easy. Workers’ compensation providers have strict timelines and require sufficient evidence for successful claims. There are many reasons to consider working with an experienced workers’ compensation lawyer, including the following.
Protecting Your Rights Throughout the Process
A workers’ compensation lawyer helps protect your rights throughout the lengthy claims process. Lawyers well-versed in workers’ compensation law help injured workers explore disability benefits and ensure they receive maximum entitlement.
Working with a law firm specializing in workers’ compensation also helps protect your legal rights. Employees deserve to have their medical bills paid and lost wages recovered when injured while on the job.
Challenging an Unfair MMI Determination
A workers’ compensation law firm can help challenge an unfair determination. Whether you believe that you can heal more with further medical treatment or the adjuster’s disability percentage doesn’t correctly describe your permanent injuries, you need a lawyer advocating for your best interests.
Negotiating a Fair Settlement
Whether extending your maximum medical improvement status or filing for permanent partial disability benefits, you deserve a fair settlement offer. Workers’ compensation policies are in place to help injured workers cover their finances until recovery. Some injuries may lead to long-term or even life-long work limitations.
You deserve a fair settlement based on your condition and ability to work. Rosenfeld Injury Lawyers is here to help protect that right.
Secure Expert Legal Representation!
Once a medical professional determines a worker has reached MMI, they may no longer receive compensation benefits. Depending on the worker’s disability percentage and permanent work restrictions, they may or may not be entitled to permanent disability benefits.
Our law firm is committed to helping injured workers go up against the insurance company and receive the compensation and benefits they deserve. From the initial workers’ comp claim to the MMI dispute, our team is here for you every step of the way.
Call (888) 424-5757 or fill out our online form to book a free consultation with a Chicago-based workers’ compensation lawyer.