Who decides when I’ve reached my maximum medical improvement and can no longer receive workers’ compensation benefits?

When you’re injured on the job and receiving workers’ compensation, a lot of factors can interfere with your recovery benefits. The workers’ compensation benefits you receive for your injuries are partly based upon the amount of time you need for your recovery.

Although impractical, a perfect injury-to-recovery time ratio would depend upon your complete recovery coincidentally falling into specific timeframe perimeters. For instance, the severity of your injuries would determine the length—short-term, long-term, or total disability—of your recovery time and the duration of your workers’ compensation benefits.

Unfortunately, circumstances don’t work with mathematical precision. Specific injuries don’t heal on a fixed schedule, and sometimes benefits don’t extend to a full recovery. In fact, for many, the maximum medical improvement deadline comes far too soon, leaving injured workers few options for continued recovery.

And there is no guarantee that even the best medical care can put you back to the condition you were in before your workplace injury.

Maximum Medical Improvement

Workers’ compensation benefits provide coverage over a predetermined recovery period. However, when your recovery reaches the maximum medical improvement (MMI) stage, your recovery period may be terminated.

The term “maximum medical improvement” refers to the notion that your injury has reached the point where further treatment would not improve the injury any further. In some cases, MMI is reached when the injury has fully healed and the patient is back to the same level of health in which he was prior to the accident. However, MMI doesn’t necessarily denote a full recovery, just that treatment is no longer effective.

This diagnosis of MMI can mean three things for an injured patient:

  • His injuries are healed fully and he can return to work.
  • His injuries aren’t completely healed but the medical examiner has determined that the injuries will not get any better. The patient may be able to return to work if the job is within his new limitations.
  • His injuries aren’t healed but the medical examiner has determined that the injuries will not get any better. The medical examiner places an impairment rating on the injury, and the patient may be eligible for extended Impairment Income Benefits (IIBs).

Impairment Income Benefits After Maximum Medical Improvement

Each state has different rules and guidelines when it comes to MMI reporting. When dealing with Texas worker’s compensation claims, doctors use the Medical Disability Advisor (MDA) to decide when a patient has reached his maximum recovery and to determine if he is capable of returning to work.

When your health care provider determines you have reached maximum improvement, he will assess whether there is any permanent physical or functional damage. If the injury proves to be affected beyond normal healing, it will be assigned an impairment rating. This rating is used to denote the degree of permanent damage as well as eligibility for Impairment Income Benefits (IIBs).

In some cases, your employer may insist on an independent medical examiner (IME) to determine MMI status. If the IME declares that your injury is as healed as it ever will be, a maximum medical improvement alert will be sent to your workers’ compensation insurance provider. This diagnosis will effectively end your impairment benefits unless you’re eligible for IIBs.

Impairment Income Benefits end after you’ve received a total of three weeks of payments for each percentage of your impairment rating, up to 104 weeks. In other words, if you received an impairment rating of 10%, you would receive an additional 30 weeks of IIBs once you’ve reached your maximum improvement.

During this extended recovery time, you can take the opportunity to discuss further recovery options with an experienced workers’ compensation attorney. Worried that you may need extra medical attention further down the line? Concerned that your workers’ compensation won’t pay for experimental treatments? Contact our office today to schedule your FREE consultation with attorney Steve Lee.

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