There are many different terms and concepts to understand when filing a workers’ compensation claim, and maximum medical improvement, commonly referred to as simply MMI, is one of them. MMI occurs when the doctor treating your injuries states that you have recovered from your work injury as much as possible.
Under the workers’ compensation system in Arizona, your MMI is very important to your claim because it impacts if you are able to return to work, if you can keep receiving benefits, and how many benefits you are entitled to. Depending on the nature and severity of your injury, it can take several weeks, months, or even years to reach MMI.
Your employer, and their insurance provider, may disagree about when you have reached MMI. In these cases, it is imperative to work with an Arizona workers’ compensation lawyer who can advise on your case.
Determining MMI in Workers’ Compensation Claims
Maximum medical improvement happens when your condition or injury stabilizes to the point that the doctor treating you determines further treatment will not result in significant improvement. Your doctor is the authority on whether you have reached MMI, but the insurance company providing coverage to your employer may also request that you undergo an independent medical examination.
It is important not to confuse MMI with making a full recovery. It simply means that your injury or condition will not become any better, but it will also not become any worse. You can reach MMI and still never fully recover.
What Happens After Reaching MMI
As you are receiving medical treatment, you will receive workers’ compensation benefits. Your employer’s insurance company is responsible for paying all reasonable medical expenses associated with your work injury or condition. If you make a full recovery, the insurance company is no longer responsible for paying your medical expenses. At that point, you may qualify for permanent partial disability benefits and settlement of your case.
What Role Does MMI Have When Settling Your Case?
After you have reached maximum medical improvement, you should consider what options you have for settling your case with the insurance company. If your injury is stable enough that the short-term medical workers’ compensation benefits will end, and your long-term treatment needs can be identified with more clarity and a value will be assigned to your case.
You may be able to obtain permanent disability benefits and your settlement could include coverage for long-term medical expenses and additional medical treatment such as occupational therapy or rehabilitation. You may receive the settlement in a lump sum, or coverage may be paid on a scheduled basis.
The workers’ compensation system in Arizona does not place a waiting period on partial permanent disability benefits after you have reached MMI.
Things to Consider When Negotiating a Settlement After Reaching MMI
There are many different factors to consider when negotiating a workers’ comp settlement after reaching MMI. These include:
- Consider any needs you may have in the future: While it may seem obvious, the future is not always certain. You may think that you know the future expenses you will face, but they could turn out to be completely different. Even though you have reached MMI, you could face additional expenses and losses in the future that you did not anticipate. A full settlement for a permanent injury should include permanent work restrictions, ongoing medical care, additional medical treatment, and vocational rehabilitation.
- Finalization: After you have accepted a settlement from the insurance company, you no longer have the right to obtain workers’ compensation benefits for the same condition or injury. If you realize in the future that you cannot return to work in the same capacity, or you require more medical care, you cannot go back to the insurance company and ask for more compensation. This is just one reason it is always advised that you speak to an Arizona workers’ compensation lawyer before accepting a settlement.
- Consider that your injury or condition may become worse: MMI does mean that injuries and conditions will not become worse, in most cases. However, there is always the possibility that your condition or injury may worsen. It is important to consider this possibility and ensure that your settlement will cover it if this happens.
- Your ability to return to work: It is possible to have a permanent partial disability but still have the ability to work in some capacity, even if that capacity is different before suffering your injury or condition. This can include working in a different position for the same employer, or have restricted duties. If the work you can perform after your injury pays less than what you earned before your injury, your workers’ compensation settlement must account for this. If your doctor states that you are able to return to work, you must do this or you risk losing your benefits.
What is a Functional Capacity Evaluation?
You may be required to undergo a functional capacity evaluation before a settlement is offered. This is an examination conducted by a health care professional, typically a physical therapist. The purpose is to determine if you are able to perform employment-related duties and if so, the extent to which you can perform those duties.
The results of your functional capacity evaluation are submitted to your employer, their insurance provider, you, and your workers’ compensation lawyer. While the functional capacity evaluation will not be the deciding factor in your ultimate workers’ compensation settlement, it does play an important role. Not everyone who files a workers’ compensation claim is asked to undergo a functional capacity evaluation, but it is more likely if you are seeking a settlement for a permanent partial disability.
Our Workers’ Compensation Lawyers in Arizona Can Help You Obtain a Fair Settlement
At Snow, Carpio & Weekley, PLC, our Arizona workers’ compensation lawyers are dedicated to helping injured workers obtain the fair settlements they deserve, and we will put our expertise to work for you, too. Contact us to schedule a free consultation and to get more information.
