MMI: What Does It Mean and When Is it Determined?

Every state provides for “workers’ compensation,” otherwise known as “worker’s comp” or “workers’ comp insurance” for workers who are injured on the job. Workers’ comp insurance works like this: employees who suffer work-related injuries or illnesses receive workers’ comp benefits for things like medical expenses and lost wages. 

The trade-off is that these workers’ comp benefits are the sole remedy for these employees. In most cases, they cannot sue their employer for these injuries, even if the employer was at fault. 

If you have been injured on the job in Pennsylvania, let a Lancaster workplace accident attorney help you with this important decision process.

What Does “MMI” Mean?

MMI, or Maximum Medical Improvement, is the point at which your doctor believes that your condition has improved as much as it ever will. You may be healed, or it may mean that your medical condition will not change in any meaningful way in the future. Your treating doctor is the one who determines whether you have reached MMI.

What Happens When I reach MMI?

The first consequence of reaching your MMI is that your insurance company will likely want you to be examined by one of its physicians for an independent medical examination (IME) to determine whether you have really reached your MMI. You may also be offered a settlement in the form of either:

• A Lump-Sum Payment. In Pennsylvania, in return for releasing your employer and their insurance company from paying any future workers’ compensation benefits, you can receive a one-time payment as a settlement.
• A Structured Settlement. You may receive payments on a schedule that you and the insurance company have agreed on.

Remember that your insurance company does not have your best interests in mind.

In Pennsylvania, reaching MMI is a prerequisite for the performance of an Impairment Rating Evaluation (IRE). When workers have been getting workers’ comp benefits for 104 weeks, a medical impairment rating is needed to verify the existence and extent of a worker’s injuries and whether he or she can return to work. If you have not reached MMI at this time, the IRE would be invalid.

Assessing the loss of physical function determines the impairment rating. If, according to the IRE, it is determined that an employee has an impairment of less than 35%, then wage loss payment benefits will be capped at a maximum of 500 weeks.

If you have reached MMI, and your IRE determines that you are healthy enough to return to work, your benefits will stop, and you will return to your job.

If the IRE shows that you are left with an ongoing medical problem that prevents you from going back to work at all or only lets you work part-time on a limited basis, you may then qualify for benefits that may include:

• Permanent Total Disability. If your injuries are such that you will not be able to ever return to work, you may receive permanent benefits.

• Permanent Partial Disability. If your injuries cause permanent partial disability, you may receive benefits based on the percentage of permanent partial disability caused by the injury.

Under Pennsylvania law, there is no limit on how long an injured employee can receive total disability payments.

If your doctor and the IME doctor disagree on your condition, you do not have to accept the IME doctor’s determination, and a Lancaster workplace accident attorney at Vanasse Law LLC can negotiate for further benefits. If both physicians agree that your MMI has been reached, but you still have an ongoing disability, your attorney can help you reach a settlement with your employer’s workers’ comp insurance company.

Contact a Lancaster Workplace Accident Attorney at Vanasse Law LLC If You Are Dealing with Workers’ Comp

The rules surrounding workers’ comp in Pennsylvania can be complicated. A Lancaster workplace accident attorney at Vanasse Law LLC will help you understand Pennsylvania law regarding workers’ comp, help you identify your options, and file any workers’ comp or legal claims on your behalf. 

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