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