The term Maximum Medical Improvement (MMI) represents one of the most confusing concepts involved in a workers’ compensation case. It raises a variety of questions concerning the continuation of medical treatment, temporary compensation benefits and fair compensation for permanent impairment.
From a legal standpoint, MMI triggers several events. One thing it triggers is the doctor referring you for a functional capacity evaluation in order to assign you permanent work restrictions and an impairment rating. This is also the time where you may be inclined to settle your workers’ compensation case for a lump sum payment.
MMI is the point where your doctors believe that you have recovered from your injuries as much as you are going to and that continued medical treatment will result in no further improvement in your condition.
This doesn’t mean that you are as good as you were before the accident. It simply means the doctors feel that there is nothing else they can do for you and that they don’t expect you to improve any further. In other words, you are as good as you are going to get.
Sometimes, you can have more than one part of your body that was injured in the accident. The law says that you are only at MMI when every one of your injuries has reached MMI. For example, if you were in an accident where you broke your leg and hurt your back, you are not at MMI until the doctors have done as much as they can for both of these injuries.
MMI is a really a big deal to your workers’ compensation case because it signifies the beginning of the end of your claim. Selection of this date is very important because this is the date that your temporary benefits end and, if you receive an impairment rating, your impairment benefits begins.
Temporary benefits are what you receive because you can’t go to work, while impairment benefits are what you receive because you are permanently impaired as a result of the injury. These are two different benefits and sometimes they are two different amounts. In fact, the impairment benefits are often substantially less than your temporary benefits.
You may still be entitled to receive medical benefits after you reach MMI if you can prove that you will need additional care to relieve symptoms or to prevent your condition from getting worse. This is generally referred to as maintenance care.
The most common form of maintenance care is medication. But, it doesn’t have to medication. It can be injections, chiropractic treatments, physical therapy or other types of medical treatment. However, it must be understood that just because your medical benefits stay open after MMI, it’s not a guarantee that workers’ compensation will pay for whatever treatment you want.
Even if they agree to keep your medical benefits open, they still have the right to require that any treatment you receive be reasonable, necessary and related to your injury. And even if they have paid for a particular treatment for several years, they can still question whether the treatment is reasonable, necessary and related to your injury at any time.
When you reach MMI, you will then need to be assessed for any permanent impairment. If you still have any ongoing problems when you reach MMI, these will be considered permanent because medically, there is nothing more that can be done to improve these problems. So, an impairment rating is a measure of the permanent damage your body has sustained as a result of the injury.
Any additional compensation you receive after you have reached MMI will be based on your impairment rating, and in most cases, you will end up with Permanent Partial Benefits based on whatever impairment rating the doctors give you. But in some cases, where you are considered totally and permanently disabled and unable to return to any type of gainful employment, you will receive Permanent Total Benefits based on your average weekly wages.
Mistakes can be made in the selection of your MMI date and/or the determination of your impairment rating. If you are being treated by a company doctor who is working on behalf of your company, they will sometimes give you a lower impairment rating or a premature MMI date which can cost a considerable amount in compensation. So, it’s very important that you have these things reviewed by someone who knows what to look for.
Your MMI Date
The selection of your MMI date is important because it changes the type of benefits you will receive under workers’ compensation. If the doctor chooses a date that is not correct, it can cost you a significant amount in benefits that you would otherwise be entitled to receive. Furthermore, if you have treatment such as a surgery scheduled and your doctor puts you on MMI, you may not be able to go forward with the treatment. So you need to make sure that your MMI date is correct.
Your Impairment Rating
An impairment rating is a mix of both subjective and objective criteria, and because of this, there is a lot of room for error. But, if there is an error made in your impairment rating, you can lose a lot of money in compensation.
The difference between a 5% and a 10% impairment rating can result in a significant loss in compensation. This difference can be even more significant when you consider the future benefits that may be available. So, you will need someone to review your impairment rating so that you don’t miss out on benefits that you might otherwise be entitled to.
If you believe that your MMI date or your impairment rating is incorrect, it has to be disputed or you can lose a significant amount in benefits. In New Jersey, you only have two years to file a dispute. If you don’t file within this two year period of time, you will lose the opportunity to dispute these issues and they will become final.
The three biggest events in a workers’ compensation claim are 1) you getting injured, 2) reaching MMI and 3) certification of your impairment rating. If you do not achieve MMI, your workers’ compensation case can theoretically remain open forever. This means, that you won’t get your impairment rating and cannot settle your case.
Therefore, if you have been seriously injured on the job, you should allow an experienced workers’ compensation lawyer to review your claim and ensure that you are not losing any of the benefits that you are entitled to receive under New Jersey Workers’ Compensation Law.