Maximum Medical Improvement MMI

Maximum medical improvement (MMI) is the point when an injured worker has reached their full functional improvement level and their medical condition from their work-related injuries has stabilized. In layman's terms, MMI is the greatest recovery level the injured worker will reach, despite any and all additional medical treatment.

Maximum medical improvement (MMI) does not mean an injured worker is 100% recovered from their work injuries, it simply means they will not regain any additional functionality, leaving some workers one-hundred percent disabled or with some degree of permanent or partial impairments.

Who determines if a worker has reached their MMI?

Determination of maximum medical improvement is made by either the treating physician or an Independent Medical Examination (IME), if requested by the insurance carrier. If there is a disagreement about whether the worker has reached their maximum medical improvement the claim is sent to the Industrial Commission or to a workers' compensation judge for a hearing and judgment (who will decide the issue can vary by state).

Maximum medical improvement (MMI) is one of the greatest areas of contention in a work comp case. After the MMI is determined, not only will the final amount of reasonable and fair compensation be established, it will also determine the amount of compensation the injured worker can expect to receive from workers' compensation insurance. Consider also, workers' compensation cannot issue an impairment rating until the injured worker has reached their MMI.

What happens after the worker reaches their MMI?

After the injured worker has reached their MMI, the insurance company may stop paying the worker payments for total partial disability benefits, they may offer a settlement offer, and they may, in some cases, determine the worker may return to work. For example, if you have a permanent partial disability the employer may request you return to a new job which you can work despite your permanent limitations.

Medical care for the compensable injury may continue for the lifetime of the worker, despite the worker reaching their maximum medical improvement. For instance, some states do not allow medical care to be waived and the compensation for medical care to be included in a work comp settlement offer.

Other states, however, do allow medical care to be waived and the payment for all future medical care to be paid within a lump sum payment offer. So whether or not an injured worker will continue to have access to paid medical care after they have reached their maximum medical improvement will depend on state laws and agreements made by the worker and the insurance company.

Workers may also be entitled to various types of rehabilitation such as vocational and occupational rehabilitation and other return-to-work programs. They may also receive on-going compensation for their permanent partial disability or their permanent total disability.