What Is Maximum Medical Improvement (MMI) in Workers’ Compensation?

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For many, workers’ compensation laws, rules, and processes are a jumble of nearly indecipherable terms that mean something to attorneys and barely anyone else. One of those terms is Maximum Medical Improvement (MMI,) which can be as perplexing as it sounds intimidating.

If you are considering a workers’ compensation lawsuit, you must familiarize yourself with MMI and what it means for your case. 

To help you, here is a rundown of what the term means and why you should contact Mottaz & Sisk Injury Law regarding your lawsuit.

What Is MMI?

When a doctor has decided that they can do no more to help you, or you have fully healed, they make a Maximum Medical Improvement (MMI) determination. From a treatment perspective, there is no reason to continue with the current program, which means you have reached one of the following two milestones in the opinion of the attending physician:

  • Treatment stops
  • Treatment gets modified to address your situation more effectively

Initially, a patient’s physician is the only person that can determine when a patient reaches the point of Maximum Medical Improvement (MMI).

Workers’ Compensation Third Party Examination

The workers’ compensation insurance company can request an independent examination of the patient. A third-party physician, approved by the insurance company, will perform an examination and review the patient’s medical history. 

If the third-party physician agrees with the attending physician, they submit a report to the attending physician, insurance carrier, and the patient’s employer confirming the attending physician’s opinion. At that point, workers’ compensation coverage ends, effective on the date of the third-party exam or upon the attending physician’s agreement of termination.

A third-party doctor can disagree with the assessment. When that happens, they submit a report to the Industrial Commission or request a special hearing before a workers’ compensation judge. In the event of disagreement between the two doctors, a judge determines when the Maximum Medical Improvement (MMI) goes into effect. 

Once the MMI point is determined, the patient must consider several options.

Disability Rating

If the MMI is determined to have been reached, the attending physician gives the patient a “disability rating.” The disability rating is an assessment of the following:

  • Where the patient’s injury or illness stands
  • How much the injury or illness limits the patient
  • What tasks they can perform at their job
  • Whether they can return to work
  • Whatever work restrictions apply

Work restrictions are job-related tasks that an employee cannot physically, mentally, or emotionally perform.


Disability Rating and the Employer

The disability rating also helps determine some things for the employer. Depending on the scope of the disability and what the employee can do, the employer must make reasonable accommodations should the employee return to work. Accommodation can mean altering schedules, working in recovery time, and modifying jobs or standard operating procedures. 

If the situation or environment that led to the injury or illness persists, an MMI and disability rating can prompt the employer to alter the workplace physically. 

They might add safety features to prevent slipping and falling or require safety clothing that was not previously required. The employer might implement a new training curriculum if other employees face the same challenge as the injured or sick employee.

What MMI Means to a Lawsuit

A Maximum Medical Improvement (MMI) and disability rating carry results for the patient, insurance company, and employer.


The Insurance Company and Employer

In most cases, an MMI means the insurance company covering medical bills will be more open to settling. The insurance company will want to settle because settling caps further financial outlay and creates an endpoint to any policy responsibilities for that case.

Risking further legal action, including heading to court, could mean an open-ended payment obligation or paying out a much more significant amount of money. Despite what any insurance representative tells you, the company is concerned with stopping the financial obligation and nothing more. An MMI is an opportunity for that to happen.

For the employer, it represents a chance to close a chapter of its legal history. It also can mean regaining the services of a valuable employee. Additionally, it can mean figuring out how to accommodate that employee if their injury or illness has any lasting effects.


The Patient’s Perspective

From the plaintiff’s perspective, a Maximum Medical Improvement (MMI) often provokes fear and concern. Many patients assume that an MMI means the court will terminate treatment and their benefits will stop. That assumption is not necessarily the case provided the patient has adequate legal representation to help them navigate an MMI’s pitfalls.

An insurance company pushing for a settlement can mean the patient lacks funds for treatment if their treatment worsens or if what they need changes. Even if the court finds the employer responsible for long-term care and benefits, a settlement can cut short what they are obligated to pay. 

A patient should never agree to a settlement without a competent workers’ compensation attorney weighing in. Unless the patient agrees to a settlement, the employer and insurance carrier must provide medical benefits to the patient, such as percentage compensation or a lump sum settlement.


Lost Wage Compensation

Lost Wage Compensation covers the difference between what the patient was making and what they can make in their current condition. The compensation can continue for the duration of their natural, expected career length. 

If the patient cannot find employment because of their injury or illness, they are eligible to receive compensation for non-working wage loss.


Permanent Total Disability

If the patient cannot return to their previous work or ever work again, permanent disability payments might be an option.


Rehabilitation Costs

Rehabilitation costs cover physical and vocational rehabilitation to help the patient return to their previous job or learn new skills for another position.


Lump Sum Settlement

A workers’ compensation insurance company will offer a lump sum settlement. The patient should never accept this without having a workers’ compensation attorney review the proposal.


Permanent Partial Disability Percentage Compensation

Permanent Partial Disability Percentage Compensation is compensation based on the disability rating and how that reduces an employee’s ability to perform the job that caused their condition.

Additionally, there are several medical and non-medical costs the patient retains eligibility to have covered. These include, but are not limited to:

  • Other physical health treatments related to the injury
  • Mental and emotional health treatment
  • Social services training
  • Purchasing in-home medical equipment
  • Long-term medical, rehabilitation, or home care costs

A Broad Impact

Obviously, an MMI and disability rating significantly impacts everyone involved in a workers’ compensation case. From the patient’s perspective, the impact could not be more significant.

Without adequate representation in settlement negotiations, when dealing with the workers’ compensation insurance company, or in court, an injured or sickened employee is at a disadvantage. They limit their ability to get adequate treatment and what they deserve in the short, medium, and long term.

That result will have tangible and lasting adverse effects on the injured party, probably for the rest of their life.

Get the Compensation You Deserve Today

If you are at the point of receiving a Maximum Medical Improvement (MMI), you can go it alone and hope that parties with a vested interest in limiting your benefits treat you fairly. Or you can work with an attorney specializing in workers’ compensation and ensure that you get every benefit you deserve and the best chance of total recovery. 
Contact Mottaz & Sisk Injury Law today to speak with one of our talented workers’ compensation lawyers for more information.