What Is Maximum Medical Improvement?

Employees who are injured on the job, suffer a work-related illness, or some other medical or physical condition caused by their employer are permitted to file a workers’ compensation claim. This type of insurance has helped millions of people get back on their feet or continue to support themselves after such an event. However, it’s often difficult to receive or keep these benefits, even when they are appropriate and necessary. 

Unfortunately, workers’ compensation insurance companies don’t like to pay claimants fairly or without a fight. They use many tactics and tools to avoid paying you what you deserve. One of them is arguing maximum medical improvement. Another is utilizing an “independent” physician who works for them to determine when you reach MMI.

What is Maximum Medical Improvement?

Maximum medical improvement (MMI) is reached when medical providers don’t expect further recovery from an injury, even with additional treatment. 

Reaching maximum medical improvement significantly impacts workers’ compensation and personal injury claims. Understanding the long-term consequences of an injury helps determine how much a case is worth. Damages for future medical expenses, lost wages, pain, and suffering depend on the victim’s maximum medical improvement.

Until someone with severe injuries reaches this point, an adequate damage assessment isn’t possible. Waiting until maximum medical improvement to negotiate a settlement increases the chances of full and fair financial recovery.

MMI is one of the most contested issues in workers’ compensation claims. Workers’ compensation attorneys and even lawmakers have many questions and concerns regarding this requirement. MMI determines fair compensation for a claim and whether or not the injured worker should settle. 

Once MMI is established, then the question as to the degree of total or partial bodily impairment can be addressed. It’s not uncommon for an injured worker and their treating physicians to be inundated with requirements for many medical exams and paperwork to meet the workers’ compensation requirements. Doctors or employees who don’t entirely understand MMI requirements might find that the case doesn’t settle or settles for a tremendously unfair amount.

The Importance of Maximum Medical Improvement

The MMI is crucial in your workers’ compensation benefits. MMI determines the payments and benefits you should receive from your workers’ compensation claim. Since the MMI is considered to be the endpoint, it determines any long-term impacts you will experience from your workplace illness or accident. It also measures fair compensation. Suppose an IME finds that you have an early MMI date. In that case, your benefits could be decreased significantly and unfairly.

After establishing MMI, you could still be totally or partially disabled but return to work depending on what functions you still have. If you have severe injuries and are permanently unable to work, then you can receive benefits indefinitely or until the time limit by the state has expired.

Who Decides the MMI?

This question is not only common; it’s crucial. Injured workers should be concerned about who determines when they have reached MMI. Only a licensed physician can determine when someone reaches this status. An insurance adjuster, injured party, attorney, or court can’t make this decision.  

Your treating physician will determine the first MMI date. It’s highly likely that the workers’ compensation insurance carrier will demand that its own doctor performs an Independent Medical Examination (IME) to decide if you are truly at MMI. You and your treating physician will be provided with a copy of their report. Your doctor will review the IME report. If they agree with the physician who performed the IME, then the total temporary compensation is then terminated on the effective date.

However, your treating physician isn’t required to agree with the IME. If they don’t agree with the IME doctor’s exam and determination, your claim is forwarded to a judge or the commission for a hearing and determination.

What Is an IME?

An IME stands for an independent medical examination. If you have sustained a work-related injury and are filing a workers’ compensation claim, you must see doctors who are approved by your employer’s insurance company. The success of your claim depends substantially on the medical opinion of the physician from the insurance company’s approved list.

Many situations can cause the workers’ compensation insurance company to require you to submit to an IME. You should expect to be scheduled for an IME if:

• The insurance carrier disagrees with your treating physician’s medical opinion
• Your claim isn’t moving quickly or is becoming too expensive, resulting in the insurance adjuster wanting to close it end your claim
• The insurance company needs evidence to resolve a dispute about your claim, limit your benefits, or deny your claim altogether

If your treating physician diagnoses you with a total or partial permanent disability, it’s almost guaranteed that the insurance company will be sending you for an IME with their doctor. In general, anytime the insurance company doesn’t like your doctor’s opinion because it doesn’t serve their purposes to keep money in their pockets, an IME will be warranted. If they don’t like the MMI your doctor is reporting, it’s time for an IME in their book.

The insurance company chooses IME doctors for a reason. They work for the insurance company and not for you. They are not there to treat you or help you get better; their only goal is to side with the insurance company. As such, having not only your physician on your side but also a well-versed workers’ compensation attorney can help when it comes to an MMI determination.

Call Us Today to Speak with a Chicago Personal Injury Lawyer

If you suffer from a work-related injury, illness, or condition, contact a workers’ compensation lawyer at the Law Offices of Michael J. Brennan for help today. Our experienced lawyers can assist you with the process of filing your workers’ compensation claim. We can also ensure that you obtain a fair IME outcome and that your MMI is accurate for full and fair claim compensation. You can receive your free workers’ compensation case consultation by calling our reputable firm at 708-894-1611 today.