This is a collaborative post from Kevin and Greg.
Being injured on the job is often a stressful and difficult situation. You are hurt, which is impacting your ability to work. You could be in constant pain and be concerned about your loss of income. This is often a difficult time in life for the injured party and their family.
What often makes this situation more complicated is the legal terminology associated with workers’ compensation. You cannot overlook interacting with the insurance company as that is rarely fun for anyone.
In the beginning, when someone is injured on the job, their immediate medical needs are met. However, some injuries are not evident from the start. Also, the initial injuries could lead to more long term injuries.
You should report any concerns you have and receive medical treatment, even for injuries that may seem minor. You can not be sure what will happen long term, and it is essential to have everything documented.
There are timeframes that are critical in workers’ compensation cases. This means that you must report injuries within a specific date of the accident.
The Basics of Workers’ Compensation
It is helpful if you have a basic understanding of workers’ compensation benefits before you ever need to use them. Workers’ compensation insurance is something just about every employer is responsible for having to protect employees in the case of an injury.
Anytime someone is injured as a result of a work injury, they must file a workers’ compensation claim to receive payment for any medical treatment related to the injury.
These payments may also cover any lost wages. When the employee receives these types of payments, they are agreeing not to sue the employer for their injuries. This process is ideal for those that have moderate range injuries.
For those that have severe injuries, it does not work as well. Those who sustain severe injuries require more extensive care and treatment combined with longer periods of time away from work.
Those with more severe injuries may never recover, which means they cannot work or earn an income. Some may have a partial recovery where they might be able to return to some type of work but not their previous job and not without pain or discomfort.
What Is MMI?
One of the most complicated portions of workers’ compensation is a maximum medical improvement (MMI) case. It is also one of the most impactful, confusing, and frustrating parts of workers’ compensation.
The definition of MMI is the point where the injured individual has reached a stable place with their condition. It also states that any more improvement of the condition is not likely, regardless of physical rehab or medical treatment.
In simpler terms, you have reached a place where your treatment is standing still, and you will not recover anymore. Unfortunately, it also means that there is no reasonable treatment available to improve your condition.
So not only is the definition of MMI confusing but understanding how it impacts you and your workers’ compensation benefits is also confusing. Not to mention that it can cause fear because the thought of having your benefits and treatments stopped can be scary.
MMI is typically determined by a physician during a Functional Capacity Evaluation. During this process, the doctor providing the assessment gives you a disability rating. The intention of this assessment is to determine what you are capable of doing and if you have any permanent restrictions.
In the assessment, the doctor should provide to you a list of your abilities as they relate to the MMI for your particular state.
The listing given to you is intended to outline all of the tasks that you are able to perform and those you cannot perform in order to reach maximum medical improvement. Typically, when you reach MMI, workers’ compensation offers you a lump sum that is intended to provide for any missed wages in the future.
What Is a Disability Rating?
A disability rating becomes one of the critical parts of your case for workers’ compensation. This is the determining factor as to whether you receive permanent benefits for disability and the amount.
The major part of a workers’ compensation settlement is compromised of the permanent disability benefit. During the early stages of your work injury, you may qualify for temporary disability benefits, which can cover wages you are not receiving.
In addition, your doctor may give you work restrictions, such as a limitation on how much you can lift.
To determine your disability rating, your doctor gives you a physical exam that tests how well you can perform typical daily activities and your ability to function. This could include balance, range of motion, and your ability to lift.
There are guidelines that the doctor uses to determine your impairment rating, which is another name for your disability rating. In the majority of states, the doctor that has been treating you for your injuries and workers’ compensation is the same doctor that evaluates you.
Sometimes, the insurance company disagrees with the determination. If that is the case, the insurance company can require you to have an independent medical exam (IME).
The authorized treating physician is the only person who can determine MMI; however, an employer can also request an Independent Medical Examination (IME) by a qualified physician to make this determination after reviewing the patient’s medical records and examining the patient. you and provides a rating.
It is rare that these two ratings conflict. However, if there is a conflict, a judge makes the determination between the two or orders one more exam, which would be the last one.
An alternative is that you and the insurance company decide to take an average of the ratings and come to a settlement agreement.
What Is Partial Impairment Rating (PIR) and Whole Person Impairment (WPI)?
When determining impairment rating, there are two different ratings that are important for you to know. A PIR is what determines how severe the injury is that you sustained. This rating is directly related to the percentage of impairment that your injury has caused.
A few other items factored into the rating, including your medical needs and your ability to go back to work. A PIR states that you have only a partial impairment but that you can also go back to work to a position that does not exceed what you are capable of doing.
Your practical limitations must be considered. These limitations are determined when your doctor gives you a functional capacity evaluation (FCE).
When your disabling condition may prevent you from ever going back to your previous job, it may mean that you are eligible to receive benefits until the statute of limitations expires.
What Is the Role of MMI In Workers’ Compensation?
An important distinction when it comes to MMI is that it does not mean that you are completely healed. It does mean that your condition has reached a point where it is as good as it can be. It is essential to note that doctors should try all methods of treatment that are available for your injuries and conditions.
