What Is Maximum Medical Improvement?

What Is Maximum Medical Improvement?

Maximum Medical Improvement (MMI) is the point, certified by your doctor, at which your medical condition has stabilized and is unlikely to change over the next year.

For most people, that means a full recovery. For the unlucky few, it means long-term or permanent disability, disfigurement, or another medical problem. The concept of MMI is most often used in workers’ compensation claims.

Summary of the Workers’ Compensation System

Summary of the Workers’ Compensation System

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 usually not permitted to sue them.

Possible workers’ compensation benefits include:

  • Reasonable and necessary medical treatment expenses, including prescription drugs and medical equipment;
  • Temporary disability benefits;
  • Permanent disability benefits;
  • A retirement pension; and
  • Survivor’s benefits in case of a fatal accident.

Not every worker qualifies for all of these benefits-–it depends on the circumstances. 

What Happens When You Reach MMI?

Once your doctor certifies that you have reached MMI, your workers’ compensation insurance company might slash your weekly benefits or eliminate them altogether. This could happen whether you are unable to work or are able to work only at a less-demanding (and lower-paid) position. This state of affairs should prompt you to contact a lawyer immediately.

MMI and Permanent Disability

Before you reach MMI, your workers’ compensation insurer must pay for your injury-related medical treatment relating to the injury for up to two years while you are off work and still recovering. Once you reach MMI (even if two years have not yet elapsed), your available options are far more limited.

If your doctor finds that, despite reaching MMI, you have not completely recovered from your accident (meaning that you may never fully recover), they may conclude that you have a permanent functional impairment. 

This determination may or may not qualify you for permanent disability benefits, but at least it gives you a fighting chance. The insurer might offer you a lump sum payment.

How the Workers’ Compensation System Might Use MMI Against You

It can benefit your employer’s workers’ compensation insurance company to state you have reached MMI because this determination can limit their liability from that point on. However, you have the right to challenge your treating physician’s MMI determination by changing doctors or by having a doctor that you choose conduct an independent medical examination (IME). The assistance of a workers’ compensation lawyer is critical under these circumstances.

MMI in an Ordinary Personal Injury Claim

Strictly speaking, a workers’ compensation claim is not a personal injury claim. In an ordinary personal injury claim, you can file a lawsuit in court. You can also seek pain and suffering and other non-economic damages, which you cannot seek in a workers’ compensation claim. 

However, a workers’ compensation claim can turn into a personal injury claim if you find a third party (not your employer) to blame. This takes the claim out of the workers’ compensation system. Other claims start out as ordinary personal injury claims because, for example, they are not work-related. 

How MMI Relates to Ordinary Personal Injury Claims

MMI can decisively affect the time you need to settle your personal injury claim. MMI still matters because you can’t claim damages until you know how much they are. After all, it is difficult to calculate your damages until your healthcare provider has completed your medical treatment. This matters greatly if you are seeking a lump sum, as you do in a personal injury claim (and some workers’ compensation claims).

If you don’t reach MMI by the time you assert your claim, your claim for damages will have to rely at least partly on estimated future medical expenses. You might also have to rely on estimated future lost earnings and estimated future non-economic damages. This is dangerous because if your estimate is too low you could run out of money many years from now. By then, it will be too late to ask for more.

Hiring a Gainesville Workers’ Compensation Lawyer Can Make a Decisive Difference in the Value of Your Claim

You have a legal right to hire a lawyer to help resolve your workers’ compensation or personal injury claim. Although no reputable lawyer will guarantee a result, your odds are better once you hire a lawyer. A good lawyer can more than pay their fee by increasing the value of your claim. 

Most Gainesville workers’ compensation and personal injury lawyers work on a contingency fee basis. This means you pay nothing upfront, and you only pay legal fees if you recover compensation. Allen Law Firm, P.A. is here to help, schedule a free consultation with us or call (877) 255-3652 today.