Introduction
I speak to a great number of individuals that are ensnared in the system attempting to secure workers’ compensation. A considerable amount of confusion relates to attempts to understand where an individual is in their recovery, and where they will reach their Maximum Medical Improvement (“MMI”). The reaching of MMI is significant in that it represents the cessation of further medical treatment, and in turn the definition of where your workers’ compensation benefits will be and for how long. In many cases this can be for the remainder of an individual’s life.
I have included an example below of the types of questions that go through an individual’s mind while attempting to recover from injury and trying to regain function to better serve themselves. It is our intention to insure that all of your rights are protected.
Define Maximum Medical Improvement (MMI) and Its Importance in Workers' Compensation
Many people can not even begin to understand MMI maximum medical improvement and how it can impact a person’s recovery from injuries sustained from an accident. As a doctor can determine when a person has reached MMI maximum medical improvement. In general terms this is when all injuries have reached a point where 100% healing has taken place and all necessary treatment has been completed.
Even after an individual has reached MMI maximum medical improvement and have completed any treatment, the effects of the injury can still remain. In assessing any permanent effects of a work-related injury, the physician of the injured worker will provide a permanent disability rating. These ratings in North Carolina are provided once an individual has reached MMI maximum medical improvement and quantifies the degree of impairment that an individual has suffered as a result of a work-related injury.
The time frame an injured worker has to reach MMI can vary greatly depending on the severity of the injury and the victim’s rate of recovery. Some of the more serious injuries involve the payment of specific amounts of money to the worker during the time that they are off work due to their injury. These amounts of money are meant to be used by the injured worker to cover some of the expenses that they incur while they are recovering from their injury. It is very important that the injured worker keeps a record of their injuries as well as a record of all of the treatment that they receive for their work-related injury. The injured worker should report their injury as soon as possible and seek medical attention right away. The injured worker then has 30 days from the date of their injury to report the injury to their employer. After the injured worker has reported their injury and begun to receive treatment for their injury, the injured worker then has one year from the date of their injury to file a formal claim for benefits with the North Carolina Industrial Commission in order to receive any benefits that they may be entitled to as a result of their work-related injury.
Assessing MMI maximum medical improvement plays a critical role in the compensation of a worker who has been injured on the job as that determination signifies the end of an injured worker’s receipt of temporary disability benefits and assesses any worker for any permanent impairment(s) that he or she received as a result of a work-related injury, determining the categories of assistance for which he or she would be eligible such as assistance for a worker that has been found to be Permanent Total Disabled (PTD) and that requires the worker to receive 100% of his or her wages for life or partial wage loss assistance should the worker’s injury impede his or her ability to return to work in some capacity.
Whether or not you believe that MMI maximum medical improvement was reached too quickly is of no matter. It can affect your claim for workers’ compensation and can have very serious implications to your claim. In order to ensure that your rights are protected, it is highly recommended that you contact a lawyer before settling your workers’ compensation claim. Even if you have settled your claim already, the lawyer can assist you in acquiring the support, care, etc. that you need to heal. It is always best to seek representation as early in the process as possible. This will help to acquire the best results possible for your particular situation.
Explain How MMI Is Determined: Medical Evaluations and Criteria
The following aspects of the MMI process that your doctor will be reviewing as you continue on your journey through your medical recovery and back to work through the claims process.
- Stability of the diagnosed condition(s): Whether the worker’s condition(s) diagnosed are stable and will not improve.
- Treatment History: This includes a listing of all of the treatment that Injured Worker has received for their diagnosed condition(s) including but not limited to surgery, physical therapy as well as all of the prescription medications that have been prescribed for them as well as any other treatment.
- Functional Capacity: Assesses the ability to perform work related functions as well as activities of daily living and indicates the need for future treatment and the degree of disability/functional limitations resulting from the injury/condition. Physician’s use Functional Capacity Evaluations (FCE’s) to assess an Injured Worker’s current Functional Capacity.
Note: The term MMI (Maximum Medical Improvement) as it is used in Injured Worker claims processes means that, although the injured worker may have experienced permanent injury, the condition has stabilized (i.e. cannot be made better). The process of achieving MMI is an important part of an injured worker’s recovery as well as enabling both the injured worker’s and the adjuster to attempt to arrive at an understanding of the injured worker’s ongoing needs and their entitlements as a result of the permanent effects of their work-related injury that affect their ability to undertake work as well as their usual activities.
