Many employees find the workers’ compensation system confusing. They know that there are systems in place to protect them, but they have limited information about those benefits. Workers may be unsure of when they become eligible and how to obtain benefits.
There are so many specialized terms and jargon during a workers’ compensation claim that even talking about benefits can quickly become confusing. One of the terms that frequently comes up in scenarios involving significant injuries or long-term illnesses is maximum medical improvement (MMI).
What is MMI, and what impact does it have on workers’ compensation benefits?
MMI relates to treatment efficacy and a worker’s prognosis
A medical doctor oversees much of the workers’ compensation process. They diagnose the injured professional, develop a treatment plan and determine when they may be ready to return to their employment.
In some cases, workers can make a full recovery. Other times, they may have persistent symptoms even after completing treatment. In a situation where a condition is unlikely to fully resolve, a physician may eventually determine that the patient has stopped responding to treatment.
At that point, the doctor may declare that the patient has achieved MMI. Their lack of response to treatment means that medical benefits for ongoing treatment may end. Medical benefits for symptom management may still be available, but workers’ compensation doesn’t pay for treatment that is unlikely to yield any significant impact on the employee’s recovery.
A designation of MMI generally means that a worker must accept their ongoing symptoms because the doctor does not believe they are likely to make a full recovery. In cases where the doctor may have made an incorrect assumption about a worker’s prognosis, they may be able to appeal the designation of MMI or the treatment plan that hasn’t worked for them.
If the worker agrees with the determination, they may need different forms of support. The worker may have to request a list of restrictions or necessary accommodations for when they return to work. In some cases, they may be eligible for permanent partial disability benefits if they cannot maintain the same job they previously held or permanent total disability benefits if they cannot continue working.
Learning more about the rules that apply during workers’ compensation claims can help people get the benefits they need. Workers who reach MMI may need help securing disability benefits and accommodations from their employers. They may also need to learn about their rights, including the right to appeal an unfavorable determination that can impact the benefits they receive, and that’s okay.