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PROTECT YOUR BUSINESS

MMI in Workers' Comp: What Does Maximum Medical Improvement Mean?

5-minute read

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Ed Grasso

Ed Grasso

25 August 2022

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One of the most satisfying parts of running your own business can be bringing on employees. It’s usually a sign that your business is doing well and that idea you had to actually start it was a pretty good one after all.

It can feel great to hire people. You’re helping provide opportunities for others to earn money, gain experience, or build a career.

Adding to your payroll also can come with some additional challenges and questions, especially when it comes to workers' compensation insurance. And in just about every state in the U.S., if you have employees, you need to have workers' comp coverage.

We get it. Just getting your employees up to speed takes a good amount of time and effort. So trying to understand the ins, outs, and unique language of workers' comp probably isn’t something you’re excited about.

Not to worry. We’ve created a series of helpful articles to break it all down for you. Let’s get started by tackling, “What is MMI in workers' comp?”

MMI Medical Abbreviation Definition

MMI stands for “Maximum Medical Improvement.” Here’s what that means.

If an employee gets injured while on the job, workers' compensation insurance is there to help cover a variety of costs, including the ones needed to help heal and recover from the employee’s injuries.

The hope is that with time and treatment, your employee will fully recover and be able to get back to work and resume enjoying their life. Unfortunately, there may be a case where a complete recovery is not possible, and the employee has reached a point in the healing process where their condition will not improve further with standard medical treatment.

This is the point of “Maximum Medical Improvement,” or MMI.

MMI Personal Injury Example

To help get a better sense of how MMI works, consider this scenario. One of your employees is climbing a ladder on a job site when their foot slips from one of the rungs and they fall several feet to the ground. After a trip to the ER, they’re diagnosed with a back injury and are unable to work.

Typically, the costs for medical treatment, rehabilitation, and possibly lost wages would be covered by workers' comp insurance, up to the policy’s coverage limits.

If the policy covers this injury, after treatment has continued for a certain amount of time (more on that below), the workers' comp insurance company providing the coverage may request an MMI evaluation.

We Understand Small Businesses and Workers' Comp

OK, let’s take a quick break here.

If you’re feeling like the world of workers' compensation insurance is a complex and foreign one, you’re not alone. While workers' comp coverage is required in nearly every state, the laws and regulations can differ widely, even across state lines.

The good news is we understand business insurance — especially workers' comp. Just as importantly, we know what it’s like to run a small business. We work with thousands of small business owners throughout the U.S. If you need workers' comp insurance or just some answers to workers' comp questions, we’re happy to help.

And we make the process easy. Just tell us a little bit about your business online, or you can speak with one of our licensed insurance pros at 884-643-7272.

Whether it’s MMI or other workers' comp questions, we can get the answers for you. And we can help get the coverage you may need for the state, or states, where you do business.

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How is MMI Determined?

While MMI is an insurance term, a physician needs to determine if and when an employee has reached MMI.

If an employee is receiving workers' comp payments, the insurance company may, at some point, request an independent medical examination to determine if the employee has reached MMI.

Based on the exam and the employee’s medical history, the physician will send a report, to:

  • The insurance company
  • The employer
  • The employee
  • The employee's treating physician

If the treating physician doesn’t agree with the report, the claim can be forwarded to a workers' comp commission or judge for a hearing.

If the treating physician agrees with the report, it’s determined the employee has reached MMI and will likely no longer receive additional payments from the insurance company. But that’s not always the end of the story.

What Happens After MMI in Workers' Comp?

Once an employee reaches MMI, the process may move toward determining if the employee has a permanent disability, and to what degree. As with workers' comp insurance itself, the rules governing disability vary from state to state.

Generally, the employee’s treating physician will make the call as to whether an impairment is temporary or permanent, and whether it creates a partial or total disability. Part of this evaluation often includes a Medical Impairment Rating (MIR) rating.

What is a Medical Impairment Rating?

A medical impairment rating is a measure that helps determine the severity of an employee's injury. The rating is a percentage (between 0 and 100), with 100% being fully impaired and 0% being not impaired at all.

The result of an MIR is used to determine how long an employee may receive benefits, how much compensation for which they may be eligible, and whether or not they can return to work.

MMI rating for a back injury that is severe.

Let’s go back to our injured worker. If his MMI report includes an MIR of 30%, it means he has only 70% functionality of his back. Depending on the state where he works, he may be able to receive partial permanent disability benefits.

Part of the disability determination can depend on the type of job the injured worker performed. If the injury prevents the employee from being able to do a job (in our example, let’s say that the back injury prevents our employee from climbing ladders and carrying heavy tools and equipment), the employee may be considered to be disabled.

On the other hand, if the employee had a desk job, they might be able to go back to work, and would likely have a lower disability rating.

How Long Does it Take to Reach Maximum Medical Improvement?

When an insurance company can request an MMI evaluation The amount of time it may take to reach MMI will can vary, based on the employee's injury. A broken leg may heal in several weeks or a few months. On the other hand, more complex injuries, such as back injuries that may or may not require surgery, could require anywhere from a few weeks to several months to heal. The insurance company will consider these timetables before requesting the MMI.

In addition to the type of injury, the type of treatment available also can affect when an MMI evaluation is appropriate. For example, if there is a delay in getting access to required medication or surgery, it may delay an MMI evaluation.

Taking Care of Your Employees Matters

Building a business is much like building just about anything. If it’s done with skill, care, and the best possible materials, there’s a good chance it will thrive and last.

Finding good people to hire is hard. And once you’ve found them, you want to do all you can to treat them well. That’s one of the big reasons to have workers' compensation insurance and an understanding of how it works.

We know the value of having good people to work with. We also know it doesn’t have to be complicated and difficult to get workers' comp insurance to help ensure they are taken care of if they get sick or hurt on the job.

We’re here to not only help get you the insurance coverage you may need. We’re also here to help you understand what that coverage is and what it does. You can find a wealth of great articles about workers comp and other small business topics in our online resource center, Simply U.

Ed Grasso

Written by

Ed Grasso

As a 9-year-old at summer camp, I hated it — especially after being pulled screaming from the pool during the swimming competition. While this left me without an aquatic achievement patch, it also inspired the letter to my parents that got me an early release from Camp Willard. That showed me the power of writing. I’ve done my best to use it only for good ever since, such as writing for small business owners.

This content is for general, informational purposes only and is not intended to provide legal, tax, accounting, or financial advice. Please obtain expert advice from industry specific professionals who may better understand your business’s needs. Read our full disclaimer

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