Once you reach maximum medical improvement (MMI), the insurance company is going to make determinations about what benefits you may be able to receive in the future. Read on to learn more about the rules around MMI and workers’ comp,
Like anything else in the workers comp process, you can always dispute the insurance company’s findings as part of your appeal.
Rosenfeld Injury Lawyers can guide you through the process of reaching MMI while receiving workers’ compensation benefits.
What Is MMI?
MMI stands for maximum medical improvement. Maximum medical improvement is when your condition will not get better, even with further medical treatment. Presumably, you have recovered from your injuries somewhat, or you may never recover.
This is a critical juncture of any workers’ compensation case, as it determines your future eligibility to receive benefits.
Maximum Medical Improvement and Workers’ Compensation
When you have filed a workers’ compensation claim, the rule is that you will qualify for benefits as long as you cannot work. If you can return to work, workers comp would still pay for the medical care necessary to treat your injuries.
Reaching maximum medical improvement is a milestone in your workers’ compensation case as it determines your future legibility for benefits. Before then, you can receive benefits for a temporary partial disability or a temporary total disability.
How Does MMI Impact Workers’ Compensation Benefits
Essentially, maximum medical improvement is the dividing point between receiving temporary workers’ compensation benefits and potentially receiving permanent benefits. The medical findings when you reach MMI can also determine the extent of your permanent disability and how much compensation you may be able to receive as part of a workers’ compensation settlement.
How Long Before an Injured Worker Reaches MMI?
The point of maximum medical improvement depends on the extent of your injury. For example, if you have suffered a sprain, you may reach maximum medical improvement in a matter of months, and eventually fully recover from this type of injury.
However, other injuries may require more extensive treatment before you reach the point of MMI. For example, if you have suffered a head or brain injury, you may not know for a long time that you would not improve with further treatment. It could take more than a year of rehabilitation and therapy before you know how much function you may regain.
Who Determines Maximum Medical Improvement?
Once you have reached maximum medical improvement, the insurance company may ask you to attend an independent medical examination (IME). While this examination is called independent, in reality, it is anything but.
The physician who conducts the IME is being paid by the insurance company. IMEs are a relatively lucrative business for doctors. The fee for an IME can be thousands of dollars. The physician does not want to anger the insurance company by consistently giving an opinion that will cost the insurance carrier more money.
What to Expect During the Independent Medical Examination
It is vital that you prepare ahead of time for an independent medical examination so you are not caught off guard, and you are able to speak with the doctor confidently.
The doctor administering your exam will be paying very close attention to what you say. They may ask you a number of questions designed to gauge your condition. You should answer these questions honestly because being untruthful may affect your future benefits. However, you must also be careful to answer only the questions that were asked of you.
Do not try to convince the doctor of your injuries. They will stick closely to the objective results of your test. Trying to embellish your injuries or convince them that you have a significant disability will not usually go well for you.
What if My Treating Physician Disagrees?
In a workers comp claim, the doctor who is administering the IME will reach their own conclusion about your condition and the possible need for ongoing medical care. However, they do not get the only say in your disability rating. Your treating physician may also get their say in the process if they have a different opinion about your condition.
In the end, if you disagree with the disability rating that you have been given as a result of the IME, you can always appeal the finding to the Illinois Workers Compensation Commission. They would consider the opinion of your treating physician in deciding matters relating to your permanent disability benefits.
Can You Dispute Reaching Maximum Medical Improvement?
Like everything in the workers’ compensation process, you can dispute the determination that you have reached MMI.
The insurance company may want to rush this determination because they want to close your claim and get you off their rolls to the fullest extent possible. They do not want to pay the medical bills relating to your injury. However, you may still be able to make further recovery with additional treatment.
If your future benefits and your disability rating depend on a determination that you have reached MMI, you can also dispute that in an appeal to the Illinois Workers Compensation Commission
How a Lawyer Can Help
Workers’ compensation attorneys can help you contest any finding that does not account for the full extent of your disability. Workers’ compensation law allows you to appeal an adverse decision and get a decision from an objective Administrative Law Judge.
Contact the team at Rosenfeld Injury Lawyers at (888) 424-5757. We can discuss your case during an initial consultation for free, and work for you on a contingency basis, meaning that we will not ask you to pay us anything upfront.
