blog pic

Workers Compensation - Maximum Medical Improvement (MMI) - How is it Determined?

Kevin Holmes May 5, 2021

When you get hurt at work, you are entitled to two primary forms of benefits under Workers' Compensation: Indemnity Benefits (money) and Medical Care. Your employer's workers' compensation insurance carrier usually covers both.

The medical care you obtain is generally supposed to be for the life of the injury. The insurer pays for all reasonable, necessary care that is causally related to the workplace accident.

The doctor you see for your workers' compensation medical care is obligated to provide you with an objective assessment of your injuries and a plan for how to address them and then is expected to carry out that plan.

For most injuries, there is a course of treatment that eventually resolves in you getting "better." And for many injuries, getting "better" means you make a full recovery.

But what happens if you don't make a full recovery?

You may have heard the term "Maximum Medical Improvement" in your workers' compensation claim. This means a point at which "further recovery from or lasting improvement to an injury can no longer be reasonably anticipated." But what does that mean?

In plain-English, it means you have gotten as good as the assigned doctor reasonably expects you will be able to get. But it doesn't necessarily mean you have made a full recovery.

For example, if a person loses a leg in an industrial accident, once the skin has healed, the person is at "Maximum Medical Improvement," but the person hasn't recovered from the accident (and never will).

Even so, for the purposes of the person's workers' compensation claim, the date the doctor pronounces the worker at MMI is the effective date for MMI in the worker's claim.

So what does MMI mean for my claim?

The date of Maximum Medical Improvement is important in your claim for many reasons. The most direct and obvious effect MMI has on your claim is the transition of your disability benefits from Temporary Benefits (Temporary Partial Disability (TPD) or Temporary Total Disability (TTD)) to Permanent Benefits (Permanent Partial Disability (PPD) or Permanent Total Disability). The rate of disability and the amount you're owed for permanent disability benefits is calculated under a formula, and your checks will typically change (almost always going down).

But is a Doctor's Determination of MMI Final?

You've heard the phrase "second opinion." And you've been told it's often best to get a second opinion from another doctor on an important medical decision.

In Workers' Comp, the doctors are often chosen by the insurance companies. As a result, the doctors' determination of MMI may not be correct - either the doctor may be wrong that there is nothing left to do, or the doctor's determination of the date when there was nothing left to do may be incorrect. So if you've got an unfavorable MMI decision or you disagree with it, you may want to challenge it.

How do I challenge a Doctor's Maximum Medical Improvement Rating?

There are a few ways to successfully challenge a doctor's MMI rating if you disagree with it. But every single one of them is easier and more effective if you have an experienced New Mexico Workers' Compensation attorney in your corner fighting for you.

The sooner you hire a good lawyer, the easier it may be to prevent or challenge an improper MMI rating.

So if you've been hurt at work, don't delay. Contact Holmes Law Firm for a free consultation today.