Discuss the Implications of Reaching MMI: Benefits and Compensation Changes
Maximum Medical Improvement or MMI for short is a point in time after an injury when your medical treatment reaches a point of stability. At this point in time many workers’ compensation folks consider that to be the end of the worker’s benefits. However, confusions arise as to whether or not a worker is entitled to benefits and to what extent.
- End of Temporary Disability Benefits and Shift to Permanent Disability Benefits: Temporary disability benefits stop once MMI is reached and transition to permanent disability benefits, which are determined based on the impairment rating provided by your treating physician.
- Impairment Rating: Your treating physician will evaluate your injury and assign an impairment rating. This rating will play a significant role in determining your workers’ compensation benefits. For example, in North Carolina, the amount of time and the amount of Permanent Partial Disability (PPD) benefits that you will receive will depend upon your disability rating and the affected body part(s) as set forth in N.C.G.S. § 97-31.
- Future Medical Care: Most people assume once they have reached MMI that all medical care will cease. This is not true. The extent to which you will receive future medical care will depend on the specifics of your case. If you have been denied future medical care or are in need of additional treatment, the experienced staff at Vasquez Law Firm is here to help.
It is beneficial for an injured worker to have an understanding of what the end of a phase means for them. Reaching MMI and the end of temporary disability benefits does not mean the end of ALL medical treatment. Furthermore, if an injured worker is unable to return to full duty work then the injured worker may be entitled to permanent total disability (PTD) benefits which are paid at 100% of the worker’s average weekly wage. An injured worker can also get another doctor to evaluate their injuries and many times the second doctor will agree that the treating physician’s determination of MMI and stabilized condition are not accurate. This is where a competent workers’ compensation attorney can be of great value. He can represent you 24/7 for urgent matters and still answer questions for you on non-urgent matters. We offer free consultations to review your workers’ compensation claim.
Identify Challenges in MMI Determinations and How to Address Them
Vasquez Law Firm provides a full understanding of mmi maximum medical improvement for injuries, especially for repetitive stress injuries (RSI) and how to obtain fair Workers Compensation benefits for injured workers. Below are several examples of common mmi scenarios and MMI challenges:
- Disputes Over MMI Findings: It is common for a worker to challenge the findings of a doctor regarding the worker’s inability to return to work due to work injury or illness. North Carolina law specifically limits who can determine whether or not a worker has reached mmi maximum medical improvement for workers’ compensation purposes. A worker may challenge the findings of a compensation physician regarding mmi maximum medical improvement for workers’ compensation purposes. That being said, the process can be quite challenging for the worker, especially as it pertains to preparing a proper written statement regarding mmi challenges. In some cases, a Charlotte Personal Injury Attorney will become involved in order to protect the worker’s rights. But in those instances, it is within the rights of the worker under North Carolina law to challenge a doctor’s finding of mmi maximum medical improvement. Often, the average number of days for permanent partial disability cases is approximately 363 days.
- Inconsistent Evaluations: These are typical with repetitive stress injuries and can be unusual compared to other injured workers as well. Different docs can have different opinions of the same medical facts, and that is okay. What is important is for you to document your treatment, and for all your healthcare providers to be on the same page. When a worker reaches mmi maximum medical improvement for a workers compensation injury in North Carolina, that determination of mmi is made by the workers compensation authorized treating physician. The average number of days to reach mmi for a workers compensation injury that results in permanent partial disability is approximately 363 days.
- Insurance Company Pressure: Workers often don’t realize that their insurance company can allow their doctor to evaluate the worker for MMI maximum medical improvement for Repetitive Stress Injuries and then the insurance company can use this finding of MMI to press the worker to be deemed MMI. When a worker is deemed MMI for Repetitive Stress Injuries that worker’s case then moves on to disability assessment or closure. Once MMI has been reached temporary disability benefits will cease. As a rule, temporary partial benefits will cease also as MMI maximum medical improvement signifies the end of temporary partial benefits for the worker’s Repetitive Stress Injuries. Also, keep in mind that accepting a lump sum settlement of a Workers Compensation claim for the Repetitive Stress Injuries after reaching MMI will affect the worker’s chance of collecting any more workers compensation benefits for work-related injuries in the future.
