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What is Maximum Medical Improvement and What Happens Next?

When a Treating Physician in a workers’ compensation case says an injured worker is at Maximum Medical Improvement (MMI), what they are saying is that the injury has essentially plateaued.  There could be some minor improvements over time, but basically, it is a determination that, with reasonable medical probability, that the recovery process is over, that how you are now, is how you will be in the future.

At this point, you enter Part 2 of your workers’ compensation case, where your attorney will have you evaluated by a Medical Legal Evaluator. Sometimes, when the Treating Physician declares an injured worker MMI, they can write what is called a PR-4 Report. This MMI report includes the descriptions of the injuries, the body parts affected, what kind of Whole Person Impairment there is to those body parts, and what kind of future medical care the injured worker may need. Sometimes a case can be settled with a PR-4 Report, but ninety percent of the time, your attorney will go get a legal medical evaluation to get an un-biased doctor’s opinion. Typically, a case settles much quicker based on a PR-4 Report. An attorney knows when to take advantage of the expediency of a PR-4 report, where the layman lacks the knowledge to do so.

When the Treating Physician who is writing the report is also the surgeon who performed surgery on the injured worker, what is often observed, is their disability ratings are much lower than from an unbiased third party (i.e., Medical Legal Evaluator). Surgeons truly want to believe that what they have done has made the injured worker whole and are very reticent to provide whole person impairment ratings and find permanent disability when they have done the surgery.

Now let’s say your treating physician tells you that you have reached Maximal Medical Improvement, but you don’t think that you are. You may think your condition is either getting worse or conversely, you think that continued treatment is helping you get better. What are your options? Well, if you haven’t got an attorney at this point, this is an excellent time to get one. Your attorney will get another opinion from a Medical Legal Evaluator. When the injured worker is not represented by an attorney, they will receive paperwork from the insurance company that they fill out and submit to the DWC (Division of Workers’ Compensation). The Medical Unit from the DWC will then send the injured worker a list with a panel of three doctors. The injured worker will then pick one from the panel list. The injured worker will usually pick the doctor that they can see the soonest. The problem is, the usual reason why the chosen doctor is available sooner is that he is avoided by competent workers’ compensation attorneys because they write reports that favor the insurance company’s desire to save money and often don’t take into account all of the injured worker’s symptoms.

So, the injured worker goes to this available doctor and gets a non-favorable report. This scenario is very common and is very hard to deal with, even if at that point, the injured worker gets an attorney. A competent workers’ compensation attorney can fix this dire situation to some extent, but why make your case more difficult in the first place?

Another advantage of having a lawyer during this process leading up to the Treating Physician declaring the injured worker at MMI is that an attorney can call the insurance company or the attorney for the insurance company and can discuss using what is called an AME (Agreed Medical Examiner). Injured workers without attorneys are not allowed to do this. The advantage of using an AME is that you know who the doctor is going to be. Sometimes you get a panel list and all three doctors are bad for the injured worker. An attorney can overcome this dilemma with an AME. An AME is someone you know, you trust them, and they have written excellent reports in the past. An AME is fair to both parties because the insurance company knows that the doctor is reasonable.

Sacramento Workers’ Compensation Lawyer:

We hope this answers some questions you may have about Maximal Medical Improvement. For any additional questions please call The Law Office of Alice A. Strömbom at 916-444-7557 for your free consultation. We’re here for you.


Disclaimer: The content of this article, or any content of this website, is for general information purposes only. This information does not create and is not intended to create an attorney-client relationship. No content viewed should be taken as legal/medical advice in any circumstance, situation, or individual case.