What is Maximum Medical Improvement (MMI) and How Does It Influence My Workers’ Compensation Benefits in Pennsylvania?

For those hurt at work like many construction workers, nurses, first responders, tradesmen, and others, the thought of navigating the workers' compensation system in Pennsylvania can be daunting. One of the most important concepts to understand when it comes to this is Maximum Medical Improvement (MMI). MMI is a key concept that can influence how much you receive for your workers’ compensation benefits. Let’s dive into what exactly MMI means and how it affects you.

What is Maximum Medical Improvement?

Maximum Medical Improvement (MMI) is a medical term used to describe an injured worker who has recovered as much as they possibly can from their injury or illness. This means that any additional treatment will not provide any more improvement to their condition than what has already been achieved.

Who Determines If I Reach Maximum Medical Improvement?

Only a medical professional can determine if you have reached MMI. The doctor treating your injury may be the one who determines whether you have reached maximum medical improvement.

The workers’ compensation insurance carrier may set up an appointment for you with one of their doctors commonly referenced as an independent medical exam. An independent medical examination may answer the same questions that your treating doctor addressed:

• Have you reached MMI?
• When did you reach MMI?
• Are there additional treatments or medical care that you should pursue?
• What is your impairment rating? (Explained below.)

The independent medical examination doctor provides a second opinion to the insurance company about whether you should investigate other potential medical care or treatment.

Additionally, you may also get an opinion from a third-party doctor as well.

What Happens When I Reach Maximum Medical Improvement and What Does an Impairment Rating Evaluation Have to Do with It?

When an injured worker receives workers’ compensation benefits for 104 weeks, the workers’ compensation insurance carrier may want to get a medical impairment rating evaluation to verify the extent of the worker’s injury or injuries. It determines what percentage or degree of impairment they may have under The American Medical Associations’ Guides to Evaluation of permanent Impairments. The impairment rating is determined by assessing the loss of physical function based on AMA guidelines. If you have not reached maximum medical improvement at this time, then the insurance carrier generally is not entitled to an exam for an impairment rating evaluation. Reaching MMI is essential for the performance of an impairment rating evaluation in Pennsylvania.

What happens after the impairment rating evaluation? If it is determined that you have an impairment rating of less than 35%, then your wage loss payment benefits will be labeled ‘partial disability’ and capped at a maximum of 500 weeks. Within that 500-week time frame, you can petition to stop the cap and change the label back to temporary total disability benefits if you can prove you have an impairment rating of 35% or more under the AMA guidelines.

When medical professionals determine that you reached maximum medical improvement, the workers compensation insurance carrier may have an interest in settling or closing out your case. You may be offered a:

• Lump-sum Settlement. You will receive a one-time payment as a settlement in return for releasing your employer and their insurance company from paying any future workers’ compensation benefits for either lost wages and/or medical bills. After you sign a release, typically you will not receive any further funds even if your injury grows worse. 

OR 

• Structured Settlement. A structured settlement is where instead of receiving one lump sum payments are structured to be paid in varying amounts at different times. There are numerous ways to structure a settlement. You will receive payments on a schedule that you and the insurance company have agreed on.

Under Pennsylvania law, there is generally speaking no limit on how long an injured employee can receive total disability payments.

What Do I Do if My Doctor and the Employer’s Insurance Company’s Independent Medical Examiner Disagree on My Maximum Medical Improvement?

Remember, this is often a two-step process. If your doctor and the independent medical examiner from your employer’s insurance company do not agree on whether you’ve reached maximum medical improvement, you DO NOT have to accept the determination of the insurance company’s doctor. Likewise, if the workers’ compensation insurance carrier’s doctor rates you less than 35%, you and your doctor may not agree on the percentage of rating of impairment. We can help you negotiate your future benefits.

Even if your doctor and the insurance company’s doctor agree that you reached maximum medical improvement, you and/or your doctor may not agree with the percentage of impairment rating. We are still here to help you prevent any attack on your benefits. If you choose, we’ll help you reach a settlement with your employer’s workers’ compensation insurance company.

Is the Employer’s Insurance Company’s Independent Medical Examiner the Same as an Employer Identified Doctor or Panel Doctor?

Not exactly. Under the Pennsylvania Workman’s Comp Act, employers do have a say in the health care providers injured employees can use. You can read more on this here: What to Know About Employer’s Identified or Panel Doctors in Pennsylvania Workers’ Compensation Claims.

We Fight for the Check You Deserve When You’re Hurt at Work

Maximum medical improvement (MMI) and impairment rating evaluations (IRE) plays an important role in Pennsylvania workers’ compensation law. If you were injured at work and are currently receiving workers’ compensation benefits, understanding what MMI and IREs are and how they affect your claim can help you make sure that you get all the benefits you are entitled to under state law.

If you or a loved one was hurt at work, contact us. Mitch Dugan and his highly skilled and experienced workers’ compensation lawyers at Dugan & Associates will work vigorously to pursue fair and just compensation for loss of earnings, medical expenses, and damages. Consultations are free. If there is not a recovery of compensation, there is also no fee. Contact us today online below or by telephone at 412-353-3572.