Maximum Medical Improvement in Maryland workers compensation cases
Maximum Medical Improvement (MMI) is a term regarding the status of treatment a patient or workers comp claimant has reached. When a patient is at mmi they have, according to that particular doctor, reached a plateau in treatment. They are no longer benefiting from treatment and/or there simply is no other treatment options for the injured worker.
For many injured workers being told they are at maximum medical improvement is quite troubling. Having to deal with pain knowing it will likely not improve because there are no treatment options can be a difficult fact to accept. If a person continues to have pain, limitations or problems related to a work injury then they are entitled to compensation in the form of settlement or permanency.
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What does Maximum Medical Improvement mean for my Maryland workmans comp case?
When a patient has reached MMI it has essentially been determined there is no medical necessity for further treatment at that time or in the foreseeable future. However, when you ask a defense attorney and a injured workers attorney this question you usually get different answers. It is quite common for the defense attorney to indicate that a finding of maximum medical improvement means there is no need for treatment at the time of mmi, in the foreseeable future, or at anytime in the future. When asking a workmans comp attorney representing the injured employees the answer usually indicates that there is no need for treatment now in the foreseeable future, however the need for treatment may arise at sometime unknown to all parties.
The distinction in interpretations of maximum medical improvement directly impacts the future of the injured workers case. If, as the defense attorney argues, mmi were too truly mean no future treatment at all then the claim would come to an end at every permanency hearing. Leading to the inability to reopen a case for worsening. Their interpretation directly assists their case in the future should it be believed by the deciding commissioner. Very rarely does is win.
Like the defense attorney interpretation, the claimants’ attorney’s interpretation of maximum medical improvement is also self serving. Arguing that there is a possibility for future treatment is posturing the case for a reopening if and when the injured worker needs future treatment.
As previously indicated, if a patient/claimant is found to be at mmi by their treating physician then the case can be moved to settlement or permanency. It is very difficult if not impossible to argue for continued treatment if no doctor is indicated treatment is needed and the injured worker is at MMI. Most often this means that the employee can be rated and prepare to go to a permanency hearing. The distinction between settlement and permanency is that the injured worker will be able to reopen their case for future treatment if they worsen. If a case is settled usually there is no reopening option.
In many circumstances it is not the treating doctor indicating the injured worker is at MMI but it is an Independent Medical Evaluator (IME) that is indicated maximum medical improvement. When an IME is scheduled by workmans comp they usually ask the IME doctor to indicate if the injured worker is at mmi. For more reading about IME’s go here. In the event an IME doctor indicates the patient is at maximum medical improvement the patient/injured worker may not necessarily have to stop getting treatment. As long as there is a doctor indicated treatment is needed and the treatment needed is related to the work injury than there is a chance to get further medical attention. In this scenario the injured worker should find a qualified and experienced workmans comp attorney to represent them as a hearing before the Commission will be needed.
If a hearing is held before the Commission and the Commission finds that the injured worker is at maximum medical improvement then the case must be moved to permanency and treatment will no longer be paid for by the workers comp insurer. The injured worker does however retain the right to reopen their case for worsening even if the Commission finds mmi.
Am I considered to be at Maximum Medical Improvement according to Maryland workmans comp laws?
In addition to a physician indicating that the injured worker is at maximum medical improvement the injured worker can essentially place him or herself at mmi. This can be done by simply stating that treatment is no longer wanted. When treatment is being recommended but the injured worker does not want the treatment then this may have an impact on the value of the claim. The surest way to indicate mmi is by the injured worker indicating they do not want any further treatment and prefer to move forward with permanency or settlement. Note this is not ordinarily a good idea.
In some circumstances injured workers may need ongoing, continual, and lifetime medical treatment for an injury. Consider pain management which may require a visit to the doctor every month for life or the back or neck injury that may require annual physical therapy. In these cases it must be determined if the treatment being provided is palliative in nature or if the treatment provided is for the purposes of improving symptoms. The most notable distinction in these forms of treatment is that palliative treatment seems to be for the purpose of maintaining a status quo.
What may indicate that I am not at Maximum Medical Improvement under Maryland workmans comp laws?
- A treating physician is indicating that there is a need for future treatment. This may include an opinion from a primary care doctor, orthopedic, internist, physical therapist, or other doctors.
- The IME indicates that there may be a need for treatment. Occasionally a treating physician indicates mmi while an IME doctor indicates that future treatment is needed.
- The injured worker is going to seek more treatment in the near future. Even if a treating doctor indicates the claimant to be at mmi, if the injured worker plans to see another doctor, or seek additional treatment through someone other than the doctor indicating mmi then it can be argued that maximum medical improvement has not yet been reached.
- There are follow up appointments schedule with a physician.
- The injured worker is obtaining treatment through their health insurance policy rather than through workers comp insurance. If treatment is being obtained through health insurance than the causal relationship of that treatment must first be decided before seeking a mmi finding.