Maximum medical improvement (MMI) is a medical term often used in workers’ compensation cases. It is an important point in a workers’ comp case because it can significantly impact your workers’ compensation benefits. Defining maximum medical improvement is often easier than agreeing when a worker reaches MMI.
Defining Maximum Medical Improvement
Maximum medical improvement (MMI) is when a doctor indicates that no further medical treatment is expected to improve your medical condition. A key aspect of MMI is that the patient’s condition is stable. Whether or not there might be an impairment or ongoing symptoms, the worker’s condition is not expected to improve or worsen in the future.
Symptoms and impairments might continue and require ongoing medical care to remain stable, but the likelihood of improvement is low to none. Doctors may prescribe a treatment plan that includes managing symptoms or palliative care.
How Does a Doctor Determine MMI?
A qualified medical evaluator (QME) or your treating physician performs the medical examination and evaluation. It includes clinical assessments, review of medical records, physical examination, diagnostic tests, consultations with specialists, and other assessments.
The doctor assesses your response to the medical treatment and rehabilitation therapies. The physician may also consult with you to gather subjective information, such as your pain level and limitations. However, the doctor may use several tests and evaluations to confirm subjective information, including a functional ability assessment.
Your physician or the qualified medical evaluator prepares a report that explains their findings and conclusions. There are several possible outcomes. The report may state that you have no impairments and can return to work without restrictions.
If the doctor finds you have an impairment or disability, the report should explain the impairment and the severity of the disability. Generally, impairments are rated on a scale from zero to 100, with 100 being entirely disabled. If you are partially disabled, the doctor explains the severity of the disability and how it impacts your ability to perform job duties.
How Does Maximum Medical Improvement Impact Your Workers’ Compensation Claim?
Reaching MMI could mean you have fully recovered from your injuries. If your doctor does not issue an impairment rating, you will be expected to return to work. If you have an impairment, your doctor might recommend vocational rehabilitation and further evaluation to determine how the impairment impacts your current job requirements.
When you reach MMI with no impairment, your workers’ comp benefits should stop. However, if you have an impairment, you could be entitled to disability benefits.
Partial Permanent Disability (PPD) is paid when you have an impairment but does not result in an entire impairment. Total Permanent Disability (TPD) is paid when your impairment prevents you from performing any gainful employment.
The amount you receive for disability benefits after a workplace accident depends on the degree of impairment and other factors. The workers’ compensation insurance company and your employer will try to obtain the lowest impairment rating possible. They may dispute the doctor’s findings.
On the other hand, you might need to challenge the determination of impairment if you believe the impairment rating is too low. A workers’ compensation lawyer can help you take the necessary steps to challenge the impairment rating.
What Should I Do if My Employer or the Workers’ Comp Insurance Providers Try to Make Me Return to Work Early?
The insurance company or your employer may tell you that you are ready to go to work before you believe you are ready to do so. Your treating physician might say that you have reached MMI and can return to work, but you are convinced your injuries are more severe.
If this happens to you, call your Vista workers’ compensation attorney immediately. Your attorney will file the appropriate forms to dispute the doctor’s findings. You must state your disagreement within 20 days.
If you do not have an attorney, you must send a letter to the claims administrator explaining you disagree with the doctor’s report. The letter must be sent within 30 days of receiving the report. In either case, you can request a medical evaluation from another doctor if you disagree with the report from your treating physician.
Disputing a determination of MMI can be challenging. The workers’ comp system can be confusing, with many deadlines and requirements. Consulting an attorney is the best way to protect your rights. A Vista workers’ comp lawyer reviews your case, advises you of your rights, and fights to get you the benefits and compensation you deserve.
A Personal Injury Attorney Can Help You Navigate Maximum Medical Improvement
Schedule a free consultation with an attorney if you have questions about MMI determinations, impairment ratings, or what your case is worth. Learning about your options from an experienced personal injury lawyer who only has your best interests in mind is worth your time. Call Petrov Personal Injury Lawyers today to get the legal help you deserve at (619) 344-0360
