What Is Maximum Medical Improvement?

Where You Need a Lawyer:

(This may not be the same place you live)

At No Cost! 

 What Is Maximum Medical Improvement?

When suing over a personal injury claim, a plaintiff may be awarded money to compensate them for the injury that they suffered. When their lawyer begins negotiating or demanding a specific money amount, that amount may depend on maximum medical improvement (MMI).

Maximum medical improvement is the point where a person’s medical condition or injury stabilizes. No matter how much treatment or the amount of medication prescribed, the injury or condition will not improve beyond that point.

For example, if a pedestrian is hit by a car, they may suffer a spine injury. Their maximum medical improvement may take two years to reach. This means that, in two years, the plaintiff will end their medical treatment and be considered as recovered as they will possibly get.

MMI is one of the most controversial terms in workers’ compensation cases. Injured employees want to get the medical treatment they need for their injuries. They are concerned with their immediate needs and the costs of medical treatment. The extent of their injuries and the impact their injuries have on their job performance may not be apparent right away.

It’s important to report injuries and get medical treatment, even if your injury doesn’t seem significant. Workers must report their injuries to their employer within a certain time frame to obtain worker’s compensation. If they keep working after an injury, they could miss the deadline and risk making their injury worse.

What Does MMI Have to Do with Getting Money for My Injuries?

Negotiations and settlement demands are attempts to reach a financial deal with the other parties in the case. A plaintiff’s lawyer will demand money to financially compensate for any injuries, medical bills, or other losses suffered. A lawyer may wait until the plaintiff reaches her maximum medical improvement to obtain the full financial amount possible.

Another benefit to MMI is reaching a settlement agreement. Once a settlement is reached, the plaintiff will receive money as compensation for economic and non-economic losses. In exchange for the money, the plaintiff promises to drop the current lawsuit and not sue the defendant in the future. This means if the MMI is reached two months or three years after the settlement, the plaintiff must pay any subsequent bills and cannot sue the defendant for reimbursement.

What If I Cannot Wait until I Reach My Maximum Medical Improvement?

If a plaintiff cannot financially afford to wait until they reach their MMI, a lawyer will file the lawsuit as soon as possible.

How Does Workers’ Compensation Work?

Most employers must carry workers’ compensation insurance to protect their employees from injury. When an employee suffers a work-related injury, they file a workers compensation claim to get payment for their medical treatment. Workers compensation also covers a portion of a worker’s missed wages. In return for the insurance, injured employees can’t sue their employer.

Workers’ compensation works well for mild to moderate injuries. More severe injuries typically need more extensive treatment and more time missed from work. Some worker’s never fully recover from their injuries, leaving them unable to return to work and earn an income. Once employees reach MMI, workers compensation provides a payment to cover future missed wages.

What Is a Fair Settlement?

Employers and their insurance companies want to pay injured workers as little as possible. Once MMI is reached, an injured employee must choose between a lump sum settlement or ongoing benefits. If the employee is offered a settlement, they must sign a release and forfeit their rights to any future claims. If the employer is found liable for the employee’s medical treatments for life, they are responsible for the employee’s benefits even after they reach MMI.

Signing a release without legal guidance could result in the loss of medical treatment. Employees have the legal right to challenge a physician’s designation of maximum medical improvement. The laws related to workers’ compensation are complex and challenging to navigate.

Every employee has the right to fair compensation for their work-related injuries. Use LegalMatch to find a workers’ compensation lawyer and schedule a free case evaluation. LegalMatch can help you get the best results from your workers’ compensation claim.

What are Insurer’s Requirements?

Until you reach MMI, an employer’s insurer is required to pay for the recommended medical treatment that the treating provider believes will improve your condition. After you reach MMI, the insurer remains obligated to pay for medical treatment related to the injury, but the treatment available may be more limited. After you reach MMI, an insurer is generally only responsible for paying for “secondary medical services.”

Secondary medical services are treatments that allow you to continue working or help you to maintain MMI. Because the treatment available to you may be restricted once you reach MMI, your physician must exhaust all possible treatment options to make you better.

How Can I Monitor My Progress With a Doctor?

Don’t hesitate to tell your doctor about any ongoing symptoms, treatments that are or are not helpful, how a particular therapy is working for you, and whether you think you have room for improvement. Give yourself the opportunity to heal as best you can. Insurers may try to rush a finding of MMI to limit their liability for medical treatment. Your best protection is open, effective communication with your doctor.

After reaching MMI, you will be entitled to additional medical treatment related to the injury for a limited time. This time is generally 5 years after the date you were injured. Additional medical treatment is geared towards maintaining MMI and helping you to continue working, as opposed to improving your condition.

Additional medical treatment can help you after reaching MMI. The type of treatment provided varies from case to case and can be a source of dispute with insurers. It is important to be your own best advocate. Press the insurer to continue paying for treatment that helps you maintain your physical condition.

Medical Expenses Under Workers’ Compensation

One of the most important benefits of a workers’ compensation claim is the payment of medical expenses needed to heal from an injury. Payment of medical expenses should not be delayed by the insurer. To leave you in the best place possible to successfully move forward after a work-place injury, it’s crucial that you receive all the necessary and appropriate treatment to help you recover.

Once a claim is accepted, the insurer is required to pay for reasonable primary medical services, including prescription drugs for conditions that are a direct result of injury. Primary medical services are those that are necessary to help an injured worker get to maximum medical improvement.

Should I Discuss My Maximum Medical Improvement with an Attorney?

Your MMI and statute of limitations on filing a personal injury lawsuit may conflict. You should ask a personal injury attorney about the stages of a personal injury lawsuit and MMI to understand more about how to proceed.

Don’t ignore the signs and symptoms of a workplace injury. If you’ve sustained an injury at work, use LegalMatch to hire an experienced attorney near you. Your attorney can help you treat with a doctor, who will then determine your MMI status. There is no fee to schedule a consultation.


16 people have successfully posted their cases

Find a Lawyer