maximum medical improvement

Maximum Medical Improvement Date: Mar 4, 2019

If you’ve been injured on the job, you are entitled to receive workers’ compensation benefits in Illinois. These include lost wages benefits and benefits to cover medical costs and treatment. These benefits will help you if you are injured for the short-term, and they will also provide long-term benefits if your injuries are permanent.

While there are many terms that you’ll need to know in regard to a workers’ compensation claim, one of the most important terms you will hear is maximum medical improvement (MMI).

What Is Maximum Medical Improvement?

MMI is the point at which your doctor believes that your condition has stabilized. It could mean that you are completely healed, or it could mean that your injury or your medical condition will not get any worse or any better.

MMI is important because it plays a key role in establishing several factors about your workers’ compensation claim. For a physical injury, it means that any further treatment you receive or will receive will not change your condition for better or worse. For a patient with a work-related mental disability, it means that your doctor or doctors believe that you have healed as much as you’re going to heal. Normally this occurs two to three years after a serious brain injury. You may still have trouble functioning, putting your thoughts together or completing simple tasks but when you reach your MMI, the likelihood that you will recover your complete mental capabilities is unlikely.

MMI is also essential in terms of reaching a workers’ compensation settlement with your employer’s insurance company. Until you reach your MMI, you should never begin to discuss or accept a settlement offer with the insurance company. Until you reached MMI, you won’t know what future medical treatment you may need, whether you can return to work on a part-time basis or if you are permanently disabled and unable to work.

Who Determines Maximum Medical Improvement?

Only your physician can determine your MMI date. Your lawyer, their lawyer or the insurance company itself play no role in determining your MMI. Only after your doctor conducts a thorough assessment can they determine if your disability or condition has stabilized and no further recovery will take place.

While your physician will provide your initial MMI date, your employer’s insurance carrier will likely want you to use one of its physicians for an independent medical examination (IME) to determine if you have really reached your MMI. The IME physician will send a copy of their examination to you and your doctor. If your doctor agrees with the insurance company’s physician that your MMI date means that you are healthy enough to return to work, your benefits will stop and you will return to your job.

If both physicians agree that your MMI has been reached and that you will have an ongoing disability, you may be interested in working out a settlement with your employer’s workers’ compensation insurance company.

If your physician disagrees with the IME, it is likely that your claim will be forwarded to the Illinois Workers’ Compensation Board or to a judge who hears workers’ compensation cases to make a final decision on your disability benefits and how much you are entitled to receive.

Here’s an example of how a doctor determines an injured worker’s MMI:

  • An employee of a delivery company is involved in a motor vehicle accident while doing her route one day. Under workers’ compensation, it doesn’t matter whose fault it is that the employee was injured — she is still eligible for workers’ compensation benefits.
  • During the initial examination, her doctor determines that she will need several months of physical therapy for a leg injury she suffered during the accident. After the course of physical therapy is completed, the worker’s leg is much better, but she still feels pain and walks with a limp.
  • On further examination by her doctor, they conclude that, while her physical condition has improved, she will continue to suffer pain in her leg. As a result, she will need to take pain medication, receive occasional physical therapy and wear a compression stocking for the rest of her life.
  • If the doctor determines that no other treatment will improve the condition of her leg and that she will have pain in that leg for the rest of her life, then she has reached her maximum medical improvement.

Maximum Medical Improvement and Workers’ Compensation

Once you have reached your MMI, the insurance company may reach out to you with a settlement offer. Or you may decide to tell your attorney to make a settlement demand on your behalf. Your attorney and the attorney for the insurance company will make several different offers back and forth until they find a figure that both parties can agree upon.

As we noted above, you never want to think about a settlement until you have reached MMI. If your employer’s insurance company tries to talk to you about a settlement before you have reached MMI, you should politely decline. You are not obliged to accept any settlement offer. Until you reach your MMI, you have no idea what your future medical costs will be or how severe your disability will be.

If your injury is severe, and the insurance company knows it, they will try to settle with you as soon as possible to save money. Remember — the insurance company is not your friend. They are not there to ensure that you receive all the benefits to which you are entitled. It is their job to make sure that you receive as little money as possible, and if they can, not pay you anything at all. That is why in Illinois any settlement reached within the first seven days of injury is considered fraudulent.

It’s your attorney’s job to make sure that the settlement offer considers any future medical expenses and lost wages. Once the contract has been reached, the Illinois Workers’ Compensation Commission must approve it. The commission prefers specific language to broad language to protect workers. They will either affirm the settlement or send it back to the parties to work out any problems.

For injured workers in Illinois, when you sign a settlement, you relinquish all your rights to future workers’ compensation benefits. That’s why it’s important to work with an attorney who can protect your rights and make sure you receive appropriate compensation to help you in the future.

What Happens After Your MMI Has Been Determined?

Once your doctor has determined that you have reached MMI, they may ask another physician or physical therapist to perform a functional capacity testing. This will help determine whether you need work restrictions. Some restrictions may only be temporary, but others will be permanent.

