Getting injured at work and filing a workers’ compensation claim is an introduction to a lot of legal terms and jargon. One of the most controversial terms related to workers’ comp is that of maximum medical improvement, or MMI. Initially, the injured employee wants to get the needed medical treatment for their injuries. Their concern is with their immediate needs and the cost of medical treatment. The extent of their injuries and the impact on their job isn’t always apparent right away.

That’s why it’s so important to report injuries and get medical treatment even if the injury doesn’t seem significant. Workers must report their injuries to their employer within a specific time frame to obtain workers’ compensation. If they keep working after an injury, they, their San Diego workers comp lawyer, workers compensation attorney, or their work injury lawyer could miss the deadline. They also risk making their injury worse.

maximum medical improvement

How Workers’ Compensation Works

Most employers must carry workers’ compensation insurance to protect their employees. When an employee suffers a work-related injury, they file a workers’ comp claim to get payment for their medical treatment. It also covers a portion of their missed wages. In return for the coverage, the injured employee can’t sue their employer.

The process works well for mild to moderate injuries. That isn’t always the case when the injuries are more severe. These workers typically need more extensive medical treatment and more time off from work. Some never fully recover, leaving them unable to return to work and earn an income. This is why it is so important to partner with a work comp lawyer if you have been injured on the job. Once employees reach MMI, workers’ compensation often provides a lump sum payment to cover future missed wages.

The Role of Maximum Medical Improvement

MMI is the point in an employee’s treatment where the doctor tells them further improvement in their medical condition is no longer possible. This doesn’t mean that they are completely healed or as ‘good as new.’ It means that whatever their condition is right now is as good as it will ever be. Before designating MMI, medical doctors should try every means of treatment available.

The doctor will provide a disability rating and provide the employee with a list of capabilities and work restrictions. This information tells the injured employee which tasks they can perform physically and those they can’t. If their condition is still serious, they may be unable to return to work at all. While this sounds like a simple process, a number of issues can result in an outcome that isn’t fair to the employee. These issues also contribute to the debate that often occurs once a physician declares that a patient has reached MMI.

– Career Choice

The type of injury determines the employees’ restrictions and how much impact it has on their job. If a person’s foot is crushed when an object falls on it, for example, there might be permanent nerve damage. If that person works at a desk all day, their injury might not interfere with their job tasks at all.

On the other hand, if the person is a dancer, they can’t perform any of the tasks involved with their job. The area of debate here is that while the person can’t do the same job they did before, they can do a different job. That isn’t as likely to be an issue where every position requires the employee to use their injured body part anyway. But in an office setting, the employer might give an employee who used to stand a desk job. Even those situations where another position is available to the employee, it often means a drop in prestige and salary.

A partial impairment rating determines the severity of the injury. An evaluation that measures their functional capabilities determines whether they can go to work in their original position or in a different one.

– The Physician Stops Seeking Treatment

The employee’s physician determines maximum medical improvement. If the employer’s workers’ comp insurance company requests an independent examination, the employee must submit to a second examination by a different physician. The employee’s physician will determine whether they agree with the report submitted by the second physician. If they do, the employee’s temporary workers’ comp becomes terminated.

If the employee’s physician disagrees with the report, the case will proceed to a special hearing. A judge will make the final ruling on whether the employee has reached MMI. At that point, the treating physician believes that future treatment is of no benefit. Once MMI is reached, insurance benefits no longer cover treatments. If the physician hasn’t tried every potential avenue of treatment, the employee could miss an opportunity to improve.

– They Get Worse Later On

Reaching MMI means that the employee is not expected to get better with additional treatment. That doesn’t mean they can’t get worse once they stop receiving treatment. There’s also the risk that returning to work will make their injury worse. The impairment rating assigned by the physician at the time MMI is reached determines their limitations. Putting their permanent condition on record doesn’t keep it from progressing in real life. If it does progress, their MMI designation prevents them from obtaining further treatment they may need.


– What Denotes a Fair Settlement?

The employer and their insurance company want to pay the injured worker as little as possible. Once MMI is reached, the injured employee must choose between a final lump sum settlement or ongoing benefits. If they are offered a settlement, they must sign a release, forfeiting their rights to any future claims. But if the employer has been found liable for the employee’s medical treatments for life, they are responsible for benefits even after reaching MMI.

Signing a release without legal guidance could result in the loss of vital medical treatment. Employees also have the legal right to challenge the physician’s designation of maximum medical improvement. The laws related to workers’ compensation are complex and challenging to navigate.

Every employee has the right to get fair compensation for their work-related injuries. Don’t make one of the most important decisions of your life alone. Contact The House of Workers’ Compensation to schedule a free case evaluation. We can help you get the best results from your workers’ compensation claim at any stage of the process.