Maximum Medical Improvement and Its Effects on Your Compensation

If you have been injured and are receiving treatment, you may hear your doctor mention “maximum medical improvement” (MMI). But what does it actually mean?

In some ways, maximum medical improvement could mean a full recovery. Other times, it is not.

MMI is the point where your doctor believes your condition has improved as much as it possibly can. So, you have recovered; however, you may still deal with lingering symptoms or have limitations on what you can do daily.

Keep reading to learn more about MMI and how it can affect your compensation.

What Is Maximum Medical Improvement?

MMI is a stage where your injuries have stabilized and will unlikely get better even with further treatment. Some people might fully recover from the injuries, while others may have long-term disabilities.

When you reach MMI, your doctors may advise you that additional treatment would not make a difference. Your condition is now classified as “stable and stationary,” a common term used in processing claims.

How Long Does It Take to Reach Maximum Medical Improvement?

The time it takes to achieve MMI varies. It may take you months to reach it, or if you have a more serious injury, it may take years. It mostly depends on your injury, the type of treatment you need, and how well you respond to the treatment.

Your doctor will treat you according to established medical guidelines. Depending on how severe your condition is, treatment may include the following:

• Acute care and stabilization. You receive immediate treatment as soon as you sustain injuries. It aims to stabilize your condition and prevent further harm.
• Surgery. Your doctor may perform surgery to restore your body’s normal function if necessary.
• Physical therapy. It helps you regain movement and strength through physical exercise.

If your recovery stops improving even with continued care, you have likely reached MMI. 

What Happens After Reaching Maximum Medical Improvement?

After reaching MMI, your insurer may stop covering certain treatments, except for necessary ongoing care related to the injury. If the injury affects your mobility, then a permanent disability settlement will cover medical expenses related to the disability.

If you are able to go back to work after recovering, you may undergo a Functional Capacity Evaluation (FCE) to assess whether or not you can resume your job responsibilities. 

Usually, individuals with permanent impairments get assessed to determine their eligibility for permanent disability benefits. The calculations for determining the benefits rely on how severe the injury is and how much you were earning before being injured.

The Process for Obtaining Permanent Partial Disability

If you have achieved MMI, you may apply for Permanent Partial Disability benefits. Choosing to file for permanent disability benefits will require you to undergo a medical examination to evaluate your disability level.

Your permanent partial disability award depends on the impairment rating the medical examiner assigns you during the appointment. You have up to 20 days to contest the examiner’s assessment. If you request a higher disability impairment rating, you will have to undergo another examination. 

What Happens If You Haven’t Reached Maximum Medical Improvement Within the Statute Period?

Your insurer will undervalue your claim if you file it before reaching MMI status. That is because they might not consider future medical expenses. 

On the flip side, your case will be dismissed if you do not file the claim within the statute period, even if you haven’t yet reached MMI status. 

For that reason, you should file your claim on time to get the compensation you deserve.

How Long Will Your Claim Take After Reaching Maximum Medical Improvement? 

You should get a lawyer who prepares in advance and consistently pressures the insurer to move your claim forward. After you reach MMI, your lawyer should immediately get the necessary medical reports to push your claim toward a compulsory settlement conference.

How the Process Works

• Insurance companies, especially in motor vehicle claims, tend to delay settlements. Your lawyer must pressure them to obtain their own reports and file court applications to keep the process moving.
• Many jurisdictions require claims to move to a compulsory settlement conference as quickly as possible. In Pennsylvania, the conference typically happens several weeks to a few months before trial. It is a formal meeting between the parties to negotiate a settlement. If you have not reached a settlement at this stage, then the claim moves to court.

Expected Timelines

• Once you have reached MMI, a compulsory conference should occur within two to three months, provided your lawyer is proactive.
• If the claim does not settle after the conference, it can be filed in court, where the process typically moves to a mediation conference before a possible court hearing. A mediation conference brings disputing parties together with a neutral mediator to help them reach an agreement. The entire process could take about six to nine months.

What Maximum Medical Improvement Means for Your Future

Reaching MMI is a major achievement in your recovery process. It means that you have fully recovered from an injury. It could also mean that you need to learn how to live with the disabilities caused by the injuries. 

By understanding MMI, you can make well-informed decisions about your healthcare options and legal matters.

Frequently Asked Questions

Can I Continue Receiving Medical Treatment After Having an MMI Status?

Yes. You may still receive treatment for pain management, therapy, or maintenance care after reaching MMI. However, your insurance may not cover some of these treatments.

Can I Disagree With the MMI Report in Pennsylvania?

Yes. Under Pennsylvania Workers Compensation Law, you have a right to disagree with your MMI report. You can always seek a second opinion if you believe that you have not reached MMI.

How Does an MMI Status Affect My Settlement or Benefits?

When you reach MMI, your doctor may give you a permanent impairment rating. This rating may affect your settlement amount. The higher the rating, the greater the compensation you may receive.

Can I Work While Recovering?

Your doctor will give you a medical report showing the kind of work you can or cannot do while recovering.