What is the Maximum Medical Improvement Requirement?

Monday, March 11, 2024

What is the Maximum Medical Improvement Requirement?

Written by Malman Law, reviewed by Steve J. Malman.

When you are injured at work, you turn to workers’ compensation to help cover your medical bills and lost wages. When you are in the process of filing your claim or even collecting benefits, there will be plenty of terms thrown your way. One of those is the maximum medical improvement requirement. This is a very important requirement that can determine a lot when it comes to your workers’ compensation claim. Therefore, you need to consider its meaning and how it affects your future.

What is the Maximum Medical Improvement (MMI)?

The maximum medical improvement (MMI) is one of the biggest issues in workers’ compensation. There are plenty of questions raised by attorneys and even lawmakers regarding this requirement, and the rules are constantly changing here in Illinois. The amount of fair compensation for an injured worker and the decision whether or not to settle for a final amount will come down to the MMI. The question of the degree of total or partial body impairment is only raised once the MMI has been established. Often, the injured worker and his or her treating physicians will be bogged down with numerous exams and paperwork in order to meet the requirements. If the physician or worker does not fully understand the MMI requirements, he or she may find that the case does not settle or settles for an extremely unfair amount.

The MMI is defined as the point at which the worker’s medical condition has stabilized and further improvement is unlikely – meaning that he or she is at maximum improvement and will not improve any further. Despite medical treatment or rehabilitation, the worker is at his or her best and this is when the case must be settled. Just because the worker has reached maximum recovery does not mean that he or she is fully healed. This could include a worker who is permanently disabled and will never fully recover, or even partially disabled and can only work part-time for the rest of his or her life.

Who Determines the Maximum Medical Improvement?

This is a very common concern among injured workers – and should be. Only a licensed physician can determine a patient’s MMI. The treating physician will provide the first MMI date, but it is likely that the insurance carrier for the workers’ compensation benefits will request that its own physician conducts an Independent Medical Examination (IME) to determine if the patient is truly at MMI. A copy of that report is then provided to the worker’s treating physician for review, and to the patient as well. If the physician agrees to the report from the workers’ compensation physician, the total temporary compensation is then terminated on the effective date.

The treating physician does not have to agree with the IME. If he or she disagrees with the IME’s findings, the claim is then forwarded to the commission or a judge for a hearing and determination.

MMIs Are Extremely Important to Your Benefits

The MMI is critical to your benefits. It will determine the benefits and compensation you receive from your workers’ compensation. The MMI is considered the endpoint and determines what long-term effects you will encounter from your workplace accident. It also determines fair compensation. Therefore, if the IME determines that you have an early MMI date, you may find that your benefits are decreased significantly.

Also, after an MMI is established, a worker could still be totally or partially disabled, but return to work depending on what functions he or she still has available. If the person has severe injuries and is permanently unable to work, then he or she can continue to receive benefits indefinitely or until the time limit by the state has been reached.

What Is MMI in Workers Comp?

When a health professional declares you’ve obtained Maximum Medical Improvement(MMI), they believe your condition has improved as much as possible. Suppose you were involved in a slip-and-fall work accident and broke your hip, resulting in limited mobility. In that case, reaching MMI means your limited mobility may not improve. 

Here’s how MMI can affect your workers’ compensation claim.

Permanent Work Restrictions

Returning to work is a top priority for many workers who sustain job-related injuries. Unfortunately, it is not an easy process since it could be months or years before someone is fully healed. 

If you fail to recover fully, a health provider can recommend a permanent work restriction, which remains in place for the rest of an employee’s career. Permanent work restrictions apply when an injury is so severe that a worker is never fully expected to recover.

Examples of work restrictions include:

• Not reaching beyond the shoulder level
• Not engaging in physically demanding activities like bending, squatting, pushing, or carrying
• Not engaging in high-stress or high-anxiety situations

Temporary Work Restrictions

The Illinois workers compensation statutes encouraged employers to return injured workers to their former jobs as much as possible. The law also prohibits employers from terminating injured workers because of their physical condition.

Based on their assessment, a healthcare provider can recommend a temporary work restriction which can remain in place for weeks or months. 

