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What Is Maximum Medical Improvement?

Posted on: August 8, 2017 9:00 AM
Antonio Bruni
Antonio Bruni represents injured workers and Social Security Disability claimants. A graduate of the University of Houston Law Center, Antonio practiced law with the Pensacola branch of McConnaughhay, Duffy et. al, where he represented both small and large employers in workers' compensation claims throughout the Florida panhandle, and the Morton Law Centers of Florida, prior to joining Michles & Booth.

Many workers are faced with injuries that prevent them from returning to work for weeks. When that happens, they should receive workers’ comp while pursuing medical treatment for their injuries. But there will come a time when the weekly benefit checks stop. What happens next is one of the most contested parts of the Workers’ Compensation program.

Why did my weekly checks stop?

Why did my weekly workers' benefit checks stop?Maximum medical improvement is a term in worker’s compensation that means that you are as good as you are going to get, that your medical condition has recovered to a point that it is not going to recover any further. What that means and where it gets confusing is that it does not mean you are all better, that you’re 100% and that you’re as good as you were the day before the accident. What it means is that you are as good as you are going to get.

What that means is that your weekly checks are going to stop. Once you have reached maximum medical improvement, the insurance company is going to say that your right to temporary indemnity benefits, whether it be the temporary total disability or temporary partial disability, is gone. You don’t get those anymore.

You are now going to get what is called ‘Impairment benefits’. Your weekly checks are going to stop. You are going to be expected to return to work if possible and the carrier is going to pay you an impairment benefit.

What are impairment ratings? 

Once you’re placed at maximum medical improvement, the physician that places you there will have to assign you a permanent impairment rating. That’s a percentage number. A lot of the time, doctors who are accustomed to the system will just rattle it off, saying “You’re at MMI and you have a three percent.” You’ll say, “What’s MMI? What do you mean three percent?”

What are impairment ratings and permanent impairment benefits?MMI is maximum medical improvement. Three percent is your permanent impairment rating, which means that is your loss of function. What the doctor does is he goes to a book called: ‘The 1996 Florida Uniform Permanent Impairment Rating Schedule‘. He looks up your condition and sees the level of recovery that you’ve made and assigns the impairment based on what that book says. It’s usually, if you have a back surgery, seven percent. For pain, it’s anywhere one to three percent. They’re fairly set percentages. That’s your impairment rating.

What are permanent impairment benefits?

That percentage then translates into a permanent impairment benefit. The carrier has to pay them to you 14 days after they find out that you’ve been placed at MMI. They are paid at 75% of your temporary total disability rate.

If you were making $600 per week before you got hurt, your temporary total disability rate would be $400 per week. Your impairment benefit is 75% of that, so $300 per week. If you return to work, they can cut that $300 per week in half. You could go from making $600 per week to your impairment benefit being worth $150 per week.

The rate they pay those at is also a set rate. The way that works is if your percentage of impairment is from 1 to 10%, you get 2 weeks of lost wages. If it is from 11 to 15%, you get 3 weeks of lost wages. If it is from 16 to 20%, you get 4 weeks of lost wages. 21% or higher, you get 6 weeks of lost wages for each percentage point.

So, if your doctor has given you a 3% impairment rating, you get 2 weeks of permanent impairment benefits for every percentage point – six weeks of benefits. After that time has ended, you will not receive any additional permanent impairment benefits.  

This is one of the things that is most unfair about worker’s compensation. They do not have to pay you what is known as ‘Wage loss’. The permanent impairment benefit is meant to cover both your pain and suffering essentially and also your wage loss – your loss of ability to do the job you used to do.

If you used to be able to a job making $30 an hour, and now you can only make $9 an hour, your permanent impairment benefit is meant to make up for that. They don’t owe you lost wages forever because you can still earn $9 an hour. Which brings us to our next topic, which is:

Do they have to pay me lost wages forever if I can’t do the exact job I used to do?

What happens if I can't do the same job as before?The answer to that is ‘No’. All social security, all worker’s compensation has to pay you is your permanent impairment rating and your impairment benefit. If you can’t do the exact job you used to do, they pay you an impairment benefit. What they care about is can you do any job, which is at least sedentary work, within a 50 mile radius of your house.

You say, ‘Yeah, but I used to be able to earn $30 an hour. Now I have to work a job that pays no more than $9 an hour. You’ve cost me $21 an hour for the rest of my life.’ Work comp will say, ‘It’s not our problem. The statute is written so that as long as you can still do that job, even if it’s only part time, we haven’t disabled you. We don’t have to pay you lost wages forever. All we have to pay you is that impairment benefit.’

This is arguably the most unfair part of worker’s compensation law in the state of Florida; they can completely gut your ability to learn a living and not be responsible for more than a few hundred dollars after you’re placed at maximum medical improvement, all because they can say you can go back to working the cash register at a gas station at $9 an hour when you used to make $30 or $40 an hour.

Unfortunately, that’s the way the legislature has written the law. They do not have to pay you lost wages forever if you can’t go back to doing what you used to do. 

If you have any questions about that, we are here to help you. We have options. There are things we can do to try to fix that and try to get something out of the carrier for it. Call us today. We have no obligation free consultations.


 
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