MMI & Workers’ Comp: How Maximum Medical Improvement Affects Your Workers’ Comp Settlement

If you’ve got a work-related injury or illness, you don’t want to worry about getting the benefits you’re entitled to. But knowing a little bit about how the process works for long-term impacts from your condition can literally pay off. We’ve gathered the information you need about how maximum medical improvement (MMI) affects your workers’ compensation benefits and why you may want to work with a skilled workers’ compensation attorney.

What Is MMI?

The U.S. Department of Labor defines MMI as “when the covered illness is stabilized and is unlikely to improve with or without additional medical treatment”. Wikipedia breaks MMI down further in medical terms:

“It can mean that the patient has fully recovered from the injury or their medical condition has stabilized to the point that no major medical or emotional change can be expected in the person’s condition. At that point, no further healing or improvement is deemed possible and this occurs despite continuing medical treatment or rehabilitative programs the injured person partakes in.”

In layman’s terms, it means you’ve reached the point in your recovery process where you aren’t expected to get any better.

When Do Most Injured Workers Reach Maximum Medical Improvement?

The point where you reach Maximum Medical Improvement varies. It largely depends on your health at the time your injury or illness occurred and how severe it was. However, one study provides these general estimates:

• Days or weeks for most acute injuries and illnesses
• 6-24 months for fractures, severe soft tissue injuries and illness, and conditions that require surgery
• 2+ years for catastrophic injuries, including serious head and spinal cord injuries

Catastrophic Workers’ Compensation Injuries Are On The Rise

Catastrophic injuries are life-threatening. They create huge “functional deficits” (skills or ability gaps) and require lengthy or indefinite recovery periods. Here are some examples:

• Amputations
• Multiple fractures
• Severe burns
• Stroke
• Traumatic spinal cord injuries
• Traumatic head injuries

One insurance company’s data shows that catastrophic claims over $5 million grew dramatically over three years, including a 30% rise in claims over $10 million. The trend largely comes from advancements in trauma and ongoing medical care that boost accident survivability and life expectancy.

How Will Maximum Medical Improvement Affect My Workers Compensation Claim?

Probably. In most states, when you reach maximum medical improvement, your workers’ comp benefits end or switch over to permanent disability benefits. In some states, though, payments and benefits may stop before MMI. While every case is different, in general:

• Once you fully recover, your workers’ comp stops because you can go back to your job without any limitations or special considerations.
• If you don’t fully recover but your doctor says you’re at MMI, you receive a disability rating. This scale runs from 0 (full recovery) to 100 (total loss of use) and indicates your physical condition and capabilities. The higher the rating, the higher your lump-sum settlement or long-term disability payments.

IMPORTANT: Since policies vary from state to state and depend on your recovery status, we recommend working with an experienced workers’ compensation attorney who knows the laws where you live.

How Much Money Can You Get After Reaching Maximum Medical Improvement?

While every case is different, one organization calculated average claim values for 2021 (the most recent year available):

• Average claim value: $42,000
• Average amputation payout: $126,033
• Average death settlement: $1.34 million

States may have different ways of factoring Maximum Medical Improvement payments. Here are two examples:

1. The Alaska legislature recently made substantial changes to compensation. It upped the impairment rating percentage to $273,000 for injuries occurring on or after January 1, 2023. Other changes included increases for reasonable and necessary funeral costs ($12,000) and survivors’ lump-sum payments ($8,000).
2. Maximums for “non-scheduled losses” — permanent disabilities involving specific body parts, typically including the brain, heart, lungs, pelvis and spine — vary widely. Maryland ($667,660) and New Jersey ($639,300) have some of the highest average payouts, while Ohio ($72,334) and Alabama ($66,000) have some of the lowest.

How Long After Reaching MMI Do You Receive Your WC Settlement?

Sometimes, your employer’s insurer elects to make one big payment instead of recurring wage and medical outlays. This is usually determined when you attain Maximum Medical Improvement — often after 12-18 months. Your insurance company may offer a settlement early if they think you’ll need benefits for a long time, might experience setbacks or come down with new symptoms, or they want to issue the payout in a particular tax year.

Like everything else for workers’ compensation, the payout timeline depends on your state. For example, your employer must make payments within two weeks in California and within 6-8 weeks in New Jersey. In Illinois, however, payments usually start in two years.

Maximum Medical Improvement (MMI) FAQ: Frequently Asked Questions

1. How is MMI determined? Medical professionals typically determine MMI by assessing the worker’s injury or condition once they reach a stable state where further significant medical improvement is unlikely.
2. What happens after reaching MMI? Once you reach MMI, it signifies your condition is stable. That means further medical interventions may no longer significantly improve your condition. Your workers’ compensation will likely stop at this point. When that happens, you can either return to work or start drawing permanent disability benefits.
3. Can I contest MMI? Yes, you you contest MMI if there are valid reasons to believe that your condition isn’t at maximum medical improvement or if there are disputes regarding the assessment from medical professionals. You may need to seek an independent medical examination to determine if someone set your MMI erroneously.
4. How does MMI affect disability claims? MMI plays a crucial role in disability claims. It often determines the extent of permanent impairment and how much compensation or benefits you may qualify to receive.
5. Can MMI change over time? While MMI signifies a stable condition, there can be instances where it may change due to unforeseen circumstances, new medical developments, or worsening of the condition.
6. How does MMI affect my ability to work? Reaching MMI doesn’t necessarily mean full recovery or ability to work without limitations. It depends on the nature of your condition and its impact on your ability to perform job tasks.
7. Is MMI the same as being fully recovered? No, MMI doesn’t always mean being fully recovered. It indicates that your condition has stabilized, but you may still experience symptoms or limitations affecting your daily life or work.

An Attorney Can Potentially Get You 4x As Much Workers’ Compensation Pay

You can improve your chances of fair compensation after MMI by consulting an experienced attorney in your state. You pay $0 if your case isn’t successful and only a small one-time fee if you win.

People who work with a workers’ compensation attorney receive 390% higher payouts than those who don’t ($77,000 versus $16,000). On average, that means you keep anywhere from $73,917 in a state with a 5% attorney’s fee to $50,575 in a state with a 35% legal fee (the highest percentage in any state, and only for claims that go to trial and win).

Why settle for 22%-32% of the money you deserve by negotiating with the insurer directly? Click the button below to speak with a workers comp attorney.

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