What Is Maximum Medical Improvement?

It is common to hear about maximum medical improvement during a personal injury claim – particularly during a workplace injury claim. During a workers’ compensation claim or civil lawsuit for a job-related injury, it is necessary to determine the employee’s level of disability, if any. The level of disability can decide if, when, and how the employee can return to work after a serious injury or illness. Understanding maximum medical improvement, or MMI, can help you navigate your case in Oregon.

About Workers’ Compensation Claims in Oregon

The Oregon workers’ compensation system enables injured workers to receive financial benefits for their medical bills, disability costs, and two-thirds lost wages if their injuries occurred while on the job. It is not necessary for the injured worker to prove anyone’s fault for the accident to receive these benefits. Before a worker can obtain fair compensation for his or her damages, however, the insurance company must know the individual’s level of maximum medical improvement.

Maximum medical improvement means the worker has stopped recovering. It does not necessarily mean the employee has fully healed. Rather, he or she has reached the point where a medical practitioner determines the patient will not progress any further. Maximum medical improvement will change from patient to patient. It depends on the injuries suffered, and the health of the employee. Treatment after the point of maximum medical improvement is meant to keep the patient comfortable and functioning at his or her current level – not fully heal the patient.

Who Determines the Date of Maximum Medical Improvement?

The insurance company does not determine the injured worker’s date of maximum medical improvement – nor does the employer or a lawyer. A doctor is the only party with the authority to determine someone’s point of MMI. A doctor will use many different factors to make this determination, including your range of motion, rate of recovery, and overall prognosis. It can take months or even years for a patient to reach maximum medical improvement. It is important, however, not to rush your doctor’s determination.

Pushing a doctor to say you have reached the point of maximum medical improvement when really you have not will only serve to reduce your workers’ compensation benefits. Rushing your doctor’s decision could lead to missed medical bills on your claim. For example, imagine you suffer a severe burn injury at work and require a skin graft surgery for treatment. Six months later, your doctor recommends a second reconstructive surgery. If you rushed your date of MMI, you may not have been able to list the second surgery as part of your workers’ comp claim.

Why Is MMI Important?

It is necessary for a workers’ compensation insurance company to know the employee’s maximum medical improvement to provide fair compensation for a permanent disability, as well as for related medical costs. The insurance company will need to know the date the patient reaches MMI, as well as his or her limitations at this point. Understanding maximum medical improvement is the only way to give an injured worker the amount of compensation necessary to adequately cover lifelong medical needs or disabilities.

Your employer needs to know your level of MMI, as this will determine the longevity of your temporary total disability benefit payments. The insurance company will only grant these benefits as long as your disability persists. Once you reach your point of maximum medical improvement, your doctor will be able to know if you can return to work. This can help you complete and settle your claim.

Do not let an employer or an insurance company rush your workers’ compensation settlement. You have the right to wait until a doctor determines you have reached the point of maximum medical improvement. Hire an attorney to defend your rights if you believe your claim is worth more.