Maximum medical improvement (mmi) in a workers comp case impacts awards and medical treatment. The term refers to a legal and medical finding. An injured worker is at mmi medically when his or her physical condition has plateaued. Essentially, a claimant reaches mmi medically speaking when further active medical care will not improve his or her condition or disability. The Board may also make a legal finding that a claimant has reached maximum medical improvement. Such a finding will trigger the Board’s consideration of permanent disability.
Can a claimant reach maximum medical improvement (mmi) in a workers comp case and later have surgery?
Maximum medical improvement does not preclude the possibility of future surgery. Rather, mmi means that the claimant’s medical condition has stabilized. When a claimant is at mmi, he or she has recovered to the greatest extent expected for the time being. The Board does not mandate that a claimant undergo all recommended surgeries before reaching mmi. The timing of surgery is within the claimant’s control. A claimant may defer a recommended surgery to a later time. A change in condition or exacerbation may also re-initiate active treatment.
A common example of a claimant reaching maximum medical improvement while needing future workers comp surgery occurs in the context of arthroscopic surgery. Oftentimes, a claimant will undergo arthroscopic surgery to a joint, such as the knee. The claimant will then undergo post-operative care for several months to a year after surgery. At that time, physicians and/or the Board may find the worker to be at mmi.
Many times, a claimant who has undergone arthroscopic knee surgery will require a knee replacement in the future. In that case, a knee replacement surgery may take place several years or even a decade after an mmi finding was made in a case. The carrier would still be liable for the knee replacement surgery as long the case remains open. The surgery must also be necessary and related to the case. Simply put, an mmi finding does not close the option of future surgery on a workers comp case.
How do I know when maximum medical improvement has been reached?
A legal finding of maximum medical improvement is based on medical evidence and the Workers’ Compensation Guidelines. A claimant must consult with his or her physician to determine whether mmi has been reached. Sometimes, an insurance carrier doctor will find the claimant to be at mmi. It is in the insurance carrier’s interest to have the Board make a legal finding of mmi as early as possible in a case. This is because when mmi is found, medical care is more restricted under the Medical Treatment Guidelines. After the Board has found a claimant to be at mmi, the carrier will contest paying for medical treatment that is beyond palliative care.
Also, a legal finding of mmi can trigger awards and litigation in a workers comp case. As such, an injured worker should always consult with an attorney regarding mmi before requesting such a finding from a physician. For example in some cases, such as when an individual remains out of work for an extended period with injuries only to the extremities, an mmi finding can result in the suspension of benefits. Thus whether a worker should seek a maximum medical improvement finding from his or her workers comp physician depends on both medical and legal factors.