The workers’ compensation insurance company is bound by law to pay for all of your treatment that is medically recommended because the provider believes it will make improvements to your condition.
Once you have reached MMI, the insurance company still must pay for all medical treatment that is needed for the injury, but the treatment becomes much more limited. After you have reached MMI, the insurance company only has to pay for services that are considered secondary medical.
This secondary treatment is intended to allow you to maintain MMI or continue to work.
Who Makes the Determination About MMI?
The doctor that has been treating you for your injuries related to your work injury is the person that determines MMI. This should be a state-certified doctor. Keep in mind that the employer or insurance company requires an independent medical exam (IME) because they disagree with the determination.
A qualified doctor is the one that makes the decision once they review your medical records and give you an exam. The Bureau of Workers’ Compensation has the right to perform its own exam.
If the treating doctor agrees with the MMI that was determined by the IME, this means the temporary compensation you were receiving is terminated. These benefits stop on the date of the exam or when the treating doctor approves.
Of course, the doctor that is treating you can disagree. If this happens, the claim is forwarded to one of two places. These two places are the Industrial Commission or the workers’ compensation judge for a hearing and judgment.
The treating doctor, your employer, the insurer, and you all receive copies of the report.
How Is MMI Calculated?
A state-certified doctor must give you the exam and assessment to determine if you have gotten to the point of maximum medical improvement. The evaluation report is used to determine your MMI.
The industrial commission or Division of Workers’ Compensation uses this information to calculate your workers’ compensation MMI rating and determine your settlement amount.
A few factors are used to determine your benefits. These factors include the work you were doing at the time of the accident and subsequent injury.
In addition, the medical treatment that was needed to treat your injury is also taken into consideration. One last item that is considered is the degree of restrictions to your permanent functions.
The physician also writes a report to explain your injuries, their nature, and if you can still perform your job. This report is used to calculate your disability rating and then determine how much you are entitled to receive in workers’ compensation benefits.
Hiring an experienced workers comp law firm will help you get an MMI rating that is in your favor and therefore improves your ability to get the compensation you deserve.
How Does MMI Impact Workers Compensation?
You always have a right to file a workers’ compensation claim when you are injured in the line of work. This is also true if you become sick because of the conditions are your workplace.
When your doctor gives you an exam to determine your impairment rating, the rating is on a scale of 100. When you get a 0% MMI, that means you have completely recovered. If you have a percentage above a 0, that means that you have reduced functionality. This rating is used to give your claim a value.
The higher the MMI rating it means that you are entitled to receive a higher compensation.
Does Career Make A Difference In Workers Compensation?
The type of job that you held before you were injured makes a difference in how your injury has a bearing on your ability to do your job. Likewise, the type of injury that you have determines what your restrictions are and how much it impacts your job.
For example if something falls on your foot, you could have permanent nerve damage. If you work at a desk job and sit down all day, the damage may not prevent you from doing your job.
However, if you have a job as a dancer, you may not be able to dance. While you may not be able to do some or all of your previous job, the question remains, is there any job in the company that you can perform?
If all the positions at this company require you to use the part of your body that was injured, you most likely will not be able to take on another position. However, in the office setting, you could move from a position where you sit all the time to one where you stand or vice versa.
This change to the position could mean that you are demoted or have a decrease in wages.
What Happens If My Physician Discontinues Treatment?
Your doctor plays an integral role in determining if you have reached the maximum medical improvement. As mentioned above, there are several steps that can occur once the assessment is completed.
If the physician agrees that you have reached MMI, then your temporary workers’ compensation benefits terminate. But if your doctor does not agree, then a judge makes the final ruling. When you have reached MMI, your doctor believes there is no reason to continue treatment.
If you have reached MMI means that continuing treatment would not result in any improvement to your condition. If your doctor has not attempted every possible option for your care and treatment, you could miss out on an opportunity for improvement.
It is highly likely that once you reach MMI, your doctor will discontinue treating you. Ensure you and your doctor attempt all possible treatments before you get to the MMI stage.
What Happens If My Condition Worsens?
When you have reached the point of MMI, that means that it is unlikely your condition will improve. However, it does not mean that your condition will not get worse. It could get worse as you age, or it could get worse once treatment has ceased.
There is also the possibility that your condition may worsen when you return to work. Unfortunately, if your condition does worsen, the fact that you have a designation of MMI prevents you from receiving further treatment by that doctor, and that is covered by the workers’ compensation. This does not prevent you from seeking treatment.
No one can stop you from receiving the treatment you need. It just may not be covered by your workers’ compensation.
What Is A Fair Settlement?
The workers’ compensation insurance company and your employer want to pay as little as possible. When you have reached MMI, you may have the option of taking a lump sum or continuing to receive regular benefits.
If you are offered and accept a settlement, you will have to sign a release that indicates you are forfeiting your rights to any claims in the future.
You do not want to sign any documentation without consulting a competent and experienced workers comp law firm. If you do, you could potentially lose the ritual to necessary medical treatment.
