Workers' Compensation and Maximum Medical Improvement (MMI)

After a workplace accident, it takes time to recover from your injuries. Some injuries have permanent damage. To find out how much damage the accident caused, you have to wait until you get to the point of maximum medical improvement (MMI).

Maximum medical improvement impacts workers’ compensation claims. You have to wait until MMI to determine your disability rating. Workers’ compensation laws differ in every state. For questions about how MMI affects workers comp claims, talk to a local workers’ compensation lawyer for legal advice.

What Is Maximum Medical Improvement?

Maximum medical improvement (MMI) is the point where an injury stabilizes and is unlikely to improve, even with continuing medical care. MMI means the medical condition is fixed and stable.

MMI doesn’t mean you’re back to normal or have a full recovery. Some injuries have permanent damage. However, MMI means the injury has reached a point where doctors can’t do anything more to improve the injury.

For example, a worker with a broken arm may have a temporary partial disability. The worker will reach maximum medical improvement after the break heals and the cast comes off. However, a worker with an arm amputation can reach MMI after the wound heals or they have a prosthetic. The amputation is a permanent impairment, and no additional treatment will fix their disability.

How Does Your Doctor Determine Maximum Medical Improvement?

A doctor or medical professional can make an MMI determination. In workers’ comp cases, a medical professional makes a functional capacity evaluation. A doctor, occupational therapist, or physical therapist can make the evaluation.

A physical evaluation can determine your physical abilities to perform work activities. The evaluation includes capacity testing for basic work functions based on your job description. Work capacity testing can include:

• Mobility
• Sitting, standing, and bending
• Lifting and carrying
• Working on ladders
• Typing and keyboards
• Fine manipulation

For workers’ compensation insurance claims, a state-certified medical professional does the MMI evaluation. This is generally not your treating doctor. An independent medical examination (IME) can determine your functional capacity and work restriction. The independent medical professional will also detail how further improvement is not expected.

What Is the Significance of MMI in Workers’ Compensation Claims?

Your MMI information can affect your workers’ compensation benefits and disability benefits. Generally, you’ll stop getting temporary disability benefits after you reach MMI. Any continuing impairments are permanent disabilities. You can keep getting medical benefits to treat pain and manage your permanent impairments.

After MMI, you can get permanent disability benefits. Permanent partial disability benefits depend on your impairment rating. The impairment rating is generally a percentage of your total body function affected by the impairment or illness, from 0 to 100%. The state workers’ compensation board can use your MMI rating to determine your benefits.

MMI and impairment ratings depend on your situation. When the doctor evaluates your permanent work restrictions, it depends on the work you were doing at the time of your injury. If you were a forklift operator and suffered an injury, your work restrictions relate to your ability to operate a forklift.

If you have 0% impairment, the state will consider you fully healed, and you can return to work. You’ll no longer get workers’ comp benefits. If there are permanent impairments (1% or more), you can get permanent disability benefits. The insurance company will generally offer a lump sum benefit payment to resolve your claims.

Resolving Workers’ Comp Disputes

You can appeal your impairment rating with the state. When you get a notice of your rating, you have a limited time to protest the decision or request an appeal. You may also request a second opinion from a different treating physician. You may have to select a physician from an approved list of healthcare providers. There are specific processes for appealing a workers’ comp disability claim. There are also time limits for resolving workers’ comp disputes.

After a workplace injury, you have to deal with the state workers’ comp board, your employer, and the workers’ comp insurance company. After reaching MMI, the workers’ comp insurance company may offer a settlement for your injuries. However, the amount may not be enough to compensate you for your wage loss if you can no longer work.

A workers’ compensation attorney can review your case and represent you when dealing with the insurance company. They can negotiate for a better settlement offer and more in benefit payments. If you’re having problems getting benefits after a permanent work injury, contact an experienced workers’ compensation lawyer.