Workers’ compensation insurance is meant to be a simple and straightforward way of ensuring employees don’t suffer financial losses due to an injury sustained at work. While the process is intended to be simple, there are plenty of complex elements and confusing jargon. Some terms are heavily debated and their interpretation by an insurance company could impact your ability to receive compensation.
The experts at Waple & Houk PPL have thirty years of experience interpreting these laws and their various terms. We have helped many hard-working Charlotte residents receive the compensation they deserve. We can also help you understand the common terms that can impact your current and future benefits, such as maximum medical improvement.
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What Is Maximum Medical Improvement (MMI)?
Maximum medical improvement is a medical term and a sort of benchmark that is determined by your physician. To reach the MMI threshold is to say that you have improved as much as is medically possible for a specific condition or injury. That does not necessarily mean that you are cured or that you have entirely recovered from the injury. It simply means that continuing the medical treatment would yield no further improvement and is thus negligible.
This is around the time that the employer will begin pressuring you to return to work. Albeit, some patients are able to return to work long before they have reached their MMI. It also means that the insurance provider will want to discontinue specific workers’ comp benefits relating to treatment as ongoing treatment would provide no further benefit.
Unfortunately, reaching the point of MMI is not always a positive milestone for an employee. Just because you have recovered as much as treatment will allow does not necessarily mean you are able to return to work. And finding yourself in a position without available work and with diminishing workers’ comp benefits can be troubling. Working with the legal team at Waple & Houk PPL will help ensure you have a complete legal understanding of your options going forward.
Who Determines When The Employee Has Achieved Maximum Medical Improvement?
It is the employee’s medical doctor or osteopathic doctor who will provide a statement indicating that they have achieved MMI. A physician will only claim to have achieved an MMI threshold after trying all available means of treatment currently available. It is also possible that an independent medical examination provided by the insurance carrier will allege that the employee has reached their MMI.
Does Medical Treatment Continue After An MMI Diagnosis?
It can. It depends entirely on the nature of the injury and the lasting impact it has on the body. Simply reaching the MMI milestone does not mean that all medical treatment ceases or that no future medical treatment is required. Patients who suffer from serious injuries may deal with partial disabilities for the remainder of their life and thus require regular screenings and care.
Reaching your MMI may only be the next step in your medical journey. Afterward, you or your attorney will send a letter to the physician requesting a Permanent Partial Disability (PPD) impairment rating. This PPD rating is very important in determining if you can return to work, what sort of work is viable, and what workers’ comp benefits you can receive in the future.
A PPD indicates that your body has an impairment that impacts normal function to some degree. The level of functionality is determined by the physician and provided in the form of a percentage with 100 percent representing a completely non-functioning disability. A PPD rating can only be provided after reaching MMI, which indicates that the loss of function will never be improved or regained.
PPD is an important factor because workers’ comp insurance provides funding to compensate for the partial disability caused by workplace injury. The amount of compensation provided is calculated at 2/3rd of the employee’s average weekly pay for the past 12 months. The duration of the compensation will vary according to the part of the body injured and the degree of functionality lost.
Receiving PPD payments is not prevented by returning to work. Compensation is specifically intended for the partial loss of functionality. Thus, the employee can continue to work and earn a living while also receiving PPD payments from the workers’ comp insurance policy.
What Happens If You Are Unable To Return To Work After Your MMI Diagnosis?
This is a common and unfortunate occurrence for injured workers. Reaching MMI does not mean you have returned to your previous level of health or are fully healed from the injury. It only means that medical treatments will not improve the situation further. In some cases, you may not be able to work at the same level as before or even in the same field of work.
When you receive your PPD report your physician will also outline any permanent work restrictions. Your impairment rating is not always indicative of the work restrictions you will receive. For example, it is possible to have a very low PPD rating yet have permanent work restrictions that prevent you from continuing your previous work.
In an ideal scenario, your employer will work with you to find work you are capable of performing even if you cannot return to the same job. Otherwise, your attorney will take these factors into consideration when negotiating a settlement amount with the insurance carrier.
If your PPD and work restrictions do allow you to return to work your employer may ask you to sign an Award Agreement Form. We recommend waiting to sign these papers until you have performed your job duties for 3 months at least. This will give you time to gauge whether you are fully capable of performing the task or whether your doctor needs to reassess your restrictions.
Contact Our Charlotte Workers’ Comp Lawyers
We always hope for employers and insurance carriers who work with their injured employees for the best possible outcome. But we also understand that these businesses always put their bottom line first. The legal experts at Waple & Houk PPL will always have your best interests in mind.
We are here to ensure you don’t rush through paperwork or return to work before you are ready. We also want to make sure you receive the compensation you are owed for your injuries, your disabilities, and your ongoing care. Call us today at (704) 480-3899 for a free case review and to better understand your MMI determination.