How Does MMI Affect Your Workers Comp Claim?

If you’ve already received an MMI determination, your workers’ comp checks will likely stop coming anytime soon unless you challenge the determination. Maximum Medical Improvement (MMI) in workers’ compensation occurs when an injured worker can no longer get better than they already are. MMI can also apply to a worker fully recovering from a work-related injury.

Depending on their disability, some workers may also get an MMI even if they are permanently impaired. For instance, a worker injured his back has finally finished all the prescribed medical treatments. If his back doesn’t hurt anymore and he can get back to work, then he will receive an MMI for making a full recovery.

But even if his back still bothers him, if the medical technology currently available can’t improve his condition, he’ll still receive an MMI. Or if his injuries got him permanently disabled, he’ll receive an MMI with a provision for restrictions.       

WHAT IS MMI IN WORKERS’ COMP?

In workers’ compensation, MMI stands for Maximum Medical Improvement. This term is used to indicate the point at which an injured worker’s condition has stabilized and is unlikely to improve significantly with further medical treatment.

Reaching MMI suggests that the individual has recovered as much as possible or has reached a plateau in their recovery process. It is an essential milestone in workers’ compensation cases as it can impact the continuation of benefits and the potential transition to permanent disability status if applicable.

HOW MMI AFFECTS WORKERS COMP

You are entitled to workers’ compensation when you are injured at work. Its primary purpose is to ensure you can pay your living and medical expenses while recovering from your injuries. However, your workers’ comp benefits will be terminated when you reach MMI.

Upon reaching MMI, it is presumed that an injured worker won’t need medical treatments anymore. In some cases, reaching MMI means they are ready to return to work. If the injured worker doesn’t need medical treatments and can already earn an income, they don’t need their worker’s comp benefits anymore.

If your MMI has a permanent restriction, you may qualify for permanent disability benefits. The amount depends on your restrictions and whether you can still do any type of work.

HOW MMI IS DETERMINED

In most states, workers injured on the job receive temporary workers’ compensation benefits for up to 2 years. However, depending on the injury, an MMI determination can be obtained even after a few months.

Your treating doctor is the only qualified person to determine if you’ve reached MMI. But their pronouncements will also depend on you. If you tell them it doesn’t hurt anymore or you stop getting treatments, they’ll take it that you’ve already recovered.

However, your employer or insurance company may also request an Independent Medical Examination (IME). This usually happens if they believe you’ve recovered but haven’t yet received an MMI determination.

Another qualified physician will conduct the IME. If this isn’t enough, the Bureau of Workers’ Compensation may also conduct its test. Your temporary workers’ comp benefits will automatically stop if your treating doctor agrees with the IME results. If your doctor disagrees, you can challenge your MMI determination.