Any Injured Indiana worker with an open worker’s compensation case will be confronted with lots of new legal terms. The HR Reps and worker’s comp insurance adjusters know these terms well. Without understanding the basics, you’re at a disadvantage when trying to exercise your rights under Indiana’s Worker’s Compensation Act. One of those important terms is Maximum Medical Improvement, commonly abbreviated to MMI.
Maximum Medical Improvement, or MMI, is a phrase of legal (not medical) origin. It is the equivalent of medical quiescence. Indiana courts call it the point in which a worker has achieved the fullest reasonably expected recovery with respect to a work related injury. Indiana doctors use MMI to indicate that an injured worker no longer requires medical care that will improve his/her condition. If you really think about it, the term sort of speaks for itself. The doctor is saying there is no more available medical care that will make your current medical condition any better. MMI is a very important point in any worker’s comp case.
MMI Is An Important Time In Any Indiana Worker’s Comp Case
Maximum Medical Improvement (MMI) findings trigger quite a few new milestones:
- If your injury was minor and you have no lingering effects, the worker’s comp company may close your case;
- If you had been receiving Temporary Total Disability (TTD), the worker’s comp insurance company will terminate future payments;
- The treating doctor will issue a Permanent Partial Impairment (PPI) rating unless your injury was minor;
- The treating doctor may assign permanent restrictions depending on the severity of your injury;
- Calls into question the need for future medical care (often called palliative care);
- It triggers the injured worker’s right to dispute the doctor’s determination and possibly obtain an Independent Medical Examination (IME) free of charge;
- If you’re assigned a PPI rating, the worker’s comp insurance company will mail you an offer to settle, asking you to sign unfamiliar paperwork without offering an explanation;
- It often serves as an opportunity to settle your case on a full and final basis (which is different than the offer to settle above).
Continue reading to learn more about each of the above milestones.
MMI and Minor Injuries
If your injury was minor, when placed at maximum medical improvement (MMI), your doctor will likely release you to full duty, impose no permanent restrictions, and you can go back to work fully recovered. If you have no lingering effects, it is unlikely you’ll be entitled to a Permanent Partial Impairment (PPI) rating (after all, the term itself implies you have some sort of permanent impairment!). As long as the worker’s comp insurance company paid you for any time off, paid all the medical bills, and reimbursed mileage for any travel outside the county of employment for medical care, the case will probably be closed and you can move on with the rest of your life. You probably don’t even need to read the rest of this blog post!
But the reality is, if you’re reading this blog post in the first place, you likely sustained a more serious work injury. So, read on!
Temporary Total Disability (TTD) May Be Terminated
Imagine you’ve sustained a work injury that was so serious that during the course of your treatment, the treating doctor orders you off work. As long as you are still under the doctor’s care and before he/she places you at MMI, you are entitled to receive Temporary Total Disability (TTD) payments. Under Indiana law, however, the worker’s comp insurance company is permitted, by law, to stop paying TTD once the treating doctor says you’re at maximum medical improvement (MMI). That can put you in a serious bind if the MMI determination is accompanied by issuance of permanent restrictions that don’t allow you to return to your old job. If you can find another job within your restrictions, great, but that’s not always possible.
Continue reading below, because if you disagree with the doctor’s determination of MMI (in other words, you feel there IS more medical care out there that will improve your condition), there are ways to dispute the determination, request an Independent Medical Examination, and possibly re-instate TTD.
A PPI Rating May Be Issued
PPI stands for “Permanent Partial Impairment,” and as the name implies, this rating is an attempt to measure the permanent impairment you have sustained as a result of a work injury. It is often the #1 factor in determining the dollar value of your worker’s comp case.
Not all injuries – particularly minor injuries – result in the issuance of a PPI rating. But for more serious injuries, once the treating doctor has placed an injured employee at maximum medical improvement (MMI), the worker’s comp insurance company is under a legal obligation to obtain a PPI rating. It usually comes from the treating doctor. The insurance company’s obligation to request and obtain a PPI rating is NOT OPTIONAL.
If your doctor releases you, the insurance company should notify you of your PPI rating within a fairly short period of time (a few days to a few weeks). If the insurance company does not notify you of your PPI rating, you need to hold them accountable and force them to provide you documentation of the rating. At Salmon & Hewins, we frequently see this happen, and we’re forced to expend time and energy forcing worker’s comp insurance companies to do what they’re legally supposed to do.
You May Be Assigned Permanent Restrictions
The older we get, the more we come to realize that some injuries don’t allow us to do the things we once did! Following the doctor’s MMI determination, the worker’s comp insurance company will ask the treating doctor whether any permanent restrictions should be assigned (or the doctor may assign them on his/her own). This may be done in conjunction with a Functional Capacity Evaluation (FCE).
You need to be aware of any permanent restrictions, because not only can they impact what jobs you may or may not be able to do after your injury, they may mean you are permanently and totally disabled under Indiana Worker’s Compensation law, which unlocks a new class of future benefits. For less serious injuries, the treating doctor may offer you the opportunity to accept or reject restrictions. There are pros and cons to each, and Salmon & Hewins frequently advises clients what to be on the lookout for in the event they’re given this option.
