As an injured employee going through the workers comp claim process, you know that the weeks, months, and even years after a work accident are filled with stressful situations and strange terms and acronyms. One term you’ve probably heard from your workers comp claim adjuster, nurse case manager, treating physician or lawyer is MMI. MMI stands for Maximum Medical Improvement.
Reaching MMI is an important milestone in workers compensation. MMI has a role in determining many things, such as:
The purpose of this article is to discuss what MMI is and what you can do to protect your legal rights and increase the value of your workers comp case after you reach maximum medical improvement. I hope this information helps guide you during this important time.
Keep reading to learn more. And if you have any questions, or are looking for a top-rated workers comp attorney in Virginia call me for a free consultation: (804) 251-1620 or (757) 810-5614. Come see why my peers and past clients have voted me one of the best work injury lawyers in the state, and the results I’ve helped injured workers just like you get.
Maximum Medical Improvement (MMI) is the term used by your workers comp doctor to indicate that your physical condition has stabilized and further improvement in your functional abilities is unlikely.
Put another way, MMI means that your recovery from your work injury has leveled and you are as good as you are going to get. You may have some change in your treatment and disability status over time, but no significant improvement or worsening of your condition is expected.
For many of you, MMI does not mean that you have recovered completely and are back to normal. While some of you may be able to return to your baseline level of functioning after a work accident, many of you have injuries that plateaued before you returned 100% to your pre-accident state.
Only a medical doctor (MD) or osteopathic doctor (DO) can determine that you are at maximum medical improvement for your work-related injury.
Usually your authorized treating physician – the doctor you chose from the panel of physicians provided by your employer or its insurer, or that you started seeing at the panel doctor’s referral – decides when you have reached MMI.
Sometimes, however, an insurance carrier will allege that you have reached MMI based on the opinions of a doctor that examines you for an Independent Medical Examination (IME).
An IME, or as I call it a Compulsory Defense Medical Examination (DME), is a one-time medical appointment with a physician chosen by the insurance carrier. Under the Workers Compensation Act your employer or its insurer can force you to attend one IME per medical specialty per year.
If you are asked to attend an IME, then there is a good chance the resulting report will be unfavorable to your claim and find that you have reached MMI even though your treating physician disagrees. Insurance carriers tend to use the same IME doctors over and over again. And in my experience these IME doctors know they are being asked to provide a report that helps the insurance carrier, not you. Specifically, the insurance carrier wants the IME doctor to find that you have reached maximum medical improvement for your work-related injuries so that it can deny medical treatment recommended by your authorized physician in the future.
When it comes to the length of time it takes to reach maximum medical improvement, every person and injury is different.
As a general rule, the more severe your injury and the more surgeries you need, the longer it may take to reach MMI.
For example, those of you who have suffered a traumatic brain injury (TBI) resulting in post-concussion syndrome, fracture, amputation injury, burn injury, or back injury causing a herniated disc and the need for a spinal fusion surgery will take longer to reach MMI than those of you who have suffered a muscle strain, minor ligament sprain, or bruise.
This is a general rule though. I have represented many employees whose seemingly minor whiplash injury or lumbar or cervical spine injury resulted in chronic pain and radiculopathy, and made them more likely to develop post-traumatic arthritis that required treatment when exacerbated or flared.
Yes.
Your doctor’s statement that you are at MMI is not a statement that no further medical treatment is required.
After reaching maximum medical improvement you can still use your lifetime medical award to return to the doctor and get the diagnostic tests (MRIs, CT scans, X-rays), physical therapy, work hardening, prescription medication, injections, medical equipment, and other palliative care (chiropractic treatment, acupuncture) you need for your work injury.
Usually not.
Your workers comp benefits do not stop automatically when you reach MMI. If you have a Workers Compensation Award Letter that provides an Open Award of wage loss benefits, meaning temporary total or temporary partial disability, then your cash benefits will continue as long as you continue to have restrictions that prevent you from performing all the requirements of your pre-injury job.
But depending on other factors, your employer and its insurer may try to stop your income replacement benefits at this time.
For example, if your treating physician says you are capable of full duty when you reach MMI, then you should expect to receive an Employer’s Application for Hearing to suspend or terminate your benefits. There are ways to defend against an Employer’s Application and keep your wage loss benefits, but you will likely need to use the workers comp discovery process to give yourself the best chance of doing so.
In my experience many injured employees are concerned that their workers comp case will end when their doctor states they are at MMI. But the truth for many of you is that the settlement process is just getting started when you reach maximum medical improvement.
Let’s look at what actions your doctor, your employer’s insurance carrier, and your attorney are likely to take when you’re at MMI.
The actions your doctor will take when you reach MMI depends on the doctor’s medical specialty.
Most of you will treat with an emergency room or primary care physician initially. That doctor will then refer you to an orthopedic doctor, who will become your treating physician for the workers comp case.
Usually an orthopedic doctor will (1) refer you to a physiatrist or pain management if there is nothing more to offer you from an orthopedic standpoint and (2) recommend that you undergo a Functional Capacity Evaluation (FCE) to determine your permanent restrictions from the work injury when you reach maximum medical improvement.
If you suffered a concussion on the job or are treating for depression or PTSD related to your work injury, then it is unlikely that your treating physician, usually a neurologist or psychiatrist, will refer you for a FCE. Instead that doctor will recommend a period of counseling and medication, as well as work restrictions. For example, your treating doctor may state that you can never return to the work environment where you were injured because of your continuing restrictions and limitations.
Make sure you tell your attorney that your doctor has put you at MMI because there are several actions they should now take.
