Maximum Medical Improvement

Maximum Medical Improvement

An injured worker may be out of work for several weeks or months while recovering from a workplace injury. Workers’ comp benefits provide income benefits if the injured employee cannot work because of their work injury. However, the weekly benefits stop when the person reaches maximum medical improvement or MMI.

What Is Maximum Medical Improvement in a Workers’ Comp Case?

What Is Maximum Medical Improvement in a Workers’ Comp Case?

A person reaches maximum medical improvement when the person’s condition is unlikely to improve with or without further medical treatment. Some individuals reach MMI after recovering fully from their injuries. They can return to work without any restrictions.

However, an employee may not fully recover from their injuries. They could have a permanent impairment or disability. The treating physician does not expect their medical condition to improve, even with additional medical care. 

The employee could be entitled to additional benefits under Texas workers’ compensation law if they have a permanent impairment. However, obtaining a fair impairment rating could be difficult, especially if the workers’ comp insurance company requests a rating from a designated doctor. 

Temporary Income Benefits for a Workers’ Compensation Claim 

When an employee cannot work after an injury on the job, the worker receives temporary income benefits (TIB). TIB begins on the eighth day the employee is out of work. 

Injured workers receive 70% of the difference between their average weekly wage before the accident and how much money they can earn after the accident. Suppose, they earn less than $10 per hour. In that case, TIB percentage increases to 75% of the difference between the average wage before and after the injury. 

However, temporary income benefits end when the worker reaches maximum medical improvement or after 104 weeks of receiving TIB payments. At that point, the worker is not entitled to receive temporary income benefits, even if they are not fully recovered from their injuries. Instead, the worker receives income benefits based on an impairment rating.

What Happens After I Reach Maximum Medical Improvement?

When your doctor states you have reached maximum medical improvement, the workers’ comp insurance provider stops paying benefits. A medical examination determines your partial impairment rating if you have not recovered fully from your injuries. The impairment rating is between 0% (no impairment) to 100% (total disability). 

An impairment rating must be assigned in a specific manner. The doctor assigning the rating must follow the instructions and guidelines in the state’s Guide to Evaluation of Permanent Impairments, which dictates percentages for impairment for various types of work injuries. 

You may receive an impairment rating from:

  • Your treating physician 
  • A physician your doctor asks to provide an impairment rating (referral doctor)
  • A state-designated doctor
  • A doctor the insurance company hires to perform a Required Medical Examination (RME)

If you do not have an impairment rating before your doctor states you have reached MMI, your benefits stop. You will not receive any income if you cannot return to work. 

Therefore, you might want to talk with an experienced workers’ compensation lawyer if it has been close to two years after your work injury or if your doctor says you are close to reaching MMI. You need to know your rights under workers’ comp laws and your options for receiving additional benefits.

What Benefits Can You Receive After You Reach Maximum Medical Improvement?

Texas workers’ compensation laws provide impairment income benefits for workers who receive an impairment rating. The benefits equal 70% of your average weekly wage. The duration of impairment income benefits depends on your impairment rating.

Workers are entitled to receive three weeks of benefits for each percentage point. Therefore, if the doctor gives you a 40% impairment rating, you receive impairment income benefits for 120 weeks. 

After your impairment income benefits cease, you might be eligible to receive supplemental income benefits. You must have an impairment rating of at least 15% to receive supplemental income benefits. In addition, the benefits are capped and cannot exceed 64% of your average weekly wage. 

Can I Challenge My MMI Date or My Impairment Rating?

Contact an attorney immediately if you disagree with the MMI date or impairment rating. You can challenge both, but you need to act quickly. You have just 90 days to challenge your physician’s MMI date or impairment rating. 

Even though doctors have guidelines for determining impairment ratings, doctors can have different opinions. Furthermore, doctors are often paid by workers’ compensation insurance providers. The financial connection between the doctor and the insurance company can result in some doctors assigning lower impairment ratings. 

Schedule a Free Consultation With Our Houston Workers’ Compensation Lawyers

Don’t let your employer or the workers’ comp insurance company force you to settle your workers’ comp claim before you complete the healing process. Doing so could result in a lower workers’ comp settlementContact our law firm to schedule a free consultation at (713) 500-5000 with one of our experienced Houston workers’ compensation attorneys to discuss how much your workers’ comp case is worth.