If you’ve ever experienced a workplace injury or illness, you understand the challenges that come with it. The pain, the uncertainty, and the paperwork can be overwhelming. Thankfully, workers’ compensation exists to provide financial support and medical care during these challenging times. However, there is a significant milestone in this process that can affect how much compensation you receive: Maximum Medical Improvement (MMI).
What Is Maximum Medical Improvement?
Maximum Medical Improvement (MMI) signifies the maximum recovery after a work-related personal injury or illness. This point is reached when, after extensive evaluation, medical professionals determine that more treatment is unlikely to improve your condition. This doesn’t mean you’re back to the same state you were in before the injury. It just means that you have achieved the utmost improvement possible, and your condition isn’t expected to improve moving forward meaningfully. This element has a significant impact on your future treatments and compensation.
Who Determines This?
A medical doctor will determine if you’ve reached your MMI. This healthcare professional, carefully chosen and approved by your company’s workers’ comp provider, is responsible for evaluating your condition impartially. They closely track your progress and recovery journey to reach an accurate conclusion.
The Decision-Making Process
Through a series of assessments, consultations, and ongoing monitoring, your doctor will gauge the trajectory of your recovery. They observe how your body responds to treatments, documenting every improvement and setback. It’s a meticulous process where your physician considers not just the current state of your health but also the potential for future progress. Once you’ve reached MMI, your workers’ compensation benefits change based on the transition from intensive treatments to a focus on managing and improving your quality of life. Generally speaking, your compensation may be lowered or even stopped once you’ve reached your MMI.
How Long Does It Take To Reach Maximum Medical Improvement?
The duration to reach MMI varies based on the injury, prescribed treatments, and your body’s response to therapy. It could take several months, especially if you’re showing gradual improvement through treatments like physical therapy. But if treatments are ineffective and there are no improvements in your condition, your doctor could declare you’ve reached MMI in a shorter amount of time.
What Happens When You Reach MMI?
The outcomes post-MMI are varied. But you can expect two scenarios based on whether or not you’ve made a full recovery.
You Have Fully Recovered
For those fortunate enough to achieve a full recovery, where you regain your health to the extent that you can resume work without any restrictions, your workers’ compensation benefits will typically cease upon reaching MMI. That means you won’t receive more money since you don’t need to pay for extra treatments.
You Haven’t Fully Recovered
If your treating physician determines that you’ve reached MMI, but you’ve only partially recovered, they will assign a disability rating to quantify the extent of your permanent work restrictions. This rating ranges from 0 (indicating a full recovery) to 100 (indicating a complete loss of use for the injured body part). The severity of your disability rating will influence your post-MMI benefits. A higher disability rating translates to more substantial and potentially longer payments.
Challenging the MMI Diagnosis
An MMI diagnosis can mean a very drastic change in your compensation and overall quality of life. So, if reaching this milestone results in a negative outcome for you, then you can challenge this diagnosis. Challenging an MMI diagnosis helps you seek benefits that align with the reality of your recovery, especially if you believe further treatments could improve your condition.
For example, in Texas, if you and your employer don’t agree on all disputed issues after a benefit review conference, a contested case hearing is scheduled. During this hearing, an Administrative Law Judge (ALJ) listens to the evidence presented by both parties. The ALJ then makes a decision. If you still disagree with the ALJ’s decision, you can request a review by the DWC Appeals Panel. This panel examines the evidence and has the authority to affirm the ALJ’s decision, issue a new decision, or send the case back to the ALJ for further action. If there is still no agreement, you can seek a judicial review by filing an appeal in district court.
Going through all of these steps alone is not recommended because you may not have the legal knowledge needed to maximize your benefits. An attorney specializing in workers’ compensation can be the helping hand you need to have the best chance of success. They can accompany you to dispute resolution proceedings, present evidence, and help you fight for the benefits you deserve.
As you can see, the dispute process can be long and complicated, but building a good case is not impossible, and it can result in getting the additional compensation you need. With this in mind, if you think that you haven’t reached MMI, it is worth contesting the decision.
Other Implications of Reaching MMI
After you reach MMI, you can qualify for post-MMI benefits. In Texas, the main post-MMI benefit is called Impairment Income Benefits (IIBs). These benefits are granted when you have permanent damage to your body. The specific amount of IIBs is determined by an impairment rating assigned by your designated doctor. For every percentage of impairment, you are eligible for three weeks of IIBs. You can expect to start receiving IIBs the day after you reach MMI.
As you can tell, workers’ compensation is not as straightforward as many would think. If you’re not careful, the insurance company could accelerate your MMI in order to pay you less. This is why you need a workers’ compensation law firm you can consult on the best steps moving forward. And if you need help challenging an MMI, your lawyer can make an impactful case to help you get the benefits you truly deserve. In these scenarios, a lawyer also demonstrates to the insurance company and employer that you can’t be taken advantage of.
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