What is Maximum Medical Improvement, and How Does it Impact Your Workers’ Comp Claim?

Maximum medical improvement or MMI is a standard used in legal cases. It is particularly prevalent in workers’ compensation cases.

MMI is a point that you reach in your medical care. It does not mean that you are fully healed from your work injury in a lot of cases, but, from a medical standpoint, you are “as good as you are going to get.”

Your workers’ compensation claim may involve permanent injuries or disfigurement that will affect you for the rest of your life. In some cases, you may require medical treatment for years to come simply to deal with a chronic condition. In other situations, further treatment may not be necessary—not because you are completely healed, but because you will not get any better.

MMI is used as a point in time to determine the difference between an injured worker’s state before the work accident and after the injury. To determine permanent impairment benefits, you have to “measure” the change between your pre-injury self and your capabilities and limitations once you reach MMI.

Who Determines if a Claimant Meets MMI Standards?

Only a doctor or other medical professional can determine if you have reached MMI. In most cases, your treating doctor will provide an opinion about whether you meet the MMI standards.

In general, you should have exhausted virtually every possible treatment before you will meet the MMI standard. Once you reach MMI, your medical treatment will stop. When a doctor determines that you are at MMI, he or she is essentially saying that you can continue treatment, but it will not help you get any better. That also means that your employer or its insurance company will stop paying for treatment once your treating doctor determines that you are at MMI.

MMI and Impairment Ratings

Once you reach MMI, your treating physician will provide you with an impairment rating. This rating sets out how much you are debilitated because of the injury. It is expressed as a percentage.

You may also get an independent medical examination (IME) from a third-party doctor as well. An IME answers some of the same questions that your treating doctor may have already addressed, such as:

  • Whether you have reached MMI
  •  When you reached MMI (if it was in the past)
  • Whether there are additional treatments or medical care that you should use
  • Your impairment rating

The IME doctor provides a helpful second opinion about whether you should investigate other potential medical care or treatment.

What if a Work Injury Gets Worse?

A work injury may get worse after you reach MMI. While you may be at MMI at one point, setbacks can always happen. In fact, you may end up later qualifying for total disability benefits if your situation gradually gets worse.

For example, imagine you have an ankle injury that is generally doing well. However, the screws and pins that were implanted end up breaking and moving. The damage to your ankle because of those pins is often considered a continuation of your work injury, and you will likely require more treatment or surgery. The insurance company, in many cases, should continue to pay for medical treatment in this type of situation.

An MMI determination cannot account for future injuries or deteriorating medical conditions. MMI also does not mean that you no longer have symptoms. In many cases, you will have pain or movement limitations for the rest of your life following your work injury. These limitations are your permanent impairment that determines your workers’ compensation benefits over the long term.

What is a ‘Fair Settlement’?

There really is no bright-line rule about what a fair settlement is or is not. Instead, what is fair depends on your unique situation. Workers’ compensation law in Pennsylvania is designed to help you deal with the loss of function and ability to continue working that might result from a work injury. You should also get the medical care you need to address your injuries and pain.

When a doctor determines that you have reached MMI, he or she will provide a disability rating. This rating is a combination of many factors, including:

  • Your level of pain
  • Your range of motion
  • What activities are limited or restricted
  • How you respond to certain treatments or medications

Then, that rating is converted into how your restrictions and impairment will affect your working life. If the doctor is reasonable in his or her assessment, the insurance company will hopefully offer a fair settlement based on that assessment and a combination of your lost wages and work restrictions. If not, then you have the option to get a second opinion or ask a judge from the Department of Labor and Industry to decide your case for you.

Can I Get a Second Opinion?

One doctor’s opinion about whether you reached MMI is just that—an opinion. If you think you can improve further by getting additional treatment or trying something new, then you can get a second opinion. You also have the right to get your own independent medical examination (IME) to determine whether you are at MMI and what your functional impairment rating may be.

Your insurance carrier’s goal is to cut costs and stop paying your medical benefits after your work-related injury as soon as possible. They want to send you back to work as quickly as they can, even if you are not ready. However, you can take action if you think you need more medical treatment.

Worried About MMI? Talk to a Workers Compensation Attorney

Your employer’s workers’ compensation carrier may try to cut your medical benefits off short by using their doctor to say that you have reached MMI without exploring other options for medical treatment. You do not have to just go with what their doctor says. You have different options that can help you heal completely—and you have a legal right to use them!

Explore your rights under workers’ compensation law with legal advice from our law firm. Contact us to schedule a free consultation today: 844-243-4808.

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