MMI (Maximum Medical Improvement)

Maximum medical improvement (MMI) represents the point after which an employee is not likely to recover any further. For many, it means a patient has experienced a full recovery and can go back to work without any constraints. For some, however, it means the current condition is as good as it gets. These individuals may face lifelong paralysis, chronic pain, or other permanent injury effects.

When you receive workers’ compensation benefits, the insurance company needs to know the outcome for an employee after an injury. Knowing whether a patient is at a point where he or she cannot recover any further can help insurance companies and employers make decisions regarding the future of the employee.

What Happens When a Patient Reaches MMI

If you are receiving benefits for an injury and your doctor acknowledges MMI, he or she will then forward disability or recovery information to the insurance provider so it can make changes to your benefits structure. The doctor may also speak with your employer to establish work restrictions. Only a physician can make an MMI determination for a patient.

For many, the MMI point represents the information an insurance provider needs to create a settlement with an injured employee. The level of impairment evaluated will determine if the individual continues to receive some level of benefit in the form of partial or full disability, as well as if and when an individual can return to work.

What to Do After Achieving MMI

As soon as your doctor establishes an MMI point for you, tell your workers’ compensation attorney and have your doctor send his or her rating information and evaluation to your attorney. If you, your primary care provider, or your legal counsel do not agree with the determination, you may petition for a reevaluation and the pursuit of a claim in court.

If you agree with the findings of the MMI report, the workers’ compensation provider may either approach you with a settlement or cease benefits. Depending on the circumstances of your case, you may need to approach your employer with an attorney’s guidance to pursue an appropriate benefits settlement after achieving MMI.

After you have achieved MMI, you are still entitled to benefits including:

• Compensation in the form of permanent partial or total disability to cover the degree of damage caused by the injury that affects your overall quality of life.
• Lost wages. Compensation to cover the cost of lost or lower wages due to the injury.
• After reaching MMI, a patient still may need additional rehabilitation to maximize a return to work after suffering from a life-altering injury.
• Depending on the case, some employers may pay out a lump-sum settlement to cover an employee’s injury.

While MMI can bring peace of mind to a patient because it represents the point of understanding of long-term effects, it can also cause anxiety and confusion. Some employees may unfairly have their workers’ compensation benefits cut off as a result, and some may suffer from additional side effects from the injury years down the road for which they are not compensated. However, there are legal remedies available for employees who have reached an established MMI point.

If you have concerns regarding your MMI and workers’ compensation benefits in California, you may have the opportunity to contest the findings or to challenge the settlement an insurance provider offers. The team at DiMarco Araujo Montevideo can help you explore your claim, pursue action if your health starts to deteriorate after reaching MMI, and obtain fair compensation to help you move forward after a workplace injury. Contact us today to learn more.