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What is Maximum Medical Improvement (MMI) in New York Workers’ Comp?

Our attorneys can guide you throughout your recovery

Recovering from a work injury is a process. You need to report the injury, get medical attention, and then follow your doctor’s instructions: take your medications as prescribed, go to your follow-up appointments, go to physical or occupational therapy, and so on. Some injuries heal quickly, while others may take months or years, and still others are permanent.

In workers’ compensation claims involving long-term and permanent injuries, a key change occurs when you reach maximum medical improvement (MMI). What MMI is and what it means for your claim can be confusing and controversial. Our experienced New York workers’ compensation attorneys can guide you through the process.

What’s the definition of maximum medical improvement?

In New York, reaching maximum medical improvement means you have recovered from your work injury or illness to the greatest extent that can be reasonably medically expected, and further improvement is unlikely.

If you have a permanent injury, MMI is the moment when your workers’ compensation claim transitions from “temporary” disability to permanent disability. It’s also when you will be evaluated for schedule loss of use (SLU) or non-schedule loss of use (PPD) benefits.

Finally, note that under New York law, it is presumed you will reach MMI two and one half years (130 weeks) after the date of your injury, regardless of the actual status of your medical treatment.

What does workers’ compensation cover before you reach MMI?

There are two types of workers’ compensation benefits you can receive prior to reaching maximum medical improvement. First, workers’ compensation pays for the full cost of reasonable and necessary medical treatment for your work injury. That includes doctor’s appointments, medication, medical devices, surgery, and other medical procedures. In other words, before you reach MMI, workers’ comp pays for the treatment you need to reach MMI.

Second, you can receive temporary disability benefits. If you are totally unable to work because of your injury, then temporary disability pays two-thirds of your average weekly wage (AWW). If you are able to work but need to take on reduced hours or reduced duties for less pay, then workers’ comp pays two-thirds of the difference between your pre-injury average weekly wage and your post-injury wage.

What happens when you reach MMI?

Maximum medical improvement significantly changes the workers’ comp insurance company’s obligation to pay for medical treatment and services. That doesn’t mean you can’t get medical bills paid at all, but the insurance company only has to pay for medication and medical services needed to maintain your condition or manage your ongoing symptoms.

What types of disability benefits can you get after reaching MMI?

If you are determined by the Workers Compensation Board to be partially disabled, then you can receive permanent partial disability benefits. The type of benefits you can receive depends on the body parts affected by your injury:

  • Schedule loss of use (SLU) benefits are awarded for permanent injuries to the extremities (arms, legs, hands, feet, etc.) as well as the eyes and ears. Each body part is assigned a certain number of weeks of compensation, which is then multiplied by that body part’s percentage of impairment. You receive two-thirds of your average weekly wage for that many weeks (regardless of how many weeks of work you actually missed).
  • Non-schedule loss of use (PPD) benefits are awarded for permanent injuries to other parts or systems of the body. Your PPD benefits are calculated using a formula based on your overall loss of wage-earning capacity.

If, even after reaching maximum medical improvement, you are totally disabled, then you can receive permanent total disability benefits: two-thirds of your pre-injury average weekly wage each week. There is no durational limit on permanent total disability benefits.

Who decides when you have reached MMI?

In general, your treating physician determines when you have reached maximum medical improvement. Your physician compiles the results from your medical appointments, then shares that information with the workers’ compensation insurance company.

If the insurance company agrees that you have reached MMI, then your case transitions from temporary to permanent disability as described above. If they disagree, however, they can require you to attend an independent medical examination (IME) with a physician of their choice (making the word “independent” a bit of a misnomer). The IME doctor may confirm or dispute whether you have reached maximum medical improvement.

Can you dispute your finding of maximum medical improvement?

Yes, either you or the insurance company can dispute whether you have reached MMI. As with most other aspects of workers’ compensation, MMI disputes are handled in a hearing with an administrative law judge (ALJ). The ALJ will consider the medical evidence and other relevant information and reach a decision on whether you have reached MMI.

If you disagree with other aspects of your claim related to MMI, you can likewise bring those disputes to an ALJ hearing.

Can MMI be changed once it has been reached?

Yes, it’s possible for your finding of maximum medical improvement to be changed if your medical condition changes. While reaching MMI means further improvement in your condition is unlikely, that doesn’t mean it’s impossible. Advances in medicine or unexpected changes in your medical condition could change your MMI status, which in turn could have big implications for your workers’ compensation claim.

How an experienced workers’ compensation attorney can help

The ways MMI status can affect your workers’ compensation claim are complex and technical. That’s why it’s so important to have an attorney who knows the system on your side. An experienced workers’ compensation lawyer can advocate for your rights throughout your medical treatment and represent you in any disputes regarding your MMI status or your entitlement to medical and disability benefits. Your attorney can also negotiate with the insurance company to reach a mutually agreeable solution and help you move forward from your work injury.

If you have questions about your MMI status or any other aspect of a workers’ compensation claim, the experienced attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP are here to help. Give us a call or contact us online for a free consultation with a New York workers’ compensation attorney.

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