Content reviewed by:
Alex Shulman
Maximum medical improvement (MMI) is the point where you’ve recovered from your condition as much as can be reasonably expected and further improvement is unlikely with additional treatment. It’s a medical determination that your healthcare providers may make when treating your work-related injury or illness.
MMI can affect both the value of your NYC workers’ compensation claim and how long it takes to receive benefits. When you turn to Shulman & Hill after a workplace injury, we can help you understand how MMI may impact your unique claim.
Who Decides When You’ve Reached MMI, and What Does It Mean for Your Recovery?
Your treating physician typically decides when you’ve reached MMI. The insurance company may also request an independent medical evaluation from a different doctor to provide a second opinion.
A doctor may determine that you’ve reached MMI when they expect that no further meaningful improvement in your work-related injury or illness can be achieved with additional treatment.
In other words, your recovery has reached a plateau. The New York Workers’ Compensation Board presumes that MMI occurs no more than two years after the injury, however this can vary depending on the severity of your injuries and the type of treatment received.
How MMI Affects Your Workers’ Comp Benefits
Reaching maximum medical improvement in New York stops your “temporary” disability benefits and you may then transition to permanent benefits if your condition leaves you permanently disabled.
Your benefits might continue, but the amount and type may change. The outcome depends largely on the workers’ comp impairment rating you receive.
What Happens After You Reach MMI?
You may undergo a Functional Capacity Evaluation (FCE) to assess your physical abilities and limitations. This can determine what type of work tasks you may be physically capable of performing. Your doctor may recommend permanent work restrictions based on the results.
You’ll also receive an impairment rating to determine if your workplace injury caused a permanent disability. For extremities (arms/legs/hands/feet) this rating can be a schedule loss of use percentage between 0 and 100 that measures how much your injury affects your ability to work after you reach MMI, and for other body parts (neck/back/head) you may receive a severity rating.
An insurance company may make a settlement offer, but however, it may not be enough to cover your long-term needs. Accepting the offer means you cannot seek any more compensation for your workplace injury, so we recommend that you consult with a lawyer before proceeding.
If you don’t settle early in the legal process, there may be a permanency hearing. Both you and the insurance company will have the opportunity to present evidence related to your permanent work restrictions and impairment rating. The judge will decide what compensation you’re entitled to based on the severity of your impairment and other vocational factors.
You might also have the opportunity to dispute your MMI determination if you believe additional medical treatment could improve your condition.
Can You Dispute an MMI Determination in New York?
You have the right to challenge an MMI decision. Some scenarios in which you might want to dispute an MMI determination include:
- Improvement After MMI: Your doctor determined that you’ve reached MMI, but an independent medical examiner determined that your condition improved after that point.
- Premature Determination: You believe you haven’t reached the point of maximum recovery and that additional medical treatment could further improve your condition.
- Errors in Medical Evaluation: Your doctor made the MMI determination based on incomplete, outdated, or incorrect information.
- Conflicting Opinions: You have a second opinion from another medical provider who disagrees with the original MMI determination.
A New York City workers’ compensation lawyer can help you determine if you have a strong case to dispute your MMI determination. If you do, Shulman & Hill will help you with each step of the process.
Why MMI Doesn’t Mean Your Case Is Over
Reaching MMI doesn’t mean your case is closed. In fact, an MMI determination is often just the beginning of a legal process. You may receive a settlement offer, undergo evaluations of your work capacity, or appeal the workers’ compensation decision altogether.
Our firm has experience helping injured workers through all stages of the workers’ comp process, including denied claims and appeals. No matter what comes next, we’re ready to help you navigate it.
Speak to a Workers’ Compensation Attorney Today
The issues that arise after MMI can be complex, and you may feel more comfortable with an expert in your corner. If you or a loved one was injured at work, Shulman & Hill is here to guide you through your legal options and advocate for your best interests. Contact us today to schedule a free consultation and learn how MMI in workers’ comp affects your case.
