At some point in your work comp claim, you will almost certainly receive a letter or notice from the insurance company advising you that you have reached Maximum Medical Improvement (MMI). After receiving such a notice, these are some of the questions you may have:
What is MMI?
Will it have an effect on my benefits?
Can I dispute a finding of MMI?
What is Maximum Medical Improvement (MMI)? The concept of MMI was added to Minnesota work comp law in 1984. It applies only to injuries which occur on or after October 1, 1984, which basically means pretty much all claims that are ongoing these days. The most recent definition contained in the work comp statutes (subdivision 13a.) states:
“Maximum medical improvement” means the date after which no further significant recovery from or significant lasting improvement to a personal injury can reasonably be anticipated, based upon reasonable medical probability, irrespective and regardless of subjective complaints of pain.”
Simply put, it means that you are not expected to get any better, even though you may have ongoing pain or work restrictions related to your injury. If there are no additional treatment recommendations, no pending surgeries and no reasonable expectation of significant improvement, then you have probably reached MMI. The fact that you may get worse does not mean you haven’t reached MMI.
What effect will a finding of MMI have on your work comp benefits? The most direct affect will be on your receipt of weekly wage loss benefits, specifically, Temporary Total Disability benefits (TTD). The law provides that TTD benefits will cease 90 days after you have been provided with notice of MMI. “Notice” means that the insurance company must provide you with a written report or documentation of MMI. Typically, this means that the insurance company mails you a copy of a medical note or report which gives the opinion that you have reached MMI. This opinion can come from your own physician or from a doctor which the insurance company sends you to for an Independent Medical Exam (IME).
Can my TTD benefits be discontinued based upon MMI even if I remain out of work and still have restrictions? Unfortunately, yes.
Does a finding of MMI affect my temporary partial disability benefits (TPD)? No. If you still have restrictions from the work injury and are working but earning less than your pre-injury wage, a finding of MMI does not affect your partial wage loss benefits.
Will a finding of MMI affect my entitlement to ongoing medical care for the work injury? Technically no, but some insurance companies will take the position that if you have reached MMI you don’t need any additional medical care. You may need to hire a lawyer or fight with the insurance company for payment of additional medical bills or authorization for medical care.
Can I dispute or fight a finding of MMI? Yes you can. If an insurance company doctor says you have reached MMI but your treating physician disagrees, you may have a good chance at a hearing to overturn the MMI finding. The insurance company doctor will almost always give the insurance company the opinion they want (and are paying for) but it isn’t always consistent with the medical evidence or the opinions of your treating doctor. If you are fortunate enough to have a treating doctor who is supportive of your claim and willing to write a report, you have a very good chance of winning at a hearing. That’s why it’s very important to choose your physician carefully when you have a work comp claim.
The concept of MMI can be confusing and can have a significant impact on your work comp claim. It is important to know that you have the right to contest an MMI finding and to fight the insurance company if you disagree with any determination they make on your claim. It’s a good idea to consult an experienced work comp attorney anytime the issue of MMI arises on your claim. Most attorneys will be happy to provide you with information or a free consultation about your claim and whether you need legal assistance. At Bradt Law Offices, we have been providing work comp help to injured workers throughout northern Minnesota for 30 years. Please feel free to contact us at any time with questions about your claim or the work comp system. Your initial consultation is always free and you will always get an honest opinion about your case and whether you need a lawyer.
Thank you for visiting our blog and please read through some of our other blog posts for more information on a variety of work comp topics.