How Does MMI Affect Your Workers’ Comp Case?

Reaching MMI is a significant turning point in your workers’ compensation case. It can significantly impact your benefits.

Reaching Maximum Medical Improvement (MMI) is critical in your Missouri workers’ compensation case. It can impact your benefits, settlement amount, and future medical care. Understanding what MMI means and how it affects your workers’ comp claim can help you make informed decisions and protect your rights.

Call (314) 361-4300 today for a FREE consultation, or visit hoffmannworkcomp.com to learn more.

Call (314) 361-4300 Online Contact Form

What Is Maximum Medical Improvement (MMI)?

Maximum Medical Improvement (MMI) is the point where your treating physician determines that your condition has improved as much as it is likely to, even with further treatment. It does not necessarily mean you are fully healed. It means your condition is stable, and no significant improvement is expected. (Missouri Division of Workers’ Compensation)

Who Determines When You Reach MMI?

Only your authorized treating physician, typically chosen by your employer or insurance company, can declare that you have reached MMI.

If you disagree with their assessment, you can seek a second opinion, but the insurance company may not be required to pay for it.
In case of disputes over MMI, the matter may be reviewed by the Missouri Division of Workers’ Compensation or an administrative law judge. (Missouri Revised Statutes Chapter 287 – Workers’ Compensation Law)

How Does MMI Affect Your Workers’ Compensation Benefits?

1. Temporary Disability Benefits End at MMI

Once you reach MMI, your Temporary Total Disability (TTD) or Temporary Partial Disability (TPD) benefits will stop, even if you can still not return to work.

TTD benefits: Paid if you cannot work at all during recovery.
TPD benefits: Paid if you can work but with reduced hours or wages. (Missouri Division of Workers’ Compensation – Workers’ Comp Guide)

2. Permanent Disability Benefits Are Determined After MMI

After reaching MMI, your doctor will evaluate you for permanent disability:

Permanent Partial Disability (PPD): You can still work if your injury results in lasting limitations.
Permanent Total Disability (PTD): If your injury prevents you from ever working again.

The extent of your disability is often measured through an Impairment Rating, which impacts your settlement. (Missouri Workers’ Compensation Law – RSMo 287.190)

3. Your Settlement Value Is Calculated After MMI

Insurance companies often wait until you reach MMI before offering a settlement because your future medical needs and disability level become clearer.

PPD Settlements: Calculated using the Missouri workers’ comp formula based on your body part’s disability rating.
PTD Settlements: These can include lifetime payments if you cannot return to any form of work. (Missouri Workers’ Compensation Statutes – RSMo 287.197)

Can You Get Medical Treatment After Reaching MMI?

Yes, reaching MMI does not end your right to medical care, especially if:

You require continued treatment to maintain your condition.
Your employer’s insurance is responsible for covering future medical expenses related to your work injury if stated in your settlement agreement.

However, disputes can arise if the insurance company claims your need for additional care is unrelated to your work injury. (Missouri Division of Workers’ Compensation)

Can You Dispute an MMI Decision?

Yes. If you believe you were declared at MMI too soon, you can:

Request a second medical opinion (although you may need to pay for it yourself).
File a claim for a hardship hearing with the Missouri Division of Workers’ Compensation.
Seek an independent medical examination (IME) through your attorney.

An administrative law judge may decide on your case if the dispute goes unresolved. (Missouri Division of Workers’ Compensation – Dispute Management)

How MMI Impacts Workers’ Comp Settlements in Missouri

Lump-Sum Settlement
- You may choose a lump-sum settlement, which closes your case but may end your right to future medical benefits.
Structured Settlement
- Alternatively, a structured settlement provides regular payments and may cover future medical costs.
Stipulation with Medical Rights
- Sometimes, you can settle your disability compensation but leave future medical benefits open, ensuring the insurance company continues to pay for related treatments. (Missouri Workers’ Compensation Law – RSMo 287.390)

Frequently Asked Questions (FAQs) about MMI

Can I be forced to return to work after reaching MMI?

If your doctor clears you to return with restrictions, your employer must try to accommodate you. If they cannot, you may still receive workers’ compensation benefits.

Should I settle my workers’ comp case before reaching MMI?

No. Settling before MMI is risky because you may underestimate future medical costs and disability.

Can I receive vocational rehabilitation after MMI?

Yes. If your injury prevents you from returning to your previous job, you may qualify for vocational training to help you transition into a new career.

Don’t Face MMI Decisions Alone – Get Legal Help

Reaching MMI is a significant turning point in your workers’ compensation case. It can significantly impact your benefits, settlement, and future care. Insurance companies often use MMI as an opportunity to minimize payouts, so it is critical to understand your rights and options.