Get Free Case Evaluation
Maximum medical improvement (MMI) is the point in an injured patient’s recovery when they have stabilized and are not expected to recover further. At this point, any disabilities or injuries that remain are permanent.
MMI is vital for worker’s compensation for several reasons. First, it tells the employer, insurer, and patient that treatments aimed at further recovery won’t produce results.
If they have no lasting disabilities after an MMI determination, the worker could return to work and cease all treatments. However, if they have a permanent impairment due to the injury, an employee could seek further compensation or pursue a settlement with the help of a lawyer.
Here is a look at what an MMI determination means for employees and employers and the steps to take next.
Understanding Maximum Medical Improvement (MMI)
Medical evidence is the primary factor in deciding MMI. Physicians will run diagnostic tests and perform examinations to determine improvement. The professional prognosis of doctors plays a significant role in MMI determinations.
Doctors may also evaluate treatment responses. If the patient does not show improvement from planned treatments, they may have reached MMI. At this time, the employer may ask for a functional capacity evaluation (FCE). This measures the employee’s physical ability to perform work-related tasks.
From a medical perspective, MMI means healthcare providers shift from focusing on recovery to helping patients manage any remaining impairment. For instance, they help patients with chronic conditions caused by their injuries.
Legally, MMI does not mean full recovery. It signals the next stage in the worker’s compensation process. Employees may return to work if physically able, or they could pursue an additional settlement. Additional funds pay for support and medical care to live with any remaining disabilities.
The Importance of MMI in Workers’ Compensation Cases
Workers’ compensation has different designations for injured employees. Those undergoing treatment have a temporary disability. With this designation, workers receive coverage for medical treatment and lost wages.
Temporary disability continues until the worker returns to the job or receives an MMI determination. MMI plays a significant role in the transition between temporary disability and the next phase of the worker’s compensation case.
How MMI Affects Your Compensation
If they have a permanent disability after MMI, the employee can pursue permanent disability status. This category includes compensation for loss of earning ability and expenses necessary to live with the disability.
For instance, if a machinist lost an arm during work and reached MMI, they could receive compensation for all future lost wages and the cost of a prosthetic arm. These payments could come monthly or annually or in a lump sum, based on settlement details.
The Process of Reaching MMI
Doctors make an initial diagnosis and create a treatment plan for the injured worker. Medical staff document and assess progress and make adjustments based on continued testing and evaluation.
Physicians use stabilization to help determine MMI. Stabilization is when the patient no longer needs treatment to fully recover. It can also mean they are no longer responding to standard treatments, and any additional treatment won’t lead to additional recovery.
In some cases, employees undergo a functional capacity evaluation (FCE) to see if they can physically perform movements and tasks associated with their jobs. This test assesses whether they can return to work or are no longer able to do their job.
Who Determines That MMI Has Been Reached?
The treating physician makes the initial MMI determination. They collect medical records and documents showing diagnosis and treatment. These are important for supporting their determination.
In disputed cases, an independent medical examiner (IME) assesses the patient and documentation. These professionals make an impartial assessment of the patient’s condition. They may also review pre-accident medical records to determine any pre-existing conditions falsely attributed to the work injury.
Finally, a utilization review (UR) doctor reviews all treatment documents and medical records to see if the diagnosis and treatments align with standards of care. UR physicians typically work with insurance companies. Though they provide opinions, they are not responsible for making an overall MMI determination.
How Long Does It Take to Reach Maximum Medical Improvement?
The timeline for full recovery or MMI varies depending on the injury. However, the treating physician can follow workers’ comp guidelines to treat patients after injuries. The steps within the medically-necessary parameters might include:
- Acute care and initial stabilization happen immediately after the injury. The goal of this phase is to treat the initial trauma or illness and keep it from worsening.
- Surgical repairs, casting, and other steps seek to correct the effects of the injury.
- Ancillary services like physical therapy helps patients regain movement and function following the injury.
- Any other medical services necessary for recovery from the workplace injuries or illness.
The severity of the injury or illness can impact the timeline for recovery or MMI. Disputes or denied workers’ comp claims can delay an MMI determination even if the physicians are prepared to make a decision.
What Happens After Reaching MMI?
After an MMI determination, the insurer can close the medical portion of the workers’ compensation claim. Any ongoing care, such as support for workers with limited mobility due to a work accident, would be included in the permanent disability settlement.
Employees able to return to work may undergo an FCE to determine their ability to return to the job.
Usually, people with a permanent impairment undergo evaluation to assess the need for permanent disability benefits and the amount of those benefits. These calculations are based on the severity of the injury. Pre-injury earnings and occupations are additional considerations.
If there is a dispute, patients usually hire a workers’ compensation lawyer to handle settlement negotiations or gather evidence for an appeal. Another step could include seeking a second opinion from another physician.
What if an Injury or Illness Gets Worse After Reaching MMI?
Occasionally, a condition could worsen after an MMI determination. The treating physician can document these changes and re-evaluate the illness or injury. After revaluation, the employee needs to describe their health issues to their employer and insurance company.
Documentation and medical records are important in these cases. This evidence can help the doctors and attorneys link your condition with the injury or illness.
Maximum Medical Improvement Payout
MMI determinations mark the start of the settlement process. The amount of the settlement should cover any lost wages or opportunities due to lasting impairment. It should also cover other services, such as ongoing therapy or equipment necessary to manage disabilities caused by the injury.
Some settlements come in lump sum payments, while others may include ongoing benefits. For instance, a patient could receive a lump sum to cover lost wages for their lifetime. Another might agree to have additional treatments covered on an ongoing basis.
Often, workers’ compensation lawyers can help with settlements. At The Gatti Law Firm, our specialists understand the nuances of workers’ comp laws and can help collect the necessary evidence to negotiate on clients’ behalf to reach a fair settlement.
Call us at (503) 594-4944 or contact us online!