Maximum Medical Improvement

Many terms are used to describe workers’ compensation and the injuries that result in work-related claims. Of them, the term maximum medical improvement, or MMI, is one of the most contested. When an accident victim relies on fair compensation from workers’ comp insurance to pay their medical bills, reaching MMI puts even more of a burden on the victim to make the best financial decisions going forward.

Workers Compensation

Workers’ compensation is insurance that an employer must take out to protect their employees. When a worker is injured on the job, workers’ comp pays their medical bills and a portion of their missed wages.

Most employees with minor injuries can handle their workers’ comp claim without any help. Those who have more serious injuries and who are unable to work for an extended period require guidance from an attorney. They have more to lose if they fail to meet the demands of the legal system. The laws pertaining to workers’ compensation are complex. One mistake could result in an injured employee living with a debilitating injury without the financial support they need to treat it.

Nearly 3 million work-related injuries are reported annually in the U.S. ranging from mild to severe or fatal. For some, treatment is short-term and requires little to no time off from work. Other injury victims are not as fortunate. Sometimes they are injured so severely that they need medical treatment for the rest of their life. This long-term condition often means that they will never be able to earn an income again. When an injury is this severe, the employee may receive a lump sum payment from workers’ comp to cover their missed wages in the future.

The Meaning of Maximum Medical Improvement

Once a doctor tells a patient that their condition has reached MMI, it means they have reached the point at which further improvement is not possible. Reaching MMI doesn’t indicate that they are completely healed or improved; only that there is no reason to keep trying to improve. MMI should not be designated until they try all possible treatments.

When a workers’ comp recipient reaches MMI, a doctor gives them a disability rating. Their attorney should receive a written statement from the doctor denoting the disability rating. Also, the doctor will tell their employer what tasks they are physically capable of and whether they can return to their job at all. These limitations are called “work restrictions.”

This issue is often less black and white than it seems initially. If an injury limits physical limits or prohibits certain types of tasks but not others, it puts the person in a very challenging position. One example is a back injury that doesn’t allow them to stand for extended periods. If the doctor limits them to standing for no more than twenty minutes at a time, this may eliminate them from performing the tasks of their previous job description. Depending on the setting, their employer may put them in a different position that meets their work restrictions. Some employers have no options available to do so. For example, a person working on an assembly line doesn’t have other possible tasks to perform while sitting down.

Determining a Fair Settlement

Determining a fair settlement in a situation where a person reaches MMI is another area of contention. This position potentially forces the victim to choose between settling for a final lump settlement (thereby releasing their employer and the insurance company from any future liability), versus continuing to receive benefits to cover their ongoing medical care and other financial needs.

Maximum Medical Improvement

At this point in the process, the complex laws laws related to workers’ comp and MMI once again come into play. Most workers’ comp recipients and their physicians lack the knowledge of the law to make good decisions.  Sometimes the treating physician misinterprets the requirements of the state. Since MMI marks the end of expected improvement in the person’s case, the physician can mistakenly think that they shouldn’t continue all avenues of treatment.

Who Determines Maximum Medical Improvement?

A physician is the only person who can determine when a patient reaches MMI. The workers’ comp insurance company has the right to request an independent medical examination to confirm the MMI according to the patient’s medical history and a medical examination. They will then file a report and submit copies to the patient, the treating physician, the employer, and their insurance carrier.

The next step in the process depends on the treating physician. If they agree with the report submitted by the independent medical examiner, the patient’s temporary workers’ compensation becomes terminated on the date of either the physical exam or of the treating physician’s approval.

If the treating physician disagrees with the report, they forward the claim to the Industrial Commission or a workers’ comp judge for a special hearing. The judge has the final say in whether MMI has been reached.

Sometimes, reaching MMI means that the patient has fully recovered and has no work limitations going forward. In most cases, the line is more blurry, and the patient’s future cannot be guaranteed to stay the same. If some methods of treatment have not been tried, they still have the potential to get better. But what if they get worse later on?

What If Their Injury Worsens After Reaching MMI?

There’s no overstating the importance of MMI. It plays a pivotal role in determining how much compensation and benefits an injured employee receives. At this point in treatment, an impairment rating is assigned; never before that. The impairment rating tells everyone involved if the victim has a permanent medical condition and what limitations it will place on them for the rest of their lives.

MMI assessment determines that an injury won’t get better going forward. That doesn’t mean that the person can’t get worse or that they should suffer with their symptoms if they do. If they began to experience pain or other symptoms, the doctor needs to evaluate their condition to determine if the injury is the cause of their symptoms and if they require further treatment.

