Maximum Medical Improvement, or MMI, has a great deal of significance in workers’ compensation.  Generally, workers’ comp systems must provide for wage replacement when an injured worker can’t work, medical treatment, and some level of benefit for the lasting injury piece of the job related injury.  MMI places a significant role in each of these pieces.

What is Maximum Medical Improvement?

The definition of maximum medical improvement or MMI varies from state to state.  MMI is so important that often its definition is written into the laws or statutes of a particular state.  Other times, the definition is interpreted by workers’ compensation doctors or workers’ compensation Commissioners or Judges.  Sometimes, previous cases have defined maximum medical improvement.

By way of two examples, Ohio and Oregon both define the concept of MMI in their laws.  Ohio law states:

“’Maximum medical improvement’ is a treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical and rehabilitative procedures.  An injured worker may need supportive treatment to maintain this level of function.”

See the Ohio administrative code here.  Oregon defines MMI, but doesn’t actually call it maximum medical improvement, opting instead for the term “medically stationary.”  The Oregon statutory definition:

“’Medically stationary’ means that no further material improvement would reasonably be expected from medical treatment, or the passage of time.”

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Many other states define maximum medical improvement as part of caselaw.  One example, South Carolina, provides the definition from a case, O’Banner v. Westinghouse Elec. Corp., that reads, “Maximum medical improvement is a term used to indicate that a person has reached such a plateau that in the physician’s opinion there is no further medical care or treatment which will lessen the degree of impairment.”

Maryland’s Definition of Maximum Medical Improvement

In Maryland, there is no definition of maximum medical improvement in the statutes or written codified laws.  The definition comes from a case, Sears, Roebuck v. Ralph.  In that case, Maryland’s Court of Appeals said, “Maximum medical improvement” is the stage at which workers’ compensation claimants have ‘reached a point of stability in their disease and they have benefitted maximally from their interventional medical care.’” Sears, Roebuck v. Ralph, 340 Md. 304 (1995), also quoting Alexander v. Montgomery County, 87 Md.App. 275 (1991).

AMA Guides to the Evaluation of Permanent Impairment Definition

In workers’ compensation, often, the AMA Guides to the Evaluation of Permanent Impairment, are used in assessing the level of permanent injury in particular cases.  The fifth edition of the Guide, at page 601 defines Maximum Medical Improvement as a “condition or state that is well stabilized and unlikely to change substantially in the next year, with or without medical treatment.  Over time, there may be some change; however, further recovery or deterioration is not anticipated.”

Significance of MMI in Workers’ Compensation Cases in Maryland

In Maryland, if you are at MMI, you are typically not entitled to temporary benefits designed to serve as wage replacement.  The reason – you are ready to work.  If you are not ready to work, but you are still at MMI, that’s where permanent benefits come into play.  Often, MMI is reached and the injured worker can work – just not in the same job function as before.  There are various other benefits designed to handle this situation.  Conversely, if it can be proven that you are not at MMI, you are usually entitled to temporary total or temporary partial benefits if that’s what is appropriate in your case.

Furthermore, the finding of MMI has an impact on the medical benefits proved to you.  Sometimes, there is ongoing medical treatment needed, even when at MMI.  Sometimes not.  But either way, medical benefits, other than those necessary to sustain MMI, are typically not offered once maximum improvement has been reached.

Finally, in Maryland comp cases, indemnity or permanent benefits (like PPD) are generally not provided until MMI is reached.  This means, the bulk of the non-medical, non wage replacement compensation to the injured worker does not come until MMI is reached.  Generally, this happens at the end of the comp case.

Be Careful

Maryland workers’ comp lawyers almost never get paid until maximum medical improvement is reached.  Hence, your workers’ comp lawyer might have incentive for you to reach MMI slightly before it’s medically appropriate.

It goes without saying your employer (or former employer, as the case might be) will often have a different opinion about MMI in your case.  This is done via the workers’ compensation insurer and an “independent doctor” whom the insurer hires to evaluate you.

IT COMES DOWN TO YOU AND YOUR DOCTOR.  What do you think?  Do you believe you are at MMI?  What does your doctor believe?  If both you and your doctor believe you are not yet at MMI, you should probably fight for more treatment.  This might mean a hearing before the Maryland Workers’ Compensation Commission or even an appeal to Maryland’s Judicial Courts.  Sometimes, unfortunately, it means getting a new comp lawyer who will fight to make sure your rights are protected.

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