Below are some things you can do to help protect your own interest, and make sure that you are receiving the best medical treatment possible to recover from your Repetitive Stress Injury(s):
- Keep track of your medical treatments and your doctor's evaluations.
- Document your medical treatment and evaluations and have open communication with your health care providers.
- A fair assessment of value of your case from a Charlotte Workers Compensation attorney at Vasquez Law Firm. We provide free consultations to Injured Workers and work on a no-win, no-fee basis for injured workers with workers compensation issues with maximum medical improvement for repetitive stress injuries and other workplace injuries and illnesses.
We can take your hand through the process of reaching MMI for your injuries and fight for your rights as an injured worker to receive the best treatment and the fairest compensation for your work-related injuries.
Conclusion
Reaching Maximum Medical Improvement or MMI in your recovery from injury or illness is a major milestone on your road to recovery. Many people incorrectly believe that once they have reached Maximum Medical Improvement that there is no more treatment for their workers’ compensation claim. In reality, the person injured at work and his or her attorney are responsible for ensuring that the injured worker receives all of the medical care that he or she needs to recover from work-related injury or illness and that the worker’s compensation claim is properly paid. Treatment and care that the injured worker needs after reaching MMI can still be paid for by workers’ compensation.
In addition to determining how MMI can be used to evaluate your claim, there are several other factors that need to be addressed. First and foremost your condition must have reached a fixed state or in other words a point where it will not get any better. When determining Maximum Medical Improvement your doctor will take into consideration all of the treatment that you have received for your work-related injury, as well as any surgery that you have had. Your doctor will also evaluate your current functional capacity and how your injury affects your daily life. Even after your doctor has determined that you have reached Maximum Medical Improvement it is very important to continue to seek medical treatment for any injury related problems that you are experiencing and to document all treatment. It is also wise to speak with a workers compensation attorney to make sure that you are receiving all of the benefits to which you are entitled.
We at Heitman & Allfrey can help you. By Heitman & Allfrey understanding what MMI is and how it will affect you and your workers compensation claim, we can best represent you through the process. By the time you have reached Maximum Medical Improvement you have reached the highest level of medical recovery possible for your injuries. That does not mean that you will never have any more problems with your injury or that you will never need any more treatment. It simply means that the employee has received all of the proper medical treatment for his or her diagnosed work related injuries. By continuing to manage your ongoing care and having proper legal representation, you can receive fair compensation for the ongoing injury related problems that you are facing. Do not face this process alone, let Heitman & Allfrey guide you through the process.
Frequently Asked Questions
What is Maximum Medical Improvement (MMI)?
Maximum Medical Improvement (MMI) is the point at which an individual has healed as much as possible from their injuries, and no further treatment is expected to improve their condition.
Why is MMI important in workers’ compensation cases?
MMI is crucial because it marks the end of an injured worker's eligibility for temporary disability benefits and is used to assess any permanent impairments resulting from the injury, which influences the types of assistance the worker may qualify for.
How does a physician determine if someone has reached MMI?
A physician evaluates the individual's recovery and treatment completion to determine if they have reached MMI, meaning that all injuries have healed to the fullest extent possible.
What happens after an individual reaches MMI?
After reaching MMI, a physician provides a permanent disability rating that quantifies the degree of impairment from the work-related injury, which can affect compensation and benefits.
How long does it typically take to reach MMI after an injury?
The time frame for reaching MMI can vary significantly based on the severity of the injury and the individual's rate of recovery.
What should an injured worker do immediately after an injury?
An injured worker should report their injury to their employer as soon as possible and seek medical attention right away.
What is the time limit for reporting an injury to an employer?
An injured worker has 30 days from the date of their injury to report it to their employer.
How long does an injured worker have to file a formal claim for benefits?
An injured worker has one year from the date of their injury to file a formal claim for benefits with the North Carolina Industrial Commission.
What are the possible outcomes for compensation after reaching MMI?
Compensation outcomes can include permanent total disability benefits if the worker is found to be permanently unable to work, or partial wage loss assistance if their injury affects their ability to work in any capacity.
Should an injured worker seek legal assistance regarding their claim?
Yes, it is recommended that injured workers consult a lawyer to ensure their rights are protected and to assist with their claim, especially before settling.
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