Maximum Medical Improvement (MMI) for Workers’ Comp in Colorado
What to do after you’ve reached maximum medical improvement
Maximum medical improvement (MMI) is a critically important milestone in a workers’ compensation case. Understanding the meaning and impact of MMI can help injured workers prepare for the conclusion of their claim and what comes next.
Maximum medical improvement marks the point when the worker’s medical condition has improved as much as possible.
An MMI determination ends an injured worker’s entitlement to ongoing wage loss benefits, and can trigger the payment of a permanent disability award. Permanent disability awards are often the largest, most significant monetary benefit payable in a workers’ compensation claim. Therefore, if you have any concerns about your doctor’s determinations at the time of MMI, get in touch with a knowledgeable Colorado workers’ comp attorney right away.
What maximum medical improvement is (and isn’t)
A common misconception is that everything is back to normal or the injured worker is supposed to be 100% healed before reaching MMI. In reality, an MMI determination means that the injured employee’s condition is as good as it can get under the circumstances, and that no additional treatment would substantially improve the worker’s condition. Doctors should have used every reasonable treatment possible by this point.
At the time of MMI, the workers’ compensation physician may also assign permanent work restrictions if they deem them necessary, but that’s not required. Many injured workers are put at MMI, even with significant impairment and final award, but return to work without formal restrictions assigned. It simply depends on the circumstances of the injury.
Determining benefits after MMI
Once the treating physician determines that a worker has reached maximum medical improvement in Colorado, they also evaluate them for a potential impairment rating. Impairment ratings are assigned using the American Medical Association’s Guide to the Evaluation of Permanent Impairment. Once assigned, impairment ratings are used to help