What is MMI (Maximum Medical Improvement)?

Maximum Medical Improvement

MMI is defined as “the date after which no further significant recovery from or significant lasting improvement to a personal injury can reasonably be anticipated, based upon reasonable medical probability, irrespective and regardless of subjective complaints of pain.” Minn. Stat. §176.011(25) (2010). Stated otherwise, MMI essentially means an injured worker is as good as they are going to get. An analogous concept is that of a healing plateau.

As indicated, establishment of MMI serves two basic purposes:

• First, it constitutes a defense to payment of additional temporary total disability benefits (TTD).
• Second, it serves as a place marker, so that where appropriate, a permanent partial disability (PPD) rating can be assigned.

In order for MMI to be used as a defense to payment of further TTD, it is not enough that the injured worker has attained MMI; rather, the injured worker must also be advised about reaching MMI. This is usually accomplished by the insurer mailing a medical report to the injured worker – indicating MMI has been reached. In legal terms, this is known as service of MMI. Service can be accomplished by mail, fax, email or in person. The latter could arise if an injured worker’s physician provided a report of work ability to the injured worker indicating MMI at an office visit.

As a general rule, 90 days after the injured worker receives notice of MMI, no additional TTD is payable. Exceptions can occur if the injured worker later becomes medically unable to continue to working or participates in an approved retraining plan. Those, however, are fairly limited circumstances.

Attainment of MMI does not act as a defense to payment of temporary partial disability benefits (TPD) nor permanent total disability benefits (PTD). Rather; it only constitutes defense to payment of additional TTD. Moreover, although it appears counterintuitive, MMI does not constitute a defense to claims for further medical treatment.

Under Minnesota law, MMI occurs upon proof that the employee’s condition has stabilized and will likely show little further improvement. Moreover, an injured worker may reach MMI regardless of further flare-ups or worsened symptoms. Factors to be considered by the court when dealing with the issue of MMI include history of improvement, current treatment, pre-existing conditions and proposed treatment. An injured worker can be at MMI even if still disabled and unable to work. Moreover, a worsening condition does not preclude a finding of MMI because the issue is whether the employee has reached a point where substantial lasting improvement is unlikely.

Attainment of MMI gets decided by a compensation judge – if disputed. The judge decides MMI based upon the medical opinions, the medical records and the employee’s testimony. The opinion of the treating physician does not necessarily govern. Sometimes, insurers will hire independent medical examiners to render opinions on MMI.