Maximum Medical Improvement (MMI) and Workers Compensation
Virginia workers’ compensation has many acronyms. If you have received an Award Order from the Workers’ Compensation Commission and have been receiving temporary total disability wage loss benefits, then you’ve probably heard the term “MMI” from your doctor, your workers’ compensation attorney, or the insurance claims adjuster.
Reaching MMI is an important milestone. Questions may arise as to what future medical care you may be entitled to for your work injury, the degree of your total or partial body impairment, and whether you should settle for a final lump sum amount that releases the employer and its insurance carrier of liability for subsequent medical care and indemnity benefits.
We recommend contacting experienced workers comp attorney Corey Pollard to determine what additional workers’ compensation benefits you’re entitled to after you reach MMI and to help you negotiate a lump sum workers compensation settlement.
What Does MMI Stand For?
MMI stands for maximum medical improvement.
You’ve reached maximum medical improvement when you’re as good as you’re going to get. MMI doesn’t mean that you’ve recovered completely and are back to normal. Rather, it means that your work injuries have stabilized and that further functional improvement is unlikely with additional medical treatment or physical therapy. In other words, you reach MMI when your injuries have plateaued and no other medical treatment will help you heal.
The more severe your injury, the longer it may take to reach maximum medical improvement. Injured employees who suffer minor injuries, such as sprains and bruises, will reach maximum medical improvement quickly because surgery is not required. Injured employees who suffer traumatic brain injuries, amputations, and fractures will require extensive medical care and take longer to reach MMI.
Who Decides that I’ve Reached MMI for My Work Injury?
Only a medical doctor or osteopathic doctor can determine MMI.
In workers’ compensation the treating doctor usually determines MMI. The workers’ compensation insurance carrier may, however, ask you to attend an independent medical examination (IME). The IME physician may state that you’ve reached MMI after examining you and reviewing your medical records.
The insurance carrier may ask your treating physician if he or she agrees with the IME doctor’s opinion that you’ve reached MMI. If you’re under an open award for temporary total disability benefits then it doesn’t matter whether the treating physician and IME doctor disagree as to whether you’ve reached MMI. If, however, you’re back to work and seeking permanent partial disability benefits, then this is an issue that may need to be resolved by the Commission at a workers’ compensation hearing.
What Happens When I Reach MMI in My Workers Compensation Case?
Your workers’ compensation case does not end when you reach MMI. In fact, it is just getting started in a sense. MMI is the point where you and your attorney know the long term effects of your work injury and can value your claim for workers’ compensation settlement purposes.
Tell your attorney if your doctor has put you at MMI. Your attorney should send a letter to your doctor that explains how permanent partial disability is evaluated under Virginia workers’ comp and requesting an evaluation and disability report.
The report given after you reach MMI should contain three things:
- The date you reached MMI.
- A permanent partial disability impairment rating that states the percentage loss of use and function of the injured body part because of the work accident. You have a functional impairment when the normal function of your body is at less than 100 percent because of your work injury. Impairment ratings must comply with the AMA Guides to the Evaluation of Permanent Impairment. The percentage impairment is used to obtain additional benefits under workers’ comp.
- Your permanent work restrictions, or the job tasks that you are no longer able to perform because of the injuries you suffered in the work accident. Your disability, or work restrictions, is different from your impairment, which is the percentage loss of use of the body part on a scale from 0 to 100 percent.
For example a nurse or construction worker who injured their back at work may receive permanent restrictions that include no lifting more than 20 pounds and only 2 hours standing and walking each work day. Such restrictions would prevent the nurse or construction worker from returning to their pre-injury employment. If you’re unable to return to your pre-injury employment after reaching MMI, the potential value of your workers’ compensation settlement increases. This is because the employer must determine if it wants to settle, to continue paying wage loss benefits, or to pay for vocational rehabilitation so that you can transfer your skills to light duty work.
The permanent impairment report issued after you reach maximum medical improvement can be used to obtain permanent partial disability benefits and a top-dollar settlement.
What if I Disagree with My Doctor’s Determination that I’ve Reached Maximum Medical Improvement?
Sometimes doctors throw in the towel too early and state that a patient has reached MMI even though there may be other treatment or surgical procedures that could improve the patient’s condition. If you think you fit into this category you have three options:
- Use your private health insurance, if you have it, to make an appointment with a specialist for a second opinion.
- Ask your treating physician to give you a referral for a second opinion.
- File a claim with the Virginia Workers’ Compensation Commission seeking a second opinion.
Contact an experienced workers compensation lawyer when weighing your options. You don’t want to make a decision that could lead to forfeiture of future workers’ compensation benefits.
What if My Injuries, Condition, and Symptoms Get Worse after I’ve Reached MMI?
I’ve represented many injured employees whose symptoms worsened after their doctor told them they had reached MMI. This is why I suggest waiting at least three months before filing a claim for permanent partial disability benefits.
Three months is often enough time to determine whether you can maintain full-time employment within your permanent work restrictions. If you’re able to return to light duty work with no problem, then it makes sense to file a claim for PPD benefits or to try to negotiate a lump sum settlement. If you continue to have problems and your symptoms worsen even though you’re working light duty, you should make a follow up appointment with your doctor.
A Workers’ Comp Attorney to Guide You When You’ve Reached MMI in Virginia
Reaching MMI is one of the most important milestones in workers’ compensation claims. After you’ve reached MMI an attorney can help you determine the following:
- What type of vocational rehabilitation will help you get back into the labor market
- The projected value of future wage loss
- Your level of permanent impairment
- The projected value of future medical care to alleviate your symptoms
- The potential value of your workers comp settlement
- Whether you may qualify for SSD benefits or SSI based on your age, education, and past work. I’m also a Richmond disability lawyer who represents injured workers in VWC and SSD claims.
Call or e-mail us today for help maximizing the value of your workers comp claim after you’ve reached MMI. We help injured and disabled workers across Virginia.