Written by Raviinder Parmar, MD
After a workplace injury, workers’ compensation will pay for medical treatment for the injured employee up until they reach maximum medical improvement or MMI. What does it mean when a person reaches MMI? Does this mean that their medical treatment is finished? Does it mean that their condition won’t get any better?
What is MMI?
When a patient has reached MMI, this means that medical treatment is not expected to result in the continued improvement of the patient’s condition. Some states use the term “medically stationary” instead of MMI, indicating that the patient’s condition has reached a plateau. A patient who has reached MMI is medically stable, and doctors expect that their condition cannot be improved further by additional treatment.
Once a patient has reached MMI, the patient’s condition will be evaluated. If they have a disability at this point, it will be considered permanent. Legal and financial settlements will be negotiated based on the patient’s situation once they have reached MMI. For workers’ compensation benefits, reaching MMI is a huge milestone. At this point, the determination can be made of whether the patient is disabled (either partially or completely), and whether they have suffered a loss of future earning capacity. This will determine their eligibility for workers’ compensation benefits.
Does MMI mean that medical treatment is complete?
MMI does not necessarily mean that the patient doesn’t require any continued medical treatment, or that workers’ compensation will not cover the costs of that treatment. Some patients may need ongoing treatment in order to stay at the level of function that they currently have. A patient who has reached MMI is not expected to improve further but may require continued medical treatment in order to stay stable.
For example, if a patient develops chronic pain as a result of a workplace injury, they may require ongoing medical interventions, such as pain medications or injections, to continue dealing with that pain. A patient with a work-related lung disease such as silicosis may need medications, respiratory therapy, and even oxygen on an ongoing basis. Workers’ compensation benefits generally continue to cover medical treatment that is intended to keep the patient stable at the point of MMI.
Does MMI mean that the patient won’t get any better?
Reaching MMI also does not always mean that the person cannot continue to heal. The determination that a patient has reached MMI is made when a patient has reached a plateau and is stable, but this doesn’t mean that further improvement is impossible. Some patients do experience additional improvements in their symptoms over time.
In general, if the patient does improve further after reaching MMI, it will be due to the body’s natural healing process over time, rather than to additional medical intervention. For example, a patient with a traumatic brain injury (TBI) may experience some degree of spontaneous improvement of their symptoms over time, even many years after the initial injury. The healing process is unpredictable by nature, and it’s impossible to know for sure that a particular patient will never get any better.
It’s important to recognize that the converse is also true. It’s possible for a patient’s condition to worsen significantly in the future, even after the determination was made that they had reached MMI. In certain cases, if this occurs, workers’ compensation benefits may be adjusted to account for the patient’s worsened condition. Whether this is possible depends on the specifics of the situation.
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