Maximum Medical Improvement (MMI) is a designation given by a treating physician when an injured person’s medical condition has stabilized and is not expected to improve further with routine medical treatment. This determination signifies that the patient has reached a medical plateau, not that they are fully healed or without pain. MMI is a legal trigger point, primarily used in workers’ compensation and personal injury claims, that shifts the focus from curative care to long-term compensation. Once MMI is established, the nature of the claim changes entirely.
The Immediate Financial Shift
Reaching the MMI designation has an immediate and significant impact on the injured person’s finances. The most direct consequence is the cessation of temporary wage replacement benefits, such as Temporary Total Disability (TTD) payments. TTD payments are designed to cover lost wages while the individual is actively recovering and undergoing curative treatment. The insurance carrier is authorized to terminate these temporary benefits once the MMI finding is formally reported. This transition shifts the claim from a temporary status to a determination of permanent compensation, which is calculated differently and often received as a lump sum or structured settlement. This change can create financial instability, as weekly TTD checks stop before permanent compensation is finalized or paid.
Determining Permanent Impairment Ratings
The next step after MMI is the assignment of a Permanent Impairment Rating, which forms the basis for Permanent Partial Disability (PPD) compensation. This rating is a numerical percentage reflecting the permanent loss of function or the lasting effects of the injury on the body as a whole. Physicians determine this percentage using standardized guidelines, most commonly referencing the AMA Guides to the Evaluation of Permanent Impairment. The Guides provide a framework to objectively measure the loss of function in specific body parts or organ systems. For instance, a physician might use tables to measure joint range of motion or use a Diagnosis-Related Estimate (DRE) method for spinal injuries.
If multiple body parts are affected, the physician uses a combined value chart from the Guides to aggregate individual ratings into a single Whole Person Impairment (WPI) percentage. This WPI rating serves as the medical estimate of the degree to which the individual’s capacity to perform common daily activities has been diminished. This final percentage is then used by insurance companies, administrative boards, or courts to calculate the monetary value of the final settlement or award.
Ongoing Medical Care Authorization
MMI signifies the end of authorized curative treatment—procedures or therapies aimed at improving the medical condition. However, the injured party is still entitled to authorized maintenance or palliative care to manage the permanent condition. This distinction is necessary because maintenance care prevents the condition from deteriorating or manages symptoms like chronic pain. Examples of authorized ongoing care include prescription medications, periodic physical therapy sessions, and regular doctor visits for pain management. The insurance carrier remains obligated to cover the reasonable and necessary costs of this non-curative care required to maintain the individual’s condition at the MMI level.
What to Do If You Disagree
If the injured person disagrees with the MMI determination, the assigned impairment rating, or the denial of future medical care, formal steps can be taken. The first step involves seeking a second medical opinion, typically through an Independent Medical Examination (IME). An IME is an examination performed by a physician who is not the treating doctor, chosen to provide an unbiased assessment. If the IME report contradicts the initial MMI finding or rating, the injured party must formally dispute the determination by filing an appeal or requesting a hearing. Since challenging an MMI designation is a legal process involving complex medical documentation, consulting with an attorney specializing in workers’ compensation or personal injury law is advised to navigate the appeal procedures effectively.