A workplace injury can affect you physically and financially. Getting back on your feet means focusing on your recovery and ensuring you get the benefits you deserve while missing work. However, at some point in your benefits workers’ compensation case, you may hear the term Maximum Medical Improvement. Reaching maximum medical improvement workers’ comp means your condition has stabilized and isn’t expected to improve. This can significantly affect the type and amount of benefits you continue to receive.
Many people unfamiliar with the workings of the New York workers’ compensation program don’t understand what it means to reach MMI or how that status affects their claims and benefits. Understanding what MMI means, how it’s determined, and why it matters to your financial recovery and future care can help you make more informed decisions about your next steps after a workplace injury.
What Is Maximum Medical Improvement (MMI)?
The phrase maximum medical improvement can be confusing. Many people assume it means they have fully healed or recovered from a work-related injury. However, maximum medical improvement is a medical opinion from a healthcare provider that an individual has recovered. From a work-related injury to the greatest extent possible, or has hit a point in recovery where no further changes to their condition are expected. It is used in the New York workers’ compensation system coverage.
Maximum medical improvement does not necessarily mean that someone is fully healed and back to their pre-injury condition. It means that a person’s recovery has stabilized. Hit the point where further medical treatment and recovery are unlikely to improve the condition. An individual with a permanently disabling injury can reach MMI, meaning their condition cannot dramatically improve with further medical intervention.
Depending on the severity of the work injury, hitting MMI can mean a healthcare professional issues a medical release to work with or without restrictions and modifications to job duties or a shift in which an injured worker may be entitled to receive benefits.
Can You Still Get Workers’ Comp Benefits After MMI?
Injured workers must understand that they can still get New York workers’ compensation benefits after a doctor determines they’ve reached maximum medical improvement. However, those benefits may change depending on the nature of a person’s injuries and how they impact their life and ability to return to work, because hitting the MMI milestone can change workers’ compensation insurance obligations.
Schedule Loss of Use Benefits
Some injured workers who reach MMI may be eligible for schedule loss of use benefits if their injury caused a permanent functional impairment or disability. An SLU award is a cash benefit that helps pay for a person’s wage-earning capacity loss due to a serious workplace injury. The Workers’ Compensation Board determines SLU benefits. These benefits are generally extended to individuals with injuries that permanently impair the function of the following:
- Fingers
- Hand
- Arm
- Toes
- Foot
- Leg
- Eyesight, as in vision loss
- Hearing, as in hearing loss
- Disfigurement/Scarring, typically of the face and neck
In New York, to be eligible for SLU, an individual must suffer the permanent loss of function of an injured body part, and a healthcare provider must submit a medical report following the current state’s Permanent Impairment Guidelines that finds that the individual has reached maximum medical improvement.
Suppose the workers’ compensation insurer agrees with the healthcare provider’s findings. In that case, an SLU percentage is assigned to calculate the number of weeks of benefits the injured worker is entitled to. If the insurer does not agree with the findings in the medical report, they may request an additional opinion from an independent medical examiner.
Please read more about compensation medical leave here: What to Do if You Are Fired on Workers’ Compensation Medical Leave
The amount of an SLU award depends on several factors, including the location of the injury, the percentage of loss of function, and the worker’s average weekly wage.
Non-scheduled Loss of Use Benefits in maximum medical improvement workers’ comp
Non-scheduled awards are for permanent disability involving a body part that SLU does not cover. These are permanent disabilities that fall under the non-scheduled classification and may affect body parts such as:
- Brain
- Heart
- Lungs
- Spine
- Pelvis
Non-scheduled benefits are based on permanently losing a person’s earning capacity.
How MMI Affects Settlements and Future Care
Reaching Maximum Medical Improvement can be a significant turning point in a workers’ compensation claim. Reaching this status shifts the focus of the claim to re-employment and settlement rather than treatment.
Once an individual reaches MMI, the extent of covered medical care may change. While a person may still qualify for medical care related to their workplace injury, treatments focus on medically required ongoing care or maintenance, such as follow-up visits, pain management, or maintenance medications. This care must be deemed medically necessary.
Reaching MMI can also trigger settlement discussions. An employer or insurer may attempt to make a settlement offer to an injured worker. That settlement can include compensation for medical expenses and lost wages. However, by accepting a settlement, the injured worker generally gives up the right to seek additional compensation for their injuries.
A settlement may seem like an excellent idea because it is a relatively quick influx of money that can help them stabilize their immediate financial situation. The drawback of accepting a speedy settlement is that it may not be enough. Most initial settlement offers are lowball offers meant to save an employer or insurer money.
They potentially shortchange the injured individual. It is always in a person’s best interest to speak to an experienced New York workers’ compensation attorney before accepting any settlement offer and signing away your legal rights, especially after reaching maximum medical improvement in workers’ comp, when insurers may push for a quick settlement that doesn’t reflect your long-term needs.
Talk to a New York Workers’ Compensation Attorney About Your Claim
Hitting the maximum medical improvement threshold can significantly change your situation. At Fusco, Brandenstein & Rada, P.C., our experienced New York workers’ compensation attorneys can help you manage your workers’ compensation with our team to claim from start to finish, from filing an initial claim to battling denials for SLU and non-schedule awards and negotiating a fair settlement for your injuries.
Don’t wait for the process to play out before you seek the help you need. Contact our office online or call us at 516-496-0400 and request a free consultation to discuss the specifics of your situation and how we can help you maximize your workers’ compensation benefits.