Maximum Medical Improvement and Permanent Partial Disability
What is “maximum medical improvement?”
“Maximum medical improvement” is the point at which it is no longer likely that a body part or organ system damaged in a work-related injury will get better. It is the point when a percentage of permanent partial disability may be estimated by a physician and benefits for permanent partial disability may begin. “Maximum medical improvement” is usually abbreviated as “MMI”
For example, a work-related fracture of an employee’s right arm may require surgery, with screws and plates implanted, following which the employee is totally disabled for several months. During this time the employee will be paid temporary total disability benefits. The employee may undergo extensive physical therapy to improve the damaged arm. At a certain point, although the arm may still be healing, the doctor may release the employee to do light duty work or possibly even to do one handed work. During this period the employee may be paid “temporary partial disability” benefits. If the employer doesn’t give him light duty work and he can’t find light duty work elsewhere, he may be required to look for work in order to receive weekly temporary partial disability benefits. These benefits may continue until the doctor determines that the patient has “reached the stage of ultimate improvement,” or reached MMI. At that time, if the employee has the capacity to perform gainful employment, his benefits may be changed to permanent partial disability benefits. If the injury to the employee’s right arm results in a 20% permanent partial disability of the arm, and if the employee is right handed, in almost every state he will be paid a certain number of weeks of permanent partial disability benefits. The number of weeks of benefits is determined by a statutory schedule which sets a specific number of weeks of benefits for each listed body part or organ system. For example, in Connecticut, 20% permanent impairment of the master arm requires the payment of 41.6 weeks of permanent partial disability benefits at the injured employee’s compensation rate; the statutory schedule provides that 100% loss of use of the arm equates to 208 weeks of disability benefits, so that 20% x 208=41.6 weeks of benefits, subject to the state- wide maximum compensation rate.
The legal standards for payment of benefits after an injured employee reaches maximum medical improvement and the types of benefits which are available very somewhat from state to state. In some states, benefits for permanent partial disability are payable only if the injured employee is unable to continue to work in his or her same occupation. In some states, if a person is partially disabled but not totally disabled, indemnity benefits (i.e. payments to the injured worker rather than payments for medical treatment) are available after maximum medical improvement only if the employee is losing earnings because of the injury.
Are any weekly benefits available after the permanent partial disability benefits have been paid?
In those states where permanent partial disability benefits are paid according to a statutory schedule, which represent the vast majority of states, the availability of wage loss benefits after the statutory number of weeks of permanent partial disability benefits have been paid varies a great deal. In some states, wage loss benefits may be payable to the partially disabled employee indefinitely; in some states, for a limited period; and in some states not at all. In those states where benefits after MMI are paid only in the event of a proven loss of earning capacity, the maximum duration of these wage loss benefits may also vary.
Does reaching MMI mean an injured employee can work?
No. For example, a person with a severe injury may reach MMI but still be totally disabled from working. For example, an injured employee with a significant degree of paraplegia may be so badly crippled that he is unable to work, yet he may have reached MMI, because he is unlikely to get better. Reaching MMI merely means that the employee, in the judgement of a doctor, is unlikely to improve further and therefore may be evaluated as having a permanent impairment of the injured body part. In most states, a person who has reached MMI and yet who is totally disabled is eligible to continue to receive temporary total disability benefits. In some states, the total disability benefits may continue indefinitely; in other states there is a statutory limit to the duration of total disability benefits.
Can an injured employee receive medical treatment after reaching MMI?
Yes; under the law of most states, if continued medical treatment is reasonable or necessary, the injured employee may continue to receive appropriate treatment. For example, a person with silicosis, a lung disease, may have reached MMI, and yet may need continued medical care, such as inhalers, respiratory therapy, or oxygen, to continue to function or even to continue to live at all. A person with reflex sympathetic dystrophy may have reached MMI but need continued doctors’ visits, psychiatric treatment for depression and anxiety, pain medication or injections with botulinum toxin. If the workers’ compensation commissioner finds that the continued treatment is reasonable or necessary, he may order the employer or insurer to continue to pay for the medical treatment indefinitely. In a few states, however, the laws severely restrict the employer’s obligation to supply even necessary medical treatment after MMI. A very few states have caps, either a limit to the total dollar amount of medical benefits or a limit on the period of time for which medical benefits must be paid.
What happens if doctors disagree concerning MMI?
If a doctor hired by the employer to give his opinion disagrees with the treating physician concerning the date of the MMI, with the extent of permanent impairment, the employee’s ability to work, or the reasonableness of the continuing medical treatment, the workers’ compensation judge decides which opinion or opinions will control, and will issue orders accordingly. The injured employee may request a hearing with the workers’ compensation board to resolve disputes.
What if the injured employee’s medical condition declines after MMI?
If the work-related medical condition of an injured employee who has reached MMI later gets worse, the treating physician may decide that the degree of permanent impairment of the injured body part has increased. If this occurs, the physician may find an increase in the degree of permanent impairment, for example in an injured right master arm with osteomyelitis for which the degree of permanent partial impairment increases from 20% to 40%. If this occurs, the injured employee may be eligible to receive additional permanent partial disability benefits. However, if the condition has worsened so much that the injured employee is unable to work, he may be eligible for total disability benefits. Since these issues are usually contested by the employer, the judge can decide whether these additional benefits must be paid.
How is the date of MMI determined?
The physician may determine a precise date for MMI. However, where a doctor fails in the body of a report to identify a precise MMI date, the injured employee and the employer generally use the date of the report as the MMI date. Where doctors have different opinions concerning the date of MMI, the workers’ compensation judges or commissioners are afforded wide discretion to select among the varying opinions in order to determine the date of MMI.
Donna Civitello and Robert F. Carter
Carter & Civitello
One Bradley Road Suite 305
Woodbridge, Connecticut 06525
The firm of Carter & Civitello represents injured employees. Robert Carter was educated at Harvard, Yale, and the University of Connecticut School of Medicine. Donna Civitello was educated at Yale and the University of Connecticut. Donna and Bob are authors of the treatise, Connecticut Workers’ Compensation Law (Thomas-West 2008) and have written and taught extensively on issues of work-related injuries. Donna is the author of Injured on the Job, A Handbook for Connecticut Workers (1992). They have both been selected by their peers for inclusion in The Best Lawyers in America for many years. They have represented many hundreds of injured employees.