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What is Maximum Medical Improvement?

Posted in Workers Compensation on March 15, 2024

When an individual sustains a workplace injury in Arizona, they will likely be able to recover compensation for their losses. Workers’ compensation insurance can provide coverage of medical expenses as well as a significant portion of lost wages and disability benefits if needed. These benefits continue until the treating physician deems that the injured worker has reached what is considered maximum medical improvement, or MMI.

What the Doctors Are Looking For

When you have an open workers’ compensation claim, this typically means you are receiving medical care. Workers’ compensation insurance is designed to help individuals who sustain workplace injuries recover properly while also receiving a portion of lost wages. The main aspect of this type of insurance is covering all medical expenses related to the workplace injury.

The workers’ compensation insurance carrier does not want to pay injury expenses when they do not have to, so they most certainly keep tabs on your recovery as your claim proceeds forward. Ultimately, what the insurance carriers are looking for is information from the doctor stating that you have reached maximum medical improvement, or MMI.

Medically speaking, MMI is a way of saying that any further treatment is not going to change your outcome. If a doctor says you have reached MMI, what they are saying is that the medical care you have received up until this point has helped you recover as much as they think is possible. This may mean that you have reached a full recovery, back to the state you were in before the incident occurred.

However, MMI does not necessarily have to mean a full recovery. The workplace injury or illness may have been so severe that you have some sort of permanent deficit. Even individuals who do have a permanent deficit caused by workplace injury can and will still reach maximum medical improvement at some point, though they may not technically be “fully recovered.”

Once the medical professional determines that a work injury victim reaches MMI, this typically signals that the case is closed. Since you are no longer likely to achieve any further improvement, the insurance carrier will want to close the case out for good.

Individuals may receive the go-ahead to resume work duties. This can include either full work duties or come with doctor-approved work restrictions. However, some individuals who reach MMI may no longer be able to work due to a disability. In these circumstances, they will need to pursue disability benefits.

Can You Dispute Your MMI Decision?

If you believe that your maximum medical improvement decision was prematurely declared and it has affected your medical treatment coverage, you have rights and options. Consulting with an Phoenix workers’ compensation attorney can guide you through the process of disputing this decision effectively. Your entitlement to medical benefits for work-related injuries extends as long as treatment is necessary. In situations where MMI may have been incorrectly assessed, legal action can be initiated to reassess your condition and potentially continue your treatment. If your attorney can help you through any of the appeals processes involved in an Arizona workers’ compensation case.