What Is Maximum Medical Improvement in My Workers’ Compensation Injury Case?

Injured Worker Assisted

What Is Maximum Medical Improvement?

If you’ve been injured at work and are receiving medical treatment through authorized providers, you may have heard the term “maximum medical improvement” or MMI. What is it? In Colorado, medical treatment provided to injured workers is generally governed by a set of Medical Treatment Guidelines or MTG.  Relying on the MTG, a doctor assigned to your case will ultimately determine that additional medical care will not further improve your condition. That’s MMI.

MMI is specifically defined by statute as “… a point in time when any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonable expected to improve the condition.”

When someone reaches MMI, they have reached a plateau. The finding of MMI, however, does not mean that all medical treatment ends. Many injured workers remain entitled to maintenance care which is designed to keep them at the level of function present when they reached MMI. Maintenance care is often as important as care designed to improve a condition. Where appropriate, and so long as steps are taken to secure maintenance care, it can continue as long as the injured worker needs it.

Colorado law does not require injured workers’ to be placed at MMI within a particular time. It’s generally decided on a case-by-case basis. Before you reach MMI, it’s important to focus on healing. Communicate all symptoms, improvement and difficulties to your treatment providers. Unless a particular form of treatment is causing unforeseen complications or problems, follow your doctor’s advice and recommendations. If you are working with a physical or occupational therapist, make sure they understand your job requirements and always do your homework. Perform assigned exercises as often as recommended and as demonstrated by your therapist

As apparent from the statutory definition of MMI cited above, reaching MMI is an important milestone in every Colorado workers’ compensation case. After a doctor has determined that you have reached MMI, they will decide whether you have an impairment rating and then assign one, as necessary.

Permanent disability benefits are the financial benefits you can receive if your doctor determines that that you have an impairment rating or it is determined that you cannot return to work. The Colorado Department of Labor and Employment says that you may receive:

  • No benefits: When no impairment rating has been assigned.
  • Permanent partial disability: When an impairment rating has been assigned
  • Permanent total disability: When it is determined you are unable to work. In this case, you may be entitled to lifetime benefits.

When You’ve Been Placed at Maximum Medical Improvement, But Disagree

Injured workers frequently disagree with a determination that they have reached MMI.  This often happens when an assigned provider has refused to investigate or treat certain injuries or symptoms. Disagreements can also arise when an injured worker is left with restrictions that prevent them from returning to their date-of-injury job or when the worker was continuing to improve when treatment was terminated.

Injured workers may also dispute the impairment rating – if any – assigned by their doctor when the injured worker was placed at MMI.

If this is your situation, it’s possible to contest determinations of MMI and/or impairment. You can ask for something called a Division Independent Medical Examination or DIME.

What is a Division Independent Medical Examination?

A DIME is like a second opinion. In a DIME, a doctor performs another exam and will make a finding regarding the date of maximum medical improvement. Depending on the DIME doctor’s opinion concerning MMI, the DIME doctor may also assign an impairment rating. A DIME doctor’s opinion on the issue of MMI carries great weight. In most cases, when a DIME doctor determines that an injured worker is not at MMI, that injured worker will receive additional evaluation and/or treatment.

A DIME doctor’s opinion on MMI can be overturned, but the DIME doctor’s opinion must be overcome by clear and convincing evidence and overcoming these opinions is challenging.  Finally, a DIME doctor’s opinion concerning impairment for some injuries must also be overcome by clear and convincing evidence.  Remember, however, that on impairment a DIME doctor can: (1) increase an impairment rating; (2) assign the same impairment rating; or (3) lower the impairment rating.

The system is complicated, filled with procedural pitfalls, and obtaining a DIME can be risky.  Anyone who is dissatisfied with a finding of MMI, or with their impairment rating, should contact a lawyer who specializes in workers’ compensation.

Why Hiring the Right Lawyer Is Important After You Reach MMI

Because the law around maximum medical improvement can be complex, and insurance companies can be biased in their choice of authorized doctors and benefit determinations, it is critical to retain a skilled attorney.

Your attorney must have the in-depth knowledge of the law necessary to effectively protect your rights and make sure that you get the financial compensation and medical care that you deserve.

Contact Keating Wagner Polidori Free

The workers’ compensation attorneys at our Denver law firm have extensive experience representing the survivors of workplace accidents and injuries. We can help you understand your options after maximum medical improvement. Contact us for a free and confidential consultation. Call 303-534-0401 or send us a message to talk with us about your options.