If you’ve suffered an injury at work, you’ve probably run across some medical and insurance terms you aren’t familiar with, including “maximum medical improvement” (MMI).
While navigating the fallout from a worker’s compensation injury, it’s important to be well informed on developments that may affect your compensation.
Our informative guide below will detail what maximum medical improvement means and how it is determined.
Into to MMI
In the insurance world, maximum medical improvement (MMI) refers to a person’s medical condition or disability as well stabilized and not likely to evolve over the next year, regardless of whether or not the individual pursues additional medical treatment or rehabilitation.
Once a person reaches the point of MMI in their condition, doctors can assess how much the injury in question contributed to a permanent disability for purposes of calculating continued worker’s compensation.
How Does Worker’s Comp Work?
Workers’ compensation protects employees when they are injured on the job. Most employers carry workers’ compensation insurance that kicks in when a worker files a comp claim to get funds for medical treatment following an injury sustained at work. In return for employers securing this compensation, workers are not permitted to sue them.
Worker’s compensation can provide many benefits to workers, such as:
- Medical care (including treatments, surgeries, prescriptions, and medical aid devices)
- Temporary disability benefits
- Permanent disability benefits
- Supplemental job displacement benefits
- Death benefits
- Life pension
And many others. Your lawyer can work with you to ensure you’re receiving as much benefit as you’re entitled to.
For some, injuries sustained on the job may take an exceptionally long time to heal. Some individuals may be injured and never fully recover. In these scenarios, people are likely to reach the point of maximum medical improvement, meaning their condition is stabilized, and doctors do not believe the situation will change, even with continued medical intervention. Essentially, this means that an injured person’s condition has improved or resolved as much as it is ever likely to.
In these cases, doctors will assess patients to produce a disability rating and a list of things they can and can’t do at work moving forward, called “work restrictions.” In California, a state-certified doctor will write an “MMI Report” that includes the history of the employee’s injury or disability, a robust review of the treatments attempted, and the doctor’s conclusions and recommendations. The report may also discuss the patient’s job, other medical records, and results from physical examinations. Patients have the right to receive a copy of their MMI report.
How MMI Affects Compensation
Before reaching MMI, the insurer is required to pay for recommended medical treatment relating to the injury for up to two years while the employee is off work and recovering. After a person reaches MMI, the insurer still has to pay for some treatment, but the available options are more limited and may only include secondary medical services.
If a physician determines that a patient is not completely healed and most likely will not ever fully heal, the doctor will conclude that the patient has “permanent functional impairment.” This may mean the patient is entitled to permanent disability. The insurer may also attempt to settle with the worker by providing a lump sum payment.
FAQs About Maximum Medical Improvement
This section will review some of the questions we most commonly see regarding MMI.
Can I disagree with the MMI report?
Yes. Under California Workers Compensation Law, employees have a right to disagree with their MMI report. You can seek a second opinion from a Qualified Medical Evaluator or an Agreed Medical Evaluator.
What happens if I reach MMI but can continue working?
If your physician determines that you have reached MMI but that you are healthy enough to continue your work, your workers’ comp benefits will cease, and you will return to your place of work.
Can my employer take part of my paycheck to pay for workers’ comp?
No, your employer is not permitted to take funds from you to cover workers’ compensation. Failing to have proper workers’ comp insurance on behalf of employers is a criminal offense. Contact the information and assistance officer at your local DWC district for more information.
Can I work while recovering?
Your doctor will provide a medical report that states what kind of work you can and can’t engage in while recovering and any accommodations needed in your work schedule. For example, your doctor may recommend you spend less time on certain tasks or have an abbreviated work schedule while you recover.
Are there limits on treatments I can get following a workers’ comp claim?
You will be limited to 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits unless your claims administrator authorizes extra visits or you have recently had surgery.
Consider Obtaining Legal Counsel
Workers’ compensation attorneys are well versed in making sure patients get fair treatment following injuries sustained in the workplace. Don’t be unprepared if your insurer wants to settle and pay a lump sum. Contact or call us at (877) 300-4535 to obtain a free legal consultation today so an attorney from M&Y Personal Injury Lawyers can help you make sure your rights are protected.