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Maximum Medical Improvement
November 05, 2015

Maximum Medical Improvement

If you were injured on the job and it was someone else’s fault, you have a legal right to recover the costs of your medical care, lost wages and pain and suffering. But how much is your injury worth?

What is Maximum Medical Improvement?

That determination is vital in approaching and settling your work injury case as a workers compensation claim. A critical element of assessing your injury’s cost is what’s known as “maximum medical improvement.”

After your injury, you are deemed by your physician — and your physician only — to have reached your maximum medical improvement (MMI) when further meaningful improvement of your work-related illness or injury isn’t anticipated. You are then assigned an “impairment rating” (IR) by your physician as part of your claim.

Reaching MMI doesn’t mean you are fully fit and able to return to work in the same manner as before your injury. Rather, it means that your injury is not expected to improve significantly and now you must be assigned an IR by the same physician who determined you’d reached your maximum medical improvement.

In fact, MMI is especially pertinent after catastrophic injuries from which an employee may not fully recover, or from which recovery time may be substantial.

What is an Impairment Rating?

An impairment rating that’s assigned after MMI indicates the degree of permanent injury to the body of a worker who is not expected to gain full recovery.

If an IR is 15 or higher, a worker could be eligible for impairment income benefits as compensation for the damage caused to the worker’s body by a work-related injury.

Texas Law on MMI

By Texas law, if you haven’t yet reached MMI after 104 weeks (or two years) from the date benefits began, you are automatically deemed to have reached MMI, in what’s known as statutory maximum medical improvement.

When your IR rating is assigned, by Texas law an injured employee can receive three weeks of impairment income benefits for each percentage point of impairment. Thus, a 10% impairment rating would be three weeks times 10, providing 30 weeks of impairment income benefits.

As for the amount of impairment income benefits, which are paid weekly, these are determined by 70% of your average weekly wage. That is, if $1,000 was your average weekly wage, your impairment income benefits would be $700.

Impairment Rating Disputes

With this formula in mind, you may disagree with the impairment rating assigned by your doctor or the maximum improvement date. If so, you can file an impairment rating dispute.

You must file your dispute with the Texas Department of Insurance, Division of Workers’ Compensation. It’s important to contact the Office of Injured Employee Counsel as soon as you receive a Form DWC069 to assess the nature of your dispute. If you wait beyond 90 days, then the first impairment rating assigned becomes final.

Non-Work Cases of MMI

Not all MMI cases pertain to work injuries. Consider if a person was injured in a car accident and may not fully recover. That person should not file an immediate injury lawsuit, since it’s not yet clear how much his or her injury is worth. What remains to be determined is the person’s maximum medical improvement and the costs of not fully recovering.

Filing too early after an injury can reduce the amount of your claim. There may be unforeseen medical costs or work limitations that are not reflected in your lawsuit. Thus, it’s important to determine the point of MMI.

Don’t Settle for Less

The value of MMI is to alert victims that they should not settle their claim for less than it is worth. By defining the extent of an injury and its potential ongoing costs, it becomes possible to claim what an injury is worth — which may not be what an insurance company offers.

Insurance companies are in business to keep your money and make profits, not to dish out settlements freely and generously. An insurer thus will attempt to persuade a client to settle an injury claim prematurely — before the full extent of their injury is apparent.

Some persons eagerly accept such quick settlements without realizing that a more prudent course is to determine MMI and IR and to have an experienced injury lawyer on their side. They often can gain far more in a settlement by waiting to see what an injury truly is worth and then claiming that amount.

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