Examples of temporary work restrictions include:

• No lifting more than 25 pounds
• No standing or walking longer than 2 hours
• No kneeling, squatting, or climbing

The physician administering the treatment plan must promptly communicate the work restrictions to the claim administrator. Similarly, an injured worker should immediately present the work restrictions to the employer.

The employer must comply with the safety regulations if an injured employee returns to work with work restrictions. If the employer decides there’s no work available consistent with the limits, the injured worker continues to receive temporary disability benefits.

Termination of Future Payments

Workers’ compensation can terminate your benefits if you have attained maximum medical improvement. If a physician has ruled you fit to return to work, an employer has a legal right to terminate temporary disability benefits.

Most often, the employer will send a notice of termination once you return to work or after filing a petition to modify existing benefits. If an employer files a petition to stop your benefits, you’ll receive a letter describing the action and the justification.

Illinois Workers’ Compensation Act

The Illinois Workers’ Compensation Act compensates workers for 66% of their weekly salary. Maximum medical improvement is important in calculating permanent partial disability (PPD) and permanent total disability (PTD) benefits. The Illinois Workers’ Compensation Commission cannot calculate these benefits until a worker has reached maximum medical improvement (MMI), as indicated by a physician.

For both of these disability categories, a worker must have suffered an injury that has caused them to have a permanent disability. A worker that is permanently injured or disfigured but is able to return to work will receive permanent partial disability, while a worker that has suffered a permanent injury but cannot return to work will receive permanent total disability.

Illinois Workers’ Compensation Commission

According to the Illinois Workers’ Compensation Commission, permanent partial disability is:

1. the complete or partial loss of a part of the body; or
2. the complete or partial loss of use of a part of the body; or
3. the partial loss of use of the body as a whole.

Permanent partial disability is only paid if the injury resulted in some permanent physical impairment or loss. Often in these cases, a worker may take a lower-paying job with lighter tasks. Once a physician determines that a worker has reached MMI, the worker may be compensated for the loss of wages. This calculation is made by subtracting the average weekly wage of the lower-paying job from the average weekly wage of the pre-injury job. The worker will receive 66 2/3% of the wage differential.

On the other hand, permanent total disability is defined as either:

1. the permanent and complete loss of use of both hands, both arms, both feet, both legs, both eyes, or any two such parts; or
2. a complete disability that renders the employee permanently unable to do any kind of work for which there is a reasonably stable employment market.

Once the employee has plateaued in their condition improving, an employee is eligible to receive 66% of their average weekly wage. They are entitled to the benefit for their entire lifetime.

When Can You Receive an Offer After MMI?

Once an authorized medical doctor or a primary health provider determines that no further treatment would improve your injury, they certify that you’ve obtained MMI. An injured victim can receive a settlement 1-2 months after a doctor establishes they can no longer improve.

Despite attaining maximum medical improvement, an injured worker eligibility for:

• Lost wages
• Permanent total disability
• Vocational rehabilitation expenses
• Lump Sum settlement

A physician rates each patient’s recovery based on a particular scale, including temporary partial disability(TPD) or temporary total disability(TTD). You can receive full or partial workers’ compensation benefits based on the rating.

What if My Condition Deteriorates after Reaching MMI?

After a worker is determined to have reached MMI, a physician will need to assign them a partial impairment rating (PIR). This evaluation is performed during an IME. The PIR will determine to what extent the injury caused any impairment. If the impairment rating is below 50 percent, the worker may be eligible to return to work in some capacity.

In order to evaluate whole-person impairment (WPI), a physician will assign percentage points to determine the severity of the injury as it affects the whole body.

MMI means that a physician does not expect your condition to substantially improve with or without treatment.  Your condition could also worsen over time. If so, you should seek further treatment for your condition from a doctor.

It is also important to reach out to a workers’ compensation attorney who can seek a higher settlement amount to account for your future medical needs.

Were You Injured? Speak with a Workers’ Compensation Attorney Right Away

If you have been injured at work, contact a workers’ compensation attorney at Malman Law right away. Our attorneys are here to assess you with the process of filing your claim and also make sure that you receive a fair IME outcome and that your MMI is accurate for fair compensation. Call us now to schedule a free consultation or fill out our online contact form with your legal questions.