MMI Is the MOST IMPORTANT Part of Your Workers Comp Case!

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MMI Is the MOST IMPORTANT Part of Your Workers' Comp Case!

Reaching Maximum Medical Improvement (MMI) is a game-changer in your workers’ comp case. Discover what MMI is, what happens after you reach it, and how your decisions will determine your compensation going forward!

What is Maximum Medical Improvement (MMI)

In simple terms, it’s the point in your recovery where your condition has plateaued. This means you’ve healed as much as you’re likely to, even if you’re not back to 100%.

Who Determines MMI

Ideally, your doctor—the one who’s been treating you—should take the lead on this decision. They know your medical history, have seen your progress during recovery, and understand the treatments you’ve gone through. They’re in the best position to figure out if you’ve hit a point where further improvement isn’t likely, known as a recovery plateau.

But there’s often another player involved: the insurance company’s Independent Medical Examiner (IME). This is a doctor hired by the insurance company to evaluate your condition. Sometimes, they step in earlier than you’d expect. The IME might say you’ve reached Maximum Medical Improvement (MMI) even if you and your doctor feel there’s still room to improve. Why? Because the insurance company has a vested interest in closing your case sooner rather than later.

If that happens, don’t stress. In many states, like New York, you’ll get a notification from the Workers’ Compensation Board if the IME determines you’ve reached MMI. This usually gives you time—often 60 to 90 days—to respond.

Take the IME’s report to your doctor and ask, “This is what they’re saying. What’s your take?” It’s all about getting a trusted opinion from someone who genuinely has your back.

If your doctor disagrees with the IME, that’s where your lawyer comes in. They’ll help sort out the next steps, whether it’s negotiating, discussing a settlement, or even going to a hearing in front of a judge to resolve the disagreement.

What Happens After You Reach MMI

When your doctor decides you’ve reached MMI, a few things are likely to change—both in your medical care and your benefits.

Changes in Your Medical Care

At MMI, your recovery is considered stable. This means your doctor probably won’t suggest big treatments like surgeries or intense therapy anymore. Instead, your care shifts into “maintenance mode.” You might still see your doctor now and then or have the occasional physical therapy session, but the focus will be on managing symptoms and keeping you as steady as possible.

What This Means for Your Workers’ Comp Benefits

Here’s where things start to get serious. Once you’re at MMI, your case moves from temporary benefits—which depend on the ups and downs of your recovery—to permanent benefits, which are all about the long-term impact of your injury.

Temporary benefits are there to help you while you’re actively getting better, and they often change as your condition improves or worsens. But once you’re at MMI, that back-and-forth stops. From here on, the focus is on figuring out how your injury affects your ability to work in the long run.

How MMI Affects Your Compensation

Once you hit Maximum Medical Improvement (MMI), the way your workers’ comp benefits work changes pretty significantly. Temporary benefits, which cover you while you’re healing, shift to permanent benefits that reflect the lasting impact of your injuries.

From Temporary to Permanent Benefits

While you’re recovering, your disability level can go up and down. For example:

  • Right after your injury, you might be considered temporarily totally disabled.
  • With time and treatment, you might improve to the point of being temporarily partially disabled.

This back-and-forth is temporary because your condition is still changing. But once you reach MMI, that stops. At this stage, your injuries are evaluated for their long-term effects, and that’s what determines your ongoing compensation.

Key Challenges and Risks of MMI

Risk of Misclassification

One of the biggest concerns at MMI is being misclassified. For example:
If your doctor’s report says you’re able to do sedentary or light work, the insurance company might argue that you’re only partially disabled instead of totally disabled.
This could seriously cut your benefits—even if, in reality, your injury makes it impossible for you to work.

Labor Market Attachment Requirements

If you’re labeled as partially disabled after hitting MMI, you might have to meet something called a labor market attachment requirement. Basically, you’ll need to show that you’re actively looking for work within your physical limits to keep your benefits. If you don’t, your benefits could get reduced or even stopped altogether.

More Scrutiny from the Insurance Company

Once you’re at MMI, the insurance company usually ramps up their efforts. They might push for Independent Medical Exams (IMEs) to challenge what your doctor says or use those reports to argue for cutting your benefits. In some cases, they’ll even claim you shouldn’t be getting benefits at all.

How Long It Takes to Reach MMI

The timeline really depends on your injury and the details of your case, but there are some general guidelines to give you an idea of what to expect.

For Schedulable Injuries

If you’ve got an injury to something like your arms, legs, hands, or feet, MMI is usually assessed about a year after your accident or surgery. These types of injuries fall under what’s called “schedule loss of use,” where the main focus is on how much function you’ve regained in the affected area.

For Non-Schedulable Injuries

For injuries to areas like your neck, back, or head, the timeline is often longer. In many cases, doctors wait up to two years before deciding if you’ve reached MMI. These injuries typically take more time to stabilize and fully understand.

Why the Wait?

MMI isn’t something you can rush. Your doctor needs to see how your condition changes over time. After an injury, there’s usually a period where you make significant progress thanks to treatments. But eventually, that progress slows down, and you hit a plateau. That’s the point when your doctor can say you’ve reached MMI.

Your Rights and Options After Reaching MMI

When you hit Maximum Medical Improvement (MMI) in your workers’ comp case, you’ve got the right to push back on any findings you don’t agree with—whether it’s from your doctor or the insurance company’s Independent Medical Examiner (IME).

If the IME decides you’ve reached MMI too early, you can talk to your doctor, get a second opinion, and submit a rebuttal. If a judge’s decision doesn’t match the facts of your case, you can also appeal, but you’ll need solid evidence to back you up.

And here’s something else to keep in mind: if your condition gets worse after MMI, you might be able to reopen your case—unless it was closed for good through something like a Section 32 settlement.

Contact Us for Help With Your Workers' Compensation Case

Navigating a workers’ compensation case can feel overwhelming—especially when you’re dealing with medical jargon, insurance companies, and legal complexities. If you’re not sure what’s next or need help making sense of your situation, I’m here to help.

Give me, Rex Zachofsky, a call at 212-406-8989, and we’ll talk through your case. No pressure, no commitments—just straightforward advice.

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address

111 John Street
Suite 1615
New York, NY 10038

phone number

212-406-8989