It’s Time To Determine If You Will Require Future Medical Care, i.e. Palliative Care
Some injuries heal completely. Others don’t heal completely you may able to cope with whatever limitations exist without the assistance of doctors. However, there is a class of injuries that may require future medical care, often called palliative care. In Indiana, palliative care is not designed to cure you, or improve the underlying medical condition. Palliative care is the type of medical care that is necessary to limit or reduce the amount and extent of your impairment. People with serious nerve injuries, serious spine injuries, or catastrophic injuries can frequently benefit from palliative care. Being placed at maximum medical improvement (MMI) is the perfect time to evaluate the palliative care issue, because it can serve as the dividing line where acute medical care ends and chronic medical care begins.
Unless you’re either on, or will soon be on, Medicare (in which case a Medicare Set-Aside may be prepared, Worker’s comp insurance companies almost never volunteer to provide palliative care. At Salmon & Hewins, we frequently help clients navigate the numerous legal issues associated with obtaining palliative care recoveries for our clients.
You May Have the Right To Request an Independent Medical Exam (IME)
Once the doctor places you at MMI and the worker’s comp insurance company decides to stop paying TTD, they usually are required to issue a document entitled Report of Temporary Total Disability (TTD)/ Temporary Partial Disability (TPD) Termination. You can see a sample of this document below.
Form 38911: Report of Temporary Total Disability (TTD)/ Temporary Partial Disability (TPD) Termination
Worker’s compensation insurance adjusters and lawyers commonly refer to this document as a “Form 38911.” If you get this document in the mail or via e-mail, and you disagree with the termination of benefits (most likely because you feel you aren’t really at MMI despite what the doctor says), you have just 7 days to request an Independent Medical Examination (IME) that you will not have to pay for. Injured workers are not automatically entitled to a IME. Salmon & Hewins can help injured Indiana workers determine whether or not to request an IME.
This Is A Good Time To Evaluate Whether Settlement Is Appropriate
When a doctor places an injured employee at maximum medical improvement (MMI), that serves as a good time to evaluate whether settlement is appropriate. The Salmon & Hewins website has tons of discussion about settlement of worker’s comp cases, but in a nutshell, there are two basic methods to resolve a case (many identify a third way to settle, but it is somewhat rare).
The first is commonly called a “compromise agreement” and it’s achieved using the form below, called an Agreement to Compensation of Employee & Employer. Lawyers and insurance companies frequently call this a “Form 1043.”
Form 1043: Agreement to Compensation of Employee and Employer
Post-MMI, if you are assigned a PPI rating, the worker’s compensation insurance company should send you the above form. It will be filled out completely, offering you the opportunity to accept settlement. It will include additional paperwork asking you to waive your right to consult a physician of your own choosing. The letter may even “instruct” you to sign in the spaces they highlight, and provide you with a return envelope. We advise our clients to never sign and return those forms until they fully understand what they are doing. People who sign and return those forms may lose out on many opportunities available under the Indiana Worker’s Compensation Act. Please review our website for more information. You can also contact Salmon & Hewins with questions.
Compromise agreements are somewhat infrequent. They can be good options for people with less serious injuries who stay on with the original employer. For instance, a factory employee whose work involves overhead shoulder work may want to accept payment of the PPI rating. It would be helpful to keep the case open in case there is a re-occurrence of the same injury. This type of settlement is not perfect, however. Employees who report a re-injury to the same body part frequently have their requests for medical evaluation denied. The HR rep’s or insurance adjuster’s argument is frequently that “the doctor already placed you at MMI.” Salmon & Hewins frequently assists clients in getting re-evaluated following re-injuries in situations like this.
Full and Final Settlements a.k.a. Section 15 Agreements
The second common method of settlement is a “full and final” settlement, which those of us in the business frequently call a Section 15 Agreement. The Section 15 Agreement gets its name from the Indiana Worker’s Compensation Act’s provision governing this type of settlement.
The vast majority of cases settled on a Section 15 basis. You – the injured employee – agree to fully and finally release the employer of any liability to pay for any other Worker’s Compensation benefits in exchange for a lump sum payment. The lump sum payment is always for more money than you would receive under a “compromise agreement.” You have to be very careful before you sign one of these agreements, however.
By signing these agreements, you give up your right to reopen your worker’s comp case in the event your work injury worsens, and you may be on the hook for medical expenses that worker’s compensation insurance ordinarily should have paid. Just as with “compromise agreements,” you should not sign a Section 15 Agreement unless and until you fully understand the contents of the Agreement. Hewins Law Firm helps make sure our clients avoid these – and many other – pitfalls potentially associated with signing Section 15 Agreements.
As you can see, there is much more to maximum medical improvement (MMI) than simply understanding the meaning of the term. When clients ask how long their worker’s comp case will take, we frequently tell them there are two phases. MMI is the dividing line between Phase I (treatment) and Phase II (consideration of remaining options). That’s why it’s important to not only understand the meaning of MMI, but also what lies ahead once the treating doctor places you at MMI. As always, please contact us if you have any questions. At Salmon & Hewins, the initial consultation is always free.