In the context of workers’ compensation, maximum medical improvement refers to when your condition has healed to the extent that it can. It’s essentially when your condition plateaus and the doctors don’t think additional medical treatments will help it improve further. When you reach maximum medical improvement, the insurance company may ask you to be evaluated by a doctor. In this meeting, the doctor may assign you an impairment rating. In turn, the insurance company uses this impairment rating to determine the benefits you can receive.
When people suffer job-related injuries, they depend on workers’ compensation benefits to help them sustain themselves while they heal. Throughout our history, which spans over 85 years, Krasno, Krasno & Onwudinjo has championed the rights of those injured and unable to work. Our Pennsylvania workers’ compensation lawyers have helped people in the construction, manufacturing, steel, education, healthcare, and other sectors recover compensation totaling over $1.5 billion combined.
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What Is Maximum Medical Improvement?
Maximum medical improvement is when an injured worker’s condition reaches a point where the doctors don’t think it will get better with treatment. In other words, your condition has healed as much as the doctors expect it to under the circumstances. When you reach maximum medical improvement, the insurance company may ask another physician to evaluate you to determine your new impairment rating. The impairment rating is the difference between your pre- and post-injury function level. In other words, it measures how your injury has changed your ability to function.
Who Decides if Someone Has Reached Maximum Medical Improvement?
A qualified doctor or other medical professional determines if you have reached maximum medical improvement. In most cases, your treating doctor is the one who provides an opinion about this, but there are situations where an independent doctor may do so.
In most cases, the doctors won’t decide if you reach MMI until you have exhausted all other medical treatments available to you. Once you reach MMI, our employer or its insurance company may stop paying for some forms of treatment related to your work injury. An exception to this might be if you have a prosthesis that requires regular replacements or repairs. Lawyers for workers’ compensation assist people with understanding the impairment evaluation process, such as preparing for an independent medical examination.
What Happens After You Reach Maximum Medical Improvement?
Once you reach MMI, your treating physician may provide you with an impairment rating. This rating sets out how much your injury limits your ability to function. The doctor expresses this as a percentage.
You may also get an independent medical examination (IME) from a third-party doctor. Some of the questions an IME addresses include the following:
- Whether you have reached maximum medical improvement,
- When you reached MMI (if it was in the past),
- If you would benefit from additional treatments or medical care, and
- Your impairment rating.
The insurance company may use your impairment rating to determine what benefits you qualify for. For example, if your injury impairs your ability to function by 35 percent or more, you may be eligible for total disability benefits. If your impairment rating is less than 35 percent, you may qualify for partial disability benefits instead. Additionally, you may receive one type of benefits during the initial healing period but another once you heal or reach maximum medical improvement.
What Is the Relationship Between Workers’ Compensation and Maximum Medical Improvement?
Reaching maximum medical improvement can change how much or for how long someone receives benefits for a job-related injury. When you receive workers’ compensation, you may get payments to cover your medical expenses and lost wages. In some situations, payment of your medical expenses lasts for as long as you need them for your job-related injury. But your wage replacement benefits may not last as long. For example, someone with a partial disability may only receive a maximum of 500 weeks’ worth of benefits. If their situation worsens and they get a higher impairment rating, they may qualify for total disability. But if their condition plateaus or improves, their workers’ compensation payments may end.
What if a Work Injury Gets Worse After You Reach Maximum Medical Improvement?
If your injury worsens after you reach maximum medical improvement, you may get a new impairment rating. If your injury-related condition worsens to the point where you have a higher impairment rating than before, you may qualify for additional or different benefits. In some cases, this may mean that you can request a change to your monthly payments. In other situations, it may mean the insurance company will resume paying for your medical bills.
For example, imagine you have an ankle injury that is generally doing well. However, the screws and pins that were implanted ended up breaking or moving. The damage to your ankle because of those pins may be a continuation of your work injury. If that’s the case, the insurance company may continue paying medical expenses related to your ankle. Another situation in which your condition may worsen is if you get a second injury after returning to work.
My Doctor Says I Reached Maximum Medical Improvement, but I Disagree. 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 may also have the right to get your own independent medical examination (IME) to determine whether you reached MMI and what your functional impairment rating is.
Krasno, Krasno & Onwudinjo: Fighting for Injured Workers Since 1936
Reaching maximum medical improvement can have important implications for your right to continue receiving workers’ compensation benefits. Depending on your impairment rating, you may continue receiving benefits or lose access to them. Before the insurance company can stop paying you benefits, they must provide you with the necessary notices. A skilled workers’ compensation lawyer can help you understand what reaching maximum medical improvement may mean in your situation.
At Krasno, Krasno & Onwudinjo, our commitment to injured workers runs three generations deep. What sets us apart from other law firms is our unparalleled dedication to the challenges faced by those hurt while doing their jobs. Since 1997, Eileen Pomento has fought for workers throughout the Commonwealth and New Jersey. A leader in this field, she has given multiple presentations on workers’ compensation topics at Pennsylvania Bar Institute seminars.
If you have questions about workers’ compensation and maximum medical improvement, contact us today by calling 844-948-2338 to schedule a free, no-obligation consultation.