What is Maximum Medical Improvement (MMI) in Workers’ Comp Claims?

Maximum medical improvement (MMI) in workers’ comp claims occurs when patients cannot recover further after sustaining a work injury. The patient has either fully healed or reached a state where no more progress is possible with current medical technologies available.

The doctor will then assess the patient’s condition and determine a disability rating based on their impairment.

If you reached maximum medical improvement but still cannot return to work, you may qualify for workers’ compensation. The best way to ensure you receive a fair settlement is through legal action with a workers’ comp attorney.

Who Determines if I Reached Maximum Medical Improvement?

The only one who can decide whether you reached maximum medical improvement is the doctor examining your condition.

Your employer’s insurance company can send an independent medical examiner to analyze your injuries. They may require medical documents to see how your injury relates to pre-existing conditions you may have had in the past.

When determining whether you reached MMI, they may proceed with a functional capacity evaluation. This physical will test your capacity and tolerance to move, and the pain levels of the movement from your injured areas. The independent medical examiner’s results will then be sent to your treating physician.

“Maximum Medical Improvement (MMI) is when the covered illness is stabilized and is unlikely to improve with or without additional medical treatment.”

–U.S. Department of Labor

If your physician accepts the results, they will decide a date when your temporary workers’ compensation benefits will end and you have reached maximum medical improvement.

When unable to return back to work in MMI, your physician will assign you a disability rating which may determine your permanent workers’ compensation rate.

If your physician rejects the results, they can send the claim to your state’s industrial commission or a workers’ comp judge. They have the final say in determining whether you reached maximum medical improvement.

In worse cases, if the patient reaches maximum medical improvement, they may not be able to work or resume their daily tasks. Depending on the type of injury and disability rating, you may receive workers’ comp and disability benefits to financially assist you with your permanent impairments.

What Does an MMI Impairment Rating Mean?

An MMI impairment rating is a percentage-based score your doctor uses to describe the severity of an injury in MMI. An impairment rating estimates how much you lost in bodily function, ranging from 5%, 10%, 20%, or more. An impairment rating is calculated based on the American Medical Association (AMA) Guide.

The AMA guidebook works as a scoring system measuring a patient’s loss in bodily function due to their injury.

For instance, if you can’t move your leg to a certain extent, you get a specific number of points. If you get surgery, you also earn points. These points accumulate until your doctor assigns you an impairment rating.

Your doctor measures your MMI impairment rating based on your body’s loss of function and not on the level of pain or intensity. Your impairment rating may also be determined by the date of injury, age, and wage earnings.

The higher your MMI rating, the greater the potential for compensation in your workers’ comp and disability benefits.

What is a 100% Impairment Rating?

When a doctor assigns you a 100% disability rating, your condition fully prevents you from holding any form of employment. A 100% rating also means you sustained a total permanent disability, whereas ratings between 1% and 99% can mean permanent partial disability.

This rating is often rare, but workers who receive a 100% impairment rating may obtain the maximum amount of disability benefits authorized by their state.

Depending on the state, you may be entitled to benefits for up to 15 years or until you qualify for Social Security benefits.

How is Maximum Medical Improvement Measured

If you require permanent work restrictions or cannot work under total permanent disability, you may be tested for MMI through the following conditions:

• The type of work you did at the time of injury
• The level of pain, functional capacity, and limitations of your body
• Medical treatment needed for your injury

Avoid common injury mistakes like hiding previous injuries when filing for workers’ compensation. Stay truthful throughout the examination process and never exaggerate or undersell your injuries.

Learn your state’s workers’ compensation laws as every state varies and how much you get depends on your circumstances.

How Long Does it Take to Reach Maximum Medical Improvement?

Determining maximum medical improvement depends on your injury, medical treatment, and body’s healing process. It may take several months, even with little signs of physical therapeutic improvement.

This would also depend on the person and how many surgeries you’ve received. Your body may take longer to heal if the injury is severe.

What Happens After Maximum Medical Improvement?

The state-qualified independent medical physician will establish the MMI report reflecting your medical history. The MMI report results are then sent to your employer, treating doctor, and insurer.

Depending on your MMI and FCE results, your doctor will explain if you can return to work or if you have permanent disability.

If your doctor clears you for work but you have some partial or temporary disability, you may receive benefits and accommodations from your employer.

You may then decide to receive your workers’ comp settlement in two ways:

• Lump-sum payment: a single payment that covers all lost wages and medical payments, releasing your employer from any further liability.
• Continuous payments: numerous smaller payments over the course of a set period of time.

Otherwise, suffering from total permanent disability may allow you to obtain medical and workers’ comp benefits without going back to work.

How Does an MMI Rating Affect a Workers’ Comp Settlement?

Your MMI rating is crucial to your workers’ comp settlement because it determines how much you’ll receive for your injury and the height of your impairment rating.

The higher your MMI rating, the higher the chances you may be compensated. A 0% MMI rating means you’ve fully recovered, while anything higher indicates you sustained reduced functionality.

After you’ve reached MMI and all results have been determined, your employer or insurer will offer you a settlement that may cover all your medical costs and lost wages. However, in return, you cannot sue your employer for your losses in a civil lawsuit.

It’s important to contact a workers’ comp attorney for this matter, since you may not know your settlement is enough. Therefore, find an attorney specialized in your state’s laws when filing a workers’ comp claim.

What if My Condition Worsens Over Time?

Reaching maximum medical improvement does not mean your condition will get better. Sometimes, it may even worsen over time, potentially aggravating your injuries if you return to work again.

If your condition worsens, your doctor may need to reevaluate your condition and possibly dispute your employer’s MMI claim. Seek your doctor or physician so they can reassess your condition. Find an attorney to help evaluate your case so you may be able to reopen your workers’ comp claim.

Remember that every state has its statutes of limitations for these cases so get an attorney to assist you in learning workers’ comp laws within your state.

How to Dispute a Maximum Medical Improvement Claim

Sometimes things don’t work out in your favor and you may disagree with your doctor’s maximum improvement rating. You can talk with your doctor to change your disability rating or discuss further legal action with your attorney.

If you find yourself in a predicament where your doctor refuses to change their decision, you can dispute their claim.

Several reasons may cause you to dispute the claim. You may not feel ready to work due to your injury or feel your condition can still improve. You want to accurately assess your MMI rating as it heavily affects your benefits.

Evidence is crucial when filing an MMI dispute. Ask for copies of your medical records and discuss them with your primary doctor.

You may have them refer you to further testing for MMI without legal action. However, if it’s not likely that decisions can be changed, you may go to the Office of Workers’ Compensation Programs (OWCP).

Gather evidence such as:

• Testimonies from treating physicians and medical experts
• Documentation of your ongoing symptoms
• FCE results
• An opinion from an independent doctor

Submit them to the OWCP and they can evaluate your dispute. The OWCP determines whether you should receive a second evaluation from another independent doctor, which will determine the final result of your MMI claim.

Find Representation With a LegalASAP Workers’ Comp Attorney

If you sustain a work injury and need a legal opinion to help you with your case, find representation with a LegalASAP workers’ comp attorney. Our network of firms expand across the United States so we can help you find an attorney near you.

Fill out this short quick consultation form and see if you qualify for a workers’ comp claim. Don’t hesitate to file a claim with us, it’s critical to have an attorney navigate the legal process with you.