Maximum Medical Improvement (“MMI”) is a crucial point in the life of a workers’ compensation claim, and it is important for any injured worker to understand more about it.
What is it?
Maximum Medical Improvement for the purposes of North Carolina Workers’ Compensation Act is the point at which an injured worker’s physician determines that the healing period has ended for a specific injury. This does not necessarily mean that an injured worker is “cured” or restored completely to their pre-injury condition. Quite often it is an acknowledgment that their recovery has plateaued, and in such cases the injured worker may still continue to receive medical treatment. It also does not mean that the injured workers’ condition cannot improve or worsen. Indeed, sometimes an injured worker is found to be at MMI, but can later require significant treatment such as surgery, then found to be at MMI yet again.
Why is “Maximum Medical Improvement” important?
MMI is crucial to a workers’ compensation claim because it is at MMI that a workers’ compensation claim reaches a point where important events occur which will determine what further compensation an injured worker is entitled to receive, and an injured worker and their employer/insurance company can often look to settle a claim. MMI is normally the point at which 3 important things are determined:
What permanent partial disability rating should the injured worker be assigned?
What if any work permanent work restrictions are appropriate for the injured worker?
What ongoing and/or future medical treatment is necessary?
Permanent Partial Disability
It is at MMI that a doctor assigns a permanent partial disability rating, for which an injured worker may be entitled to compensation under the North Carolina Workers’ Compensation Act. The doctor waits until MMI to assign a rating for the obvious reason that a fair determination of impairment requires the injured worker hitting a point where they are healed or reach the point where their recovery is as good as can be. A rating is given as a percentage of the body part injured, using a ratings guide published by the North Carolina Industrial Commission, with the value of the rating calculated based on a certain number of weeks. A large component of ratings for many injuries is the range of motion of the affected body part, and often the ratings guide will dictate a minimum rating if there is permanent loss in range of motion. Thus, a rating given before an injured worker reaches MMI will probably not have a sound basis and will be subject to dispute.
For example: Wendy the Welder reaches MMI and receives a rating to her back. After she has a second opinion as to her rating, she and the insurance company agree she is owed for a 10% rating to her back. Under the North Carolina Workers’ Compensation Act, the back is worth 300 weeks, so Wendy’s rating is worth 30 weeks. Therefore, Wendy is entitled to 30 weeks of her weekly compensation rate as payment for her rating. Some injuries do not fall neatly within a category, and thus there is no way to determine a precise amount, but at MMI the factors involved in such ratings can be established to allow for the parties to discuss value.
Permanent Work Restrictions
At MMI a doctor may determine that the injured worker has permanent restrictions, and thus there may be an issue as to whether the injured worker is still disabled and entitled to disability compensation under the North Carolina Workers’ Compensation Act. The North Carolina Workers’ Compensation Act states that if an injured worker’s employer cannot accommodate permanent works restrictions with suitable employment, temporary total disability benefits will continue and/or start. At that point, the injured worker is required to start a job search to maintain disability benefits. As with a rating, waiting until MMI is the soundest way to make sure any permanent work restrictions are reliable, and protect the injured worker.
For example: Bubba the Builder is out of work with a back injury and is getting weekly disability benefits from the workers’ compensation insurance company. After an extended period of treatment, he reaches MMI and is given permanent work restrictions. His employer tells him to return to his old job, and the insurance company says it will stop weekly disability benefits since Bubba can return to work. Bubba knows that he cannot perform his old job with his permanent restrictions, and his employer has told him they do not have any other positions. If the employer cannot accommodate Bubba’s restrictions, the North Carolina Industrial Commission will probably decide that Bubba should continue to receive weekly disability benefits and begin a job search to keep receiving them until he can find work within his restrictions.
Future Medical Treatment
When an injured worker reaches MMI, their doctor can provide an assessment of what continued medical treatment they will need, as well as if any other treatment will be required in the future. This is crucial for the injured worker when deciding to settle their case or seek a second opinion. A reliable estimate of future medical treatment is extremely difficult in most cases if the injured worker is still healing.
Example: Susie the Seamstress has reached MMI after suffering a back injury and wants to settle her claim. However, the insurance company is not willing to offer any money for future medical treatment. Susie’s lawyer sends a questionnaire to the doctor, asking if Susie will need more medical treatment in the future. The doctor says she needs to keep taking expensive medication as well as a back brace that will need to be replaced regularly. Now the insurance company knows that it must consider future medical expenses if it wants to settle Susie’s claim.
Injured workers should always look to protect themselves once MMI is reached
Often when settling workers’ compensation cases there are disputes about the appropriate permanent partial impairment rating is appropriate, whether the injured worker has permanent work restrictions, and what future medical treatment an injured worker will require. Sometimes an insurance company will offer to settle a case before MMI so as to simply close out their file, and an injured worker should always be skeptical of such offers. The insurance company and injured worker are always going to have an opinion favorable to themselves when it comes to an injured worker’s permanent partial disability rating, work restrictions, or future medical treatment needs. They will always seek to minimize the impact of an injury or their future responsibility to the injured worker. At MMI the injured worker has more certainty to decide whether to settle their claim, or if they want to get a second opinion.
The experienced workers’ compensation team at The Law Offices of Jason E. Taylor can help guide an injured worker once they reach MMI to help ensure that the injured worker is protected and receives the maximum benefits to which they are entitled under the North Carolina Workers’ Compensation Act.