If your employer has been found responsible for your medical treatments for life, they are obligated to honor that regardless of your reaching MMI. You do have a right to challenge the doctor’s determination of MMI. Workers’ compensation laws are complex and difficult to navigate, especially on your own, without legal advice.
Should I Agree to the Settlement?
When you get to the point where you have reached MMI, you have the right to know all of your permanent work restrictions. You should also know the type of medical treatment you may need in the future. On the other hand, you may also feel like you just want to settle your case and move on.
This is often referred to as a compromise and releases agreement. This is when the insurance company agrees to pay you as the injured person a lump sum to settle the whole workers’ compensation claim.
The amount of the settlement is calculated primarily by the present lost wages, projected future lost wages, and medical care expenses. This settlement is intended to satisfy all concerns related to your wages and medical treatment.
Can I Challenge the MMI Decision?
When you have been injured and are receiving workers’ compensation benefits, you have the right to disagree with the determination that you have reached MMI. It is possible that you feel like you have not recovered enough to be able to go back to work.
It is also possible that the workers’ compensation insurance company may feel as though you have improved more than the doctor is indicating. They then assume you should no longer be held liable for disability payments to you.
Either you or the insurance company is legally allowed to ask for a reevaluation of your claim.
Do I Need An Attorney Once I Get To MMI?
A workers comp law firm is experienced in all of the complicated and challenging laws and rules about workers’ compensation and MMI. When mistakes are made, they can have a negative impact on your future and can be expensive.
This law firm can help you understand your rights when it comes to a settlement or long-term benefits.
When you are given the determination of MMI and given a disability rating, you can request that you receive one lump sum payment. The amount you receive would be based on your rating. You can still have your medical bills paid.
It does mean, however, that you are giving up your weekly benefits from workers’ compensation. Even if you are not able to go back to work, then you still will not receive payments.
When you achieve MMI, there are certain items that occur that have an impact on the future.
- First, it determines if you are able to return to the job that you were doing before you were injured.
- Second, your disability rating dictates your restrictions which may limit the type of work that you can do, such as switching to lighter duty and a lower amount of pay.
- Third, your disability rating indicates your permanent impairment level and if you are going to be able to receive partial disability benefits permanently.
- Finally, this rating indicates if you are going to need treatment in the future and how long you might need the treatment. This also helps to determine all of the types of workers’ comp benefits you might still be entitled to receive, as well as the value of your case for a settlement.
A qualified and experienced attorney understands the importance of taking the best actions when your doctor makes the assessment that you have reached MMI. These attorneys examine your situation and case to determine what needs to be done.
A qualified attorney is familiar with insurance companies and adjusters and how they navigate workers’ compensation cases. They address all communications and handle all negotiations with the insurance company while working to protect and enforce your rights.
They also hold insurance companies and employers accountable for acting quickly and by the law.
Documents You May Need If You Reach MMI
When a doctor determines that you have attained MMI, you have some decisions to make. First, you need to decide if you accept the permanent partial disability rating that the doctor has assigned to you.
If you do not agree with the initial determination, you are allowed to request a second opinion. Then you must decide if you want to agree to a settlement. Depending on the state in which you live, that indicates how long you have to accept the rating payment.
Understand Your Work Restrictions
During your examination to determine if you have reached MMI, the doctor determines what your appropriate permanent work restrictions should be. This may impact the type of work that you are able to do. It also indicates what work is considered to be suitable employment.
Suitable employment is one that takes into consideration any preexisting limitations and limitations that are related to your injury. This includes physical and mental limitations, experience, work skills, and education.
This employment must be within 50 miles of your house. A qualified lawyer compares your restrictions with the job duties that you were handling before your injury. This helps to determine if there are tasks that you can no longer perform because of your injuries.
What If I Do Not Agree?
If you do not agree with the MMI that was assigned to you, you do not just have to accept it. You do have paths you can pursue in reference to MMI. You can look for additional medical care once your doctor declares you have reached MMI.
This is if your workers’ compensation has not been settled. A qualified lawyer can examine the circumstances and situation to determine the best way to proceed.
You always have the right to ask for a second opinion if you do not agree with the MMI assessment. The insurance company is not required to pay for a second opinion. However, if the treating doctor refers you for a second opinion, then the insurance company must pay for it.
An attorney is able to recommend doctors who are comfortable and familiar with the litigation process that is associated with a workers’ compensation hearing if it is needed. They can review your medical evidence and your benefits. They will also advise you as to whether or not you should get a second opinion.
Once you understand how significant an MMI decision is to your future, consider contacting a workers’ compensation attorney. You do want to ensure that you are hiring someone that is right for the case you have.
You should find someone that specializes in workers’ compensation cases and MMI. Find someone that has a proven track record and many successes in the realm of workers’ compensation.
Find an attorney that understands how your injury has impacted your life and when you reach MMI. It can have long reaching implications in all aspects of your life. Ensure that whomever you select is able to assist you through every stage of your workers’ compensation case.