What Happens to Workers’ Compensation When You Reach MMI?

Maximum Medical Improvement (MMI) is a term frequently used in workers’ compensation cases. It refers to the point where a worker’s injuries will not improve using “generally accepted medical treatment.” The employee’s wellness following the injury is subsequently “as good as it can get,” which typically results in termination of TTD (“temporary total disability”) workers’ compensation benefits.

Once a doctor says a worker has reached MMI, they must inform their company, usually with the support of the doctor treating their injury. Factors that influence whether the employee is healthy enough to return to work include:

• Whether permanent health issues from the injury prevent working at full capacity.
• Whether it is possible to return to pre-injury job requirements.
• Whether the injured employee has permanent work restrictions assigned by the treating physician.
• Whether the injures employee is permanently and totally disabled.

What are the requirements of insurance companies in workers’ compensation?

Until an employee hits the MMI milestone, their employer’s insurance company must cover all reasonable medical costs associated with treatment ordered by the authorized worker’s compensation treating physician. If the employee reaches the MMI but requires ongoing treatment related to their jobsite injury, the insurer pays for it. Examples of worksite injuries that employer insurance companies pay for include:

• Slip and fall injuries
• Falling object-related injuries
• Chemical exposure injuries
• Truck collisions
• Fires and explosions
• Overexertion-related injuries
• Intentional tort (intentional violence by another person)
• Crush-related injuries, such as getting caught between poorly-maintained machines
• Violence from animals on site
• Electrocutions

How to challenge an MMI determination

If an employee and their treating physician disagree with the medical assessment by another appointed doctor, the employee has the right to request a Panel of Four physicians. It is always best to contact a lawyer before issuing the request for a Panel of Four to discuss the pros and cons of making such a request. Challenging the worker’s compensation insurance company and its selected physicians is often a long, confusing process, which can be especially stressful for the employee if they are still recovering from their injury. The legal professional helps the individual take their case to a workers’ compensation judge and explains that the jobsite-related injuries are still severe enough to warrant full medical coverage.

To prove that ongoing, full medical treatment coverage is necessary, the lawyer speaks with the employee’s treating physician and obtains copies of all medical records relating to the accident. These records could make it clear that the recovery process has been slow and that the employee still needs medical care beyond what the employer wants to provide.

For example, say the employee sustained a traumatic brain injury from an unsecured, falling object in the workplace. It was the employer’s job to keep the object secure or at least put up signage indicating a hazardous area to avoid. Because the employer did neither, they owed the employee workers’ compensation benefits. The employee made progress in their recovery, but still experiences bouts of confusion, dizziness, and other traumatic brain injury-related symptoms that make returning to work dangerous. While the employee was having a “good day” at the time of their examination by an insurer-appointed doctor, their ongoing symptoms require more care.

An experienced attorney stresses the ongoing TBI symptom issue and how it would affect the employee’s work performance. For example, if the employee routinely works on heavy machinery or operates heavy machinery, dizzy spells increase the risk of worksite accidents. A dizzy spell could subsequently result in further injuries to the employee, as well as physical harm to other workers. Property damage is another risk that the lawyer will emphasize.

If you have been seriously injured in a work related accident, contact a Huntsville workers’ compensation lawyer as soon as possible. During the initial consultation, the attorney determines how much you have to pay in medical costs after benefits termination, how much additional medical care you require, and whether the injury has left you permanently impaired. Talking to a lawyer about your case can provide invaluable peace of mind during this naturally trying time, which helps you stress less and focus on your wellness.

If now is the right time to contact an attorney, call the office of Martin & Helms. Our workers comp attorneys offer a wide range of practice areas, providing counsel and representation for employees in and around Huntsville, Decatur, Madison, and Athens, and throughout North Alabama. Call us or fill out our contact form to get started with a free consultation.