What is Maximum Medical Improvement and why does it Matter for my Workers' Compensation Case?

Types of Benefits in a Workers' Compensation Claim

If you've been hurt at work and have a workers' compensation claim, you are generally entitled to two kinds of benefits: Indemnity benefits (Money benefits) and Medical Benefits.

Indemnity benefits take two forms: Termporary disability pay for the time you've missed work due to your workplace accident, and permanent disability pay for any permanent disability you've suffered.

Medical benefits include medical treatment for the life of your injury--including treatment to help you recover and treatment to take care of you down the road.

My Doctor has placed me at "Maximum Medical Improvement" (MMI)- Now what?

Your medical benefits in a workers' compensation claim include treatment for your injury to help you recover. You'll be seen by a doctor and provided care. But just because you're getting medical care doesn't guarantee you'll recover fully.

Instead, you'll get medical treatment to get you "as good as you're going to get"- what the law calls a point of "maximum medical improvement." If you make a full recovery, that's your point of MMI. If you don't, but there's nothing else the doctors can do to help you get any better, that's you're point of MMI instead.

Once you get to MMI, the doctor is supposed to conduct an "impairment evaluation." An impairment evaluation is a form of medical screening where the doctor tries to estimate the extent to which your injury has caused you any permanent disability. The way the doctor conducts the impairment evaluation varies based on your case and injury, but there is a set of formulaic guidelines doctors rely on called the American Medical Association's Guidelines to the Evaluation of Permanent Impairment.

After your impairment evaluation, your doctor will assign you an impairment rating. This rating is a rough "percentage" of your disability. Numbers will range from 1% to 99%.

For example, consider a knee injury. Your doctor repairs your torn meniscus surgically, but you never fully recover, and your knee isn't quite the same as it used to be. The doctor will evaluate how well you can squat, how well you can move your knee, how long you can stand, etc. The doctor will use the data gathered and assign an impairment. Let's call it 20%--that's the doctor's way of saying the workplace accident caused you to lose 20% of the use of your knee. You're now entitled to permanent disability pay based on that loss of use. There are complicated formulas provided for by law that let you know how much money you'll get, but the gist of it is you get 20% of your disability pay going forward for a period of time.

Do I need a lawyer after I reach MMI?

You probably need a lawyer at every point of your workers' compensation case. An experienced workers' compensation lawyer can guide you through the claims process, selection of medical providers, the medical treatment process, and evaluation of any disability ratings and pay.

But once you reach MMI, your workers' compensation case is almost finished. The only thing left, generally, is for the insurance company to pay you what you're owed and ensure your medical treatment.

But you need a lawyer for this part more than almost any other part--at this point of the claim, the complicated formulas are going to govern how much money you receive for the rest of your claim. 

A skilled, experienced workers' compensation lawyer will help you review the medical evidence and documents to ensure:

(1) your doctor provided you with medically necessary and reasonable treatment

(2) the doctor correctly evaluated your disability

(3) the insurance company processed the claim correctly

(4) the money the insurance company claims you're owed is accurate

(5) you actually get your money

What if I want to settle my case?

Oftentimes, a worker reaching MMI is a turning point for the case. Often, insurance companies offer a settlement at this point to permanently close the claim. You'll want a lawyer for this part.

Insurance companies will often offer a "lowball" offer to try to buy their way out of responsibility for the workplace accident. They almost never offer a fair settlement (why would they? most workers don't know all they're entitled to, and no insurance company is going to offer to teach them). 

An experienced workers' compensation lawyer will review your claim and help you negotiate a favorable settlement to your claim. That may include payment of a "lump sum" settlement of your benefits all at once. Instead of a weekly check for $65.32, you might be able to receive one big check for thousands of dollars.

To obtain maximum value for your claim once you reach MMI (or, ideally, before you do), contact a workers' compensation attorney immediately

 


Recent Posts