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MMI – MAXIMUM MEDICAL IMPROVEMENT – WORKERS COMP

MAXIMUM MEDICAL IMPROVEMENT

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maximum medical improvement

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mmi

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Maximum Medical Improvement- MMI

THIS WEBSITE IS THE PRODUCT OF A WORKERS COMPENSATION ATTORNEY AND IS NOT AFFILIATED WITH  ANY WORKERS COMPENSATION INSURER.  FURTHER IT IS NOT AFFILIATED WITH THE STATE OF MARYLAND NOR ANY GOVERNMENT ENTITY WITHIN THE STATE OF MARYLAND.  Information contained herein is provided for informational purposes and expresses opinions and information best known at the time it was written.  This information and does not create an attorney to client representation.

Maximum Medical Improvement (MMI) is a term regarding the treatment status of a patient.  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 there simply is no other treatment options for the injured worker that particular doctor can offer to them.  In other words maximum medical improvement indicates the patient is at the expected maximum level of improvement current medical treatment can provide them.

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, but only after they have reached a point of maximum medical improvement / MMI.

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 employee maximum medical improvement is described as indicating 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 future medical treatment should the injured worker require so.  Their interpretation directly assists their case in the future should it be believed by the deciding commissioner.  Very rarely is the argument successful that MMI means no treatment is needed at any time in the future.  

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.  The Maryland workers compensation article allows an injured worker to seek permanency after reaching maximum medical improvement while also allowing a re-opending for a worsening of condition.  If MMI meant no treatment at all in the future then the re-opending section of the article would not exist, or the right to an initial permanency would not exist.

When MMI or Maximum Medical Improvement has been reached

As previously indicated, if a patient/claimant is found to be at maximum medical improvement 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.

If the independent Medical Evaluation (IME) indicated MMI

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.

MMI when other treatment options are being recommended

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 maximum medical improvement 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 as it tends to reduce the value of the case, however it is reasonable to turn down certain treatment options because it may not be an ideal time to undergo the particular treatment.  Such is the circumstance when surgery is recommended but summer break or holiday season is approaching.  Electing to be at MMI may not serve to reduce the value of a claim if there is a justifiable reason for turning down treatment.

In some circumstances injured workers may need ongoing, continual, and lifetime medical treatment for an injury.  There is still an option to seek permanency and argue that the injured worker is maximum medical improvement.  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 a patient is not at Maximum Medical Improvement?

    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.

See More:

All About Indepdendent Medical Evaluations (IME)

Getting rated for permanency

Workers Compensation Settlement

Do I need a workers comp attorney?

 

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Summary
Maximum Medical Improvement (MMI)
Article Name
Maximum Medical Improvement (MMI)
Description
MMI or maximum medical improvement must be met before an injured worker can seek permanency money. MMI will lead to an IME scheduled by both the insurance company and the injured workers lawyer. To reach mmi the injured worker must stop medical treatment.
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Work Injury Maryland
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