If the employee’s injury makes it impossible for them to perform any type of task, they may be eligible for permanent total disability benefits. If they can work but can’t fulfill their previous duties, it can be handled in several ways:

  • The employer finds the restricted employee a new job within the company. If this new job pays less than the employee’s previous position, the employee can collect wage differential benefits. These benefits are normally calculated as a percentage of the difference between the wages they were receiving when they were injured and what the new position will pay.
  • If the employer is unable to find a new position for the employee because of their workplace restrictions, the employee is eligible for vocational training. In this case, the employer and their insurance company will cover any lost wages and will pay for the expenses of the vocational school while the employee is learning new skills.
  • The employee can ask for permanent partial disability benefits (PPD). These benefits are calculated by determining a percentage of disability that the employee suffered as a result of their injury using the commission’s Schedule for Body Parts chart. For instance, taking the above example of the driver with the injured leg, it may be determined that she has lost 30 percent use in her leg. The benefits she receives will be based on 30 percent of what the state has determined an injured worker should receive for a leg injury over a prescribed period.

When an employee can no longer return to work, they are eligible to receive either permanent total disability benefits (PTD) or the PPD benefits mentioned above:

  • PTD benefits are designed for workers who are not expected to be able to work again. It will be necessary to provide permanent compensation for lost wages and ongoing medical expenses.
  • PPD benefits can also last a long time. The difference is that the employee in question may be able to perform some work-related tasks, either with their current employer or after vocational training a new one. Benefits will provide for lost earning power according to the schedule mentioned above.

Maximum Medical Improvement Impairment Rating

In the past, when a workers’ compensation arbitrator was considering what PPD benefits an injured worker may receive, they needed to consider four factors:

  • The age of the injured worker the time of their injury
  • The injured worker’s future earning capacity
  • The injured worker’s job
  • The severity of the injured worker’s injury or illness based on medical evidence

Employers and their insurance companies did not like the idea of paying workers’ compensation benefits to an individual for a lifetime. As a result of their complaining to politicians, the state in 2011 pushed through changes to the workers’ compensation law that reduced the benefits injured workers may receive for their injuries.

One significant change was to introduce an impairment rating evaluation (IRE) as a factor that a workers’ compensation judge or arbitrator may consider when determining final damages for an injured worker. The impairment ratings were based on guidelines from the American Medical Association (AMA), which were decidedly not favorable for workers.

It is important to note, however, that a 2016 ruling by the Illinois Appellate Court, Workers’ Compensation Division, said it is not mandatory for an injured worker to submit an AMA impairment rating to determine PPD. If an impairment rating is not available, the arbitrator can still use the other factors mentioned above to determine how much an injured worker shall receive in benefits. You should also believe the insurance company if it tells you the only benefits to which you are entitled are based on the impairment ratings.

What Is an Impairment Rating?

In states that use the impairment rating evaluation, if a worker has a PTD or PPD, the insurance company can request an IRE after 104 weeks. In states where IREs are mandatory, the injured worker must attend. If you are an injured worker living in Illinois and you receive a request for an IRE, talk to a workers’ compensation attorney immediately.

At that point, the doctor, who was chosen by the insurance company, will use the AMA guidelines to place the worker on an impairment rating scale:

  • Impairments are judged on whether they are permanent or temporary.
  • Disabilities are judged on whether they are partial or total.

Under the IRE system, an impairment refers to the physical or neurological condition of the individual, while disability refers to the restrictions and limits to everyday tasks that are the result of the person’ s disability.

An employee who has a zero percent IRE rating is expected to perform any task without a problem — they have no impairment. A worker with a rating of more than 50 percent would be considered totally impaired and have difficulties performing basic tasks.

For example, an impairment rating may say your physical condition allows you to return to work or that your IRE rating is relatively low, which means the insurance company can reduce its financial obligations to you. But this does not take into account that your disability means you have trouble completing daily tasks.

IREs are very controversial. In 2017, the Pennsylvania Supreme Court found that IREs were unconstitutional. However, the Pennsylvania legislature introduced new IRE guidelines in 2018 that changed the way IREs were determined and lowered the threshold of total impairment to 35 percent.

If you wish, you can get your regular doctor to perform an AMA impairment rating if they feel they are familiar enough with the rating system to use it. If not, ask them to create a report that talks about your injury and documents the following items:

  • If you have lost any range of motion
  • If you have lost strength
  • If your injury has caused any measure of atrophy of your tissue mass
  • Any other measurements that would help establish the extent and the nature of your impairment
  • Your job
  • Your age at the time you were injured
  • Any other medical issues, demographic factors or medical issues that could limit your future earnings
  • If you have any permanent work restrictions and how your employer has tried to accommodate them

Gathering evidence will help you achieve a much fairer PPD settlement. If you or the insurance company is unhappy with the arbitrator’s final decision, you may appeal to the Workers’ Compensation Commission.

Let Argionis and Associates Help You With Your Workers’ Compensation Claim

If you would like to have a better understanding of how maximum medical improvement or the impairment rating evaluation affect your eligibility for workers’ compensation benefits, contact the Chicago law offices of Argionis and Associates. Our talented team of Chicago workers’ compensation attorneys can help you receive all the workers’ compensation benefits to which you are eligible.

You can call us for a free consultation at 312-782-4545 or contact us online to leave your contact details and information on your workers’ compensation case.