The person also has the right to question the doctor’s evaluation of MMI. Others forms of treatment might be available that they want to explore. If they intend to ask for a second opinion, they need to hire a workers’ compensation attorney who knows the laws pertaining to MMI in their state.

Whole Person Impairment (WPI) and Partial Impairment Rating (PIR)

A partial impairment rating determines the severity of the injury. This score is in direct proportion to the percentage of impairment the injury caused. In addition to the person’s medical needs, their ability to return to work is also an area of concern. After establishing MMI, their PIR may indicate they are only partially impaired, but they can potentially go back to work in a position that doesn’t exceed their functional capabilities. The practical limitations of the injured worker are determined by a functional capacity evaluation (FCE).

An injured worker whose disability prevents them from ever returning to work may receive disability benefits continually or until the statute of limitations expires. This time frame depends on the state.

State Map

Why Maximum Medical Improvement Invokes Fear in Injured Workers

Reaching MMI is not a cause for celebration. Workers often worry that once they reach MMI, their benefits and medical treatment will come to an end. The company carrying the workers’ comp insurance for the payment may stop payment of the total partial benefit as soon as MMI is established.

The employer or workers’ compensation carrier may offer the injured worker a settlement in a specified amount in return for a release. Once the worker agrees and signs the release, they forego their rights to bring any future claims against the employer or the workers’ comp carrier. This statement means that if their injury should worsen in the future, they have no avenue to pursue additional benefits to pay for their medical treatment.

If the employer is found liable for the worker’s medical expenses related to the injury for life, they will continue to be liable even after reaching MMI. This situation also means they must continue to pay their medical care and disability benefit. Unless the injured worker agrees to a settlement and signs a release, the employer and/or insurance carrier is still required to pay medical benefits.

In fact, even after a person reaches MMI, the worker retains eligibility for:

  • Compensation for Lost Wages – When the injured worker has to work for a lower wage due to their disability rating or they are no longer able to work full-time, they may be eligible for loss of working wages. If they are unable to find a job that fits into his functional limitations, then he may receive compensation for non-working wage loss.
  • Permanent Total Disability – If a worker’s injuries are severe enough that they are unable to ever return to work, permanent benefits may apply.
  • Rehabilitation Costs – If different types of back-to-work programs are available that will help them improve their condition and get back to work, vocational rehabilitation may be an option.
  • Lump Sum Settlement – The insurance carrier may offer the injured worker a lump sum settlement, usually with the condition of signing a release from future liability. The injured worker should always consult with a workers’ compensation attorney before agreeing to a lump sum settlement after reaching MMI.
  • Compensation for Percentage of Permanent Partial Disability – This type of compensation is based on the percentage of permanent partial disability caused by the injury.

Personal Injury and Maximum Medical Improvement

It’s easy to see the critical role of MMI in workers’ compensation claims, but its designation also plays a role in some types of personal injury cases. The most common type of personal injury claims come from injuries received in car accidents. When a person receives injuries in an accident that is another driver’s fault, they make a personal injury claim to receive compensation. This money usually comes from the at-fault driver’s car insurance company.

The majority of personal injury cases get settled before they go to court. A settlement is a more affordable option for both sides. However, it is important to have an experienced personal injury attorney to handle the negotiations to ensure the settlement is a fair one that covers the injured victim’s expenses.

Personal injury victims should also wait until they reach maximum medical improvement before considering a settlement. Sometimes the injuries received from a car accident get worse over time. Settling too early could result in the person relinquishing their rights to pursue compensation later on. Once they reach MMI, it doesn’t mean that their costs or needs for medical treatment come to an end. That’s why legal representation is so essential to both personal injury victims and workers who have work-related injuries.

Choosing a Personal Injury Attorney

Once you realize the significance reaching MMI has on your future, it’s easy to see why a personal injury attorney is a necessity. The first time you need to hire an attorney, it’s important to look for the right features. You need someone with the right skills, in-depth experience, and a background that includes a long record of success.

Ingerman & Horwitz, LLP, is a Western Maryland and Eastern Shore law firm that specializes in personal injury and workers compensation law. They understand the impact your injury and reaching maximum medical improvement has had on every area of your life. Their knowledge and skills make them the perfect choice to represent you at any stage of the workers’ compensation process.

Contact Ingerman & Horwitz to speak with an experienced personal injury attorney who genuinely wants to help you get the best possible results from your case. We offer a free consultation to evaluate the details of your case. We help you understand your rights and provide the legal advice and defense you need. Our skilled attorneys are ready, willing, and able to take on the insurance companies and defendants to pursue your needs.