Maximum Medical Improvement: What Does it Mean and Should You be Skeptical?

What does it mean when your workers’ compensation doctor declares that you are at “maximum medical improvement” (MMI)?

As I discuss in this video, MMI means that this particular doctor believes that he/she has done all that he/she can do and that your post-injury condition is as good as it will get. MMI does not mean that you are cured or that you have been restored to your pre-accident health.

The insurance company likes to hear that you are at MMI as this means that your medical treatment will be winding down and that you are ready for a permanent partial disability rating. This is what the insurance company uses to close out your case.

I frequently see cases where the insurance adjuster handling your case will call or write your doctor and apply pressure to encourage the doctor to say that you have reached MMI. Understand that many of the doctors that insurance companies put on posted panels get most or all of their business from workers’ compensation insurance company referrals. When the adjuster calls the doctor to say “this claimant appears to be at MMI,” it is difficult for the doctor to push back.

Can We Contest the MMI Designation?

We do not, however, have to accept the posted panel doctor’s conclusions about MMI. After looking at medical records for 25+ years, I usually can tell if a physician is premature on his MMI determination. We can, and often do, ask for a second opinion with a more independent doctor. In some cases we can force the insurance company to pay for this second opinion.

We can also ask a workers compensation judge to order a change in treating physician if we have evidence from a second opinion that more can be done.

The point here is that a posted panel doctor’s declaration that you have reached MMI is often less of a medical decision and more of a financial one to benefit the insurance company. The insurance company is trying to save money, whereas you and I are focusing on restoring your health.

Additionally, if there is a legitimate question about whether you are at MMI, we can use this uncertainty to negotiate a better settlement for you since the insurance company has more potential exposure if you are not at MMI.

If you sense that the posted panel doctor proving treatment to you may not have your best interests at heart, please contact me to talk about your options – 770-351-0801.