What Is Maximum Medical Improvement (MMI)?

If you get sick or injured at work, workers’ compensation offers weekly payments and covers your necessary medical care. Those benefits will most likely end once you reach MMI, or maximum medical improvement.

In the words of the U.S. Department of Labor, you hit MMI when “the covered illness is stabilized and is unlikely to improve with or without additional medical treatment.”

Getting an accurate MMI diagnosis is important, but the process also isn’t the same for everyone. That means It’s important to understand what MMI means for your workers’ comp claim and when you might want to contest a doctor’s declaration that you’ve reached it.

What is maximum medical improvement?

Maximum medical improvement (MMI) is the point when you’ve recovered as much as possible from your work injury and additional care won’t lead to further improvement.

Reaching MMI doesn’t always mean you’re completely recovered to where you were before the injury or illness. You may still require medical care and you may even have a health condition or disability that requires lifelong medical care.

Who determines maximum medical improvement?

After getting hurt or sick at work, you see a doctor that’s approved or recommended by your company’s workers’ comp provider. This doctor is your treating physician. They’re the one who evaluates your condition and creates a treatment plan for your recovery. As you go through treatment, your treating physician documents any improvement and reports it back to the insurance company.

Because they handle your treatments and track your improvement, your treating physician also gets to decide when you’ve reached MMI.

How long does it take to reach maximum medical improvement?

How long you take to reach MMI depends on your injury, the treatment your doctor recommends, and how your body takes to it. If you continue seeing small but noticeable improvement through months of physical therapy, it could take many months to reach MMI. If treatment is ineffective and your doctor doesn’t expect you to get better, MMI can come quickly.

Ultimately, your doctor will continue treatment until they feel you’ve recovered as much as you can — even if that isn’t a full recovery. If your doctor says you’ve reached MMI but you disagree, you may be able to challenge the diagnosis and request more medical care.

Going against a doctor’s diagnosis isn’t always easy, but a workers’ comp lawyer can help you contest a doctor’s decision.

What happens when you hit MMI

In most states, MMI is when your workers’ comp payments will end or transition to long-term (permanent disability) benefits. It’s important to be as involved as possible in this part of your workers’ compensation claim to make sure you get the full benefits you’re entitled to.

If you have fully recovered

Your workers’ compensation benefits will end if you make a full recovery and you’ll be able to return to work without any restrictions. In some states your payments and medical benefits may even end before MMI. (See how long you can be on workers’ comp in each state.)

If you haven’t fully recovered

If your doctor says you’ve reached MMI but you haven’t fully recovered, they will also give you a disability rating between 0 (fully recovered) and 100 (complete loss of use for injured body part). This rating tells both your employer and their insurance company ​​about the severity of any permanent work restrictions you have.

It’s important to get a rating that accurately reflects your physical capabilities. If you move to permanent benefits, a higher disability rating will get you larger payments and possibly longer payments.

Instead of paying long-term benefits, many insurance companies will offer a lump-sum settlement once you hit MMI. How much you get from a settlement also depends on your disability rating.

What to do if you disagree with your doctor

It’s important to get an accurate diagnosis of your maximum medical improvement because once MMI is on the books, your options for benefits are more limited.

If the workers' comp doctor reports that you’ve reached MMI, but you think you’ll still get better with more treatment, you have a legal right to challenge the diagnosis. Your best option in that situation is to look for a workers’ compensation lawyer. A local lawyer can know how to challenge the doctor’s findings, help you get an independent medical exam if necessary, and negotiate for more medical benefits or a larger settlement from the insurance company.

Why MMI is important

If you don’t fully recover, the insurance company may offer you a settlement once you hit MMI. Accepting the settlement would mean taking a check for a lump sum and, in exchange, releasing your employer from any further liability. That means that if your injury gets worse, you’re out of luck with pursuing workers’ comp to cover further treatment.

If you don’t take a settlement, MMI still plays a big role in your ongoing benefits. Once the treating physician determines you’ve reached maximum medical improvement and issues your disability rating accordingly, the insurance company gets that info. They then create your benefits plan based on your state at MMI. If, for example, the doctor says that you can do most but not all of your workplace duties, you might get a periodic check to cover lost wages.

If you think the doctor declared MMI but you would get better with further treatment, it’s important to fight the diagnosis. You have a legal right to challenge it if you think it will interfere with you getting the benefits you deserve.

Get help navigating workers’ comp

State laws protect your ability to contest an MMI diagnosis, but the path forward isn’t necessarily easy. Fortunately, having a lawyer by your side means getting advice on what to do and how to do it so that you have the best chance of maximizing your benefits.

Our team of workers’ comp experts can help you find the right lawyer for your claim. To get started, take a few minutes to fill out our workers’ comp quiz. We’ll reach out to learn more about your exact situation and match you with an experienced lawyer. Getting matched is free and you don’t have to pay the lawyer anything upfront.

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