Medical and disability benefits are two of the primary benefit types offered for workers’ compensation claims. The availability and amount of these benefits can vary at different stages following an injury.
One of the most significant milestones to be aware of is Maximum Medical Improvement (MMI). Reaching MMI can severely alter your available benefits as well as impact your ability to work in the future.
Our Loganville, GA location employs some of the best workers’ comp attorneys in the state. We can help you achieve a better understanding of your legal rights and options for continuing benefits after receiving an MMI declaration. If you’ve recently reached MMI, then call our Loganville law offices at 470-518-5026 for a free review of your claim.
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What Is Maximum Medical Improvement?
Maximum Medical Improvement (MMI) is both a legal term and a medical term, which makes it very important to fully understand. If you have reached the MMI milestone, then it means you have reached a point where further medical treatment will not improve the condition of your workplace injury. Despite some confusion, this does not mean that the injury is fully healed, that you will be able to return to work, or that you must discontinue all future medical treatments. In the case of an occupational illness, MMI does not indicate that the illness has been cured.
You may continue to experience pain following an MMI diagnosis and you may live with a certain level of disability. After your physician has determined that treatment will not improve your injury they will assess your overall condition and provide you with a permanent partial disability rating. Any rating above 0 indicates that you have a level of disability. The rating you receive will impact the disability benefits you are able to receive going forward.
If your injury left you unable to work prior to receiving an MMI diagnosis, then you were likely receiving Temporary Partial Disability (TPD) benefits. TPD benefits have a maximum lifespan of 400 weeks or are concluded after achieving MMI. Going forward, you may receive Permanent Partial Disability (PPD) benefits in a similar manner.
The amount and duration of your PPD benefits are calculated using the disability rating you received from your physician. Certain body parts will result in a longer duration of disability benefits. For example, a disability that affects an upper or lower extremity can allow for benefits that last up to 225 weeks. A disability that only affects a finger may last between 25 and 60 weeks depending on which finger is disabled.
To determine the amount, you multiply the disability rating by the amount of workers’ compensation benefits you were receiving. A 10 percent disability rating for an employee who injured their big toe and was receiving $400 weekly would result in $40 in benefits per week for the next 30 weeks.
Who Determines When The Employee Has Achieved Loganville Maximum Medical Improvement?
The only person who has the authority to provide an MMI diagnosis is your treating physician. You cannot declare yourself that you have reached maximum improvement and it cannot be declared by your employer or their insurance provider.
An employer may attempt to intimidate you and bring an end to your benefits by claiming that you have healed from your injury. If this happens, we advise contacting a workers’ compensation attorney. Such a claim is beyond the scope of their authority and is not considered valid according to Georgia workers’ comp statutes.
Does Medical Treatment Continue After An MMI Diagnosis?
It can and likely will if the injury was severe. The insurance provider may attempt to end your medical benefits by claiming that you have reached MMI and require no further treatment. This is not allowed and a professional attorney can help ensure that your benefits continue.
Your physician may not provide you with an alternative medical treatment for the condition itself, but there are still other treatments you might require that are related to the injury. For example, most patients who suffer from permanent disabilities require ongoing treatment for pain management.
You may also require certain rehabilitation treatments to help you function normally. The insurance provider is required to pay for these treatments even after you have reached MMI.
What Happens If You Cannot Return To Work And Perform At The Same Level After Your MMI Diagnosis?
If you suffer from a permanent partial disability, then it is very likely you will not be able to work in the same capacity as before. Your physician may also impose certain work restrictions that prevent you from performing the same job.
For example, if you damaged your spine, then the doctor may impose a restriction that prevents you from lifting a certain amount of weight. If your job involved a lot of heavy lifting, then you simply would not be able to continue.
The PPD benefits you receive are intended to offset this loss in wages. You can continue to receive these benefits for a period of up to 400 weeks. The total amount of the benefits is calculated using the formula mentioned above.
The insurance provider may decide to settle your claim for a lump sum amount at this time. You may also enter into negotiations with the assistance of a workers’ comp attorney to encourage the insurance provider to settle. However, the insurance provider does have the right to refuse settlement and to instead provide benefits only on a weekly basis.
The exception to this rule is with catastrophic injuries and those that result in total disability. There is no 400 week maximum for these injuries due to the extreme severity of their nature. Total disabilities can involve the loss of both arms or legs, the complete loss of vision, severe burns over a large portion of the body, or permanent paralysis.
Call Us Today To Understand Your Loganville Maximum Medical Improvement
Reaching your MMI is an important milestone in the process of healing as well as the benefits process. It’s a time where you may consider negotiating for a lump sum settlement or you may pursue total disability benefits for an unlimited duration.
We advise discussing these options with a local workers’ comp lawyer. Call Workers Compensation Atlanta today at 470-518-5026 for assistance understanding your new MMI diagnosis.