In Virginia you cannot receive permanent partial disability benefits until you reach maximum medical improvement.
After finding out that you are at MMI, your attorney should send a letter to your doctor explaining how permanent partial disability is evaluated under workers compensation law and requesting an evaluation and disability report.
This report from your doctor should include:
Some treating physicians refuse to do impairment ratings or medical cost projections when you reach MMI, even though they are otherwise supportive of the claim.
If so, your attorney will use their network of expert witnesses to find a physician or physical therapist to evaluate your permanent impairment and a life care planner to estimate the future cost of your medical needs.
Depending on your work status and the benefits you are receiving when you reach maximum medical improvement, your lawyer may file a workers comp claim for additional benefits you deserve.
Your employer and its insurance carrier will have an opportunity to respond. Depending on their response to your claim, additional litigation may be required.
Once you’re at MMI, you will know your permanent restrictions, whether you can return to your pre-injury job with those restrictions, whether your pre-injury employer can accommodate those restrictions, and level of permanent impairment. You will also have a better idea of your future medical costs.
Your attorney can use this information to give you an educated assessment of the value of your claim for settlement purposes, and what you can expect from the employer and insurer moving forward.
In my experience the five most common actions taken by employers and their insurance companies when employees reach MMI are:
1. Ask you to make a settlement demand if you’re unable to return to your pre-injury job and your employer is unable to accommodate your restrictions, or if you have started working elsewhere and the requirement that you resign from the pre-injury employer to settle will not be an obstacle.
2. Start vocational rehabilitation with the hope that a) the counselor will find a job within your restrictions, which will decrease the insurance carrier’s financial exposure or b) you will refuse to cooperate with vocational rehabilitation, which will serve as a basis to cut off your wage loss benefits. If this fails, then the carrier will probably ask you to settle your claim.
3. Stop paying wage loss benefits if you’re released to full duty work.
4. Offer you a light duty position if you have permanent restrictions, or your pre-injury job if you are released to full duty. You are allowed to return to work with your employer after reaching MMI for your work injury.
5. Ask you to sign an Award Agreement Form for PPD benefits if you’re back to work with your pre-injury employer and not interested in resigning. Do not rush to sign this form. Instead, wait 3 to 6 months to see if you are actually capable of full duty work. If you find it too difficult, go back to your doctor and ask them to reassess whether you’re at MMI and to provide restrictions.
Sometimes doctors give up too quickly and state that a patient has reached maximum medical improvement even though there is other treatment, including surgery, that could improve your condition and functional abilities.
If you disagree with your doctor’s opinion that you are at MMI, then the first thing you should do is ask your doctor for a referral for a second opinion for your work injury. By law the insurance carrier does not have to pay for a second opinion – unless the authorized treating doctor refers you for one.
If your treating physician refuses to refer you for a second opinion on whether you’ve reached MMI, then you have a few options:
Another option if you disagree with the MMI determination is to file a change in condition application, asking the Commission to approve a change in your workers comp doctor. I don’t recommend this option, however, unless you have medical evidence from a health care provider that contradicts your treating physician’s opinion that you are at MMI. The Commission only approves changes in doctors in limited situations and you have the burden of proving a change is necessary.
Just because you can get a second opinion on the MMI determination does not mean that you should.
It’s important to assess the medical evidence, the types of benefits you are receiving, and what you hope to accomplish with your case when deciding whether to get a second opinion on maximum medical improvement.
I’ve represented many injured employees whose symptoms worsened and who needed surgery after their doctor told them they had reached MMI.
For example, those of you who undergo an arthroscopy for a torn ACL or knee injury on the job may need to undergo another surgery, such as a high tibial osteotomy. Or those of you who underwent surgery for a hand injury may need a hardware removal surgery years later if your pain worsens.
I’ve also represented many injured employees who tried going back to full duty work only to find those jobs were too strenuous and modified duty work is necessary. That is why, As discussed earlier in the article, I recommend waiting several months to pursue PPD benefits if you are released to full duty when you reach MMI.
You can always seek additional medical care after your doctor declares you at MMI, so long as you did not settle the case. And depending on the date you last received wage loss benefits under an Award Order and the applicable statute of limitations, you may be eligible for additional wage loss benefits if you have to go back out of work.
Depending on how you were hurt on the job, you may have both a workers comp claim and a negligence lawsuit under tort law. This type of civil action is called a third-party lawsuit because you are seeking damages from someone who is not connected to your employer but who caused you harm while you were working.
It is common to have both types of claims if you are hurt in an auto accident while on the job, injured by a defective product on a construction site, or the victim of workplace violence.
As with workers comp claims, MMI is a milestone in personal injury claims. You should not try to settle your car accident or tort claim until you have reached MMI for many of the same reasons you should wait until you’ve reached maximum medical improvement to settle your workers comp case. Another reason you should wait to resolve your personal injury claim until you’re at MMI is that you will not know the value of your past medical treatment, which is a major factor in the value of your case, until you’ve reached that point.
When it comes to workers comp, few milestones are as important as maximum medical improvement.
To protect your legal rights and to give yourself the best chance of getting every benefit and dollar you’re owed when you reach MMI, call me for a free consultation: (804) 251-1620 or (757) 810-5614. I help injured employees throughout Virginia, including those in Richmond, Chesterfield, Henrico, Bristol, Abingdon, Roanoke, Harrisonburg, Winchester, Fairfax, Manassas, Fredericksburg, Newport News, Williamsburg, Norfolk, Virginia Beach, and Chesapeake. Let’s finish your case together.