Key facts about maximum medical improvement in Arizona workers’ comp cases
The concept of maximum medical improvement (MMI) plays a significant role in Arizona workers’ compensation cases. It refers to the point at which a treating physician believes that your injuries have reached a point of stabilization.
Once MMI is declared, it’s time to begin exploring settlement options.
What does “MMI” mean?
A declaration of MMI does not always mean that a victim has fully recovered from the injuries sustained. In fact, MMI generally means a point has been reached in which no further improvement is likely.
Medically speaking, MMI is another way to say that additional treatment is not going to make a difference in terms of functional benefit. This is not a declaration that should be made unless a physician has exhausted other treatment possibilities, including physical therapy, surgery or other options.
How does MMI impact your workers’ compensation case?
No matter the background of your injury, reaching MMI is when your case begins. You are no longer likely to achieve further improvement; therefore, an insurance carrier will be able to attach a dollar figure to the losses you have sustained.
It’s important to note that settlement offers should never be entertained until MMI has been reached. Without a full understanding of the harm done, it is not possible to make an accurate assessment of how much compensation to which you may be entitled.
MMI is also a determining factor in whether you will be able to return to the job and whether you will be able to perform your prior duties. As such, accepting a settlement offer prior to MMI could cause you to forfeit the right to compensation for lost earning capacity, long-term and short-term disability.
Once a settlement is accepted, you may abandon further rights to workers’ comp benefits. As such, this is a critical point in time. If your doctor suggests that you will require long-term physical therapy, and you have already accepted a settlement, workers’ compensation will not cover the costs of that therapy. You will have no choice but to pay for it yourself.
When MMI has been reached, you will have the information necessary to make decisions about whether to include payment for lost wages, future medical costs, pain and suffering in your settlement demand.
How are injured workers affected?
There are times when an on-the-job accident can stop a worker from returning to their previous role, and other times, they can’t return in any capacity.
If you are deemed able to return to the job, but have a permanent disability that is partial in nature:
- You may be placed on permanent duty restrictions.
- You may be able to receive permanent partial disability benefits.
Should you suffer an injury that renders you unable to resume your prior duties, you can receive help from your employer in securing a new role at the company.
You may also be able to seek permanent partial disability benefits to provide compensation for either lasting impairment or a necessary move to a lower-paying position.
Benefits of this sort are only provided if a worker has been declared to have reached MMI. As such, it is crucial to consult with a workers’ compensation lawyer who can advise you.
Who decides MMI?
Only a medical or osteopathic doctor has the ability to determine when MMI has been reached. When it comes to workers’ comp cases, it is the treating physician who makes this assessment.
However, insurance carriers can (and do) sometimes request that a claimant undergo an independent medical examination (IME). This is intended to confirm the treating physician’s findings and protect the carrier from questionable claims.
When MMI is being discussed, practical return-to-work limitations are designated by a partial impairment rating (PIR). This measures an injury’s severity in relation to the overall impairment. This determination covers a medical needs assessment and whether the injury victim can return to the job. The level of impairment is given a functional capacity evaluation (FCE) score. This helps verify a worker’s ability to return to their prior job or another position that accommodates any limitations.
Similar to PIR, whole person impairment (WPI) measures an injury’s severity in relation to bodily function as a whole. A small body part’s impairment will be assigned a rating, which will be converted to a larger body part rating, which is then used to assess a “whole body” rating.
What is a functional capacity evaluation (FCE)?
A functional capacity evaluation (FCE) is a set of tests and evaluations performed by health care professionals to assess an individual’s ability to perform work-related tasks. This is particularly crucial in workers’ compensation cases, where there may be questions about an injured worker’s physical capabilities following an injury or illness sustained on the job.
The FCE aims to evaluate a person’s functional status, including their ability to carry out specific job-related activities such as:
It may also assess other capabilities like balance, coordination, endurance and flexibility. The test is designed to be comprehensive and to mimic the types of tasks that the individual might be expected to perform in their work environment.
Is a settlement in workers’ comp determined by FCE?
While a functional capacity evaluation is an important tool in assessing an injured worker’s physical abilities and limitations, it’s generally not the sole determining factor in a workers’ compensation settlement.
The FCE can provide valuable objective data on what an individual can or cannot do physically, but this is only one piece of evidence considered when evaluating the extent of an injury and the amount of compensation to which a worker is ultimately entitled.
Consulting with an experienced work injury attorney who can provide you with an estimate of how much your claim should be worth is the best way to ensure you get maximum compensation in any workers’ comp settlement.
What happens after maximum medical improvement?
Bear in mind that if you accept a workers’ comp settlement before MMI is reached, the employer will have no further responsibility for your medical treatment. You may ultimately require additional care, but it will be your own financial obligation.
Even if you wait until MMI is reached to settle your claim, you may lose out on significant compensation if you do not have the assistance of a seasoned attorney. Workers who sustain major work-related harm may be able to continue receiving compensation long after MMI has been reached, with possible payment for rehabilitation expenses, lost wages, disability and more.
What about injuries that worsen after MMI?
MMI is a declaration that an injury is unlikely to improve, but that is not to say that injuries can never worsen over time. As such, it really does pay to negotiate a settlement that takes into consideration this possibility and helps you prepare for all future potentialities and medical needs.
Questions and answers about compensation for a job-related accident, injury or illness in Arizona
How should you proceed when MMI is reached?
If you have been deemed to have reached MMI by a treating physician, now is the time to start thinking carefully about a settlement. However, do not jump at the first offer you receive. Rather, set aside some time to consult with an experienced Arizona lawyer who can help make sure you receive the full amount of available compensation.