What does it mean to reach maximum medical improvement?

On Behalf of | Feb 23, 2024 | Workers' Compensation

When someone gets hurt at work, they may require time off to heal. Medical treatment may also necessary for a full recovery. The Pennsylvania workers’ compensation program provides medical benefits that can pay for the cost of medically necessary treatment.

Whether someone requires surgery, physical therapy or medication, workers’ compensation can fully pay for all of those treatment requirements. If someone’s symptoms affect their ability to work, they may also qualify for disability benefits. Those benefits can replace their wages while they take a leave of absence or augment their pay if they have to take a job that pays less than their usual position.

Most workers fully recover from injuries on the job and get back to work as soon as possible. Unfortunately, a small minority of injured workers may have permanent symptoms. Their benefits may change when they achieve maximum medical improvement (MMI).

What does it mean to reach maximum medical improvement?

A determination that someone has achieved MMI is a reflection of How likely someone is to respond positively to additional interventions. If a physician believes that someone’s condition is stable and unlikely to substantially improve with additional treatment, they may assert that that worker has reached MMI.

Typically, a doctor sends notice to an employer and an insurance provider about the patient’s progress. A report indicating that someone has reached MMI can affect the benefits that they receive. In most cases, workers’ compensation does not continue paying for medical treatments when a worker is no longer reasonably likely to improve after receiving that care. Still, workers’ compensation can continue to pay for treatments that manage someone’s symptoms.

Achieving MMI can also affect someone’s disability benefits. A doctor declaring that someone is unlikely to improve in the future might force that worker to consider changing positions at a company or professions entirely. If they cannot return to work at all, they may qualify for permanent total disability benefits. Other times, permanent partial disability benefits could help them reduce the financial impact that their health challenges have on their household finances.

Occasionally, workers may question the determination that they have achieved MMI and might need assistance appealing that decision. Seeking legal guidance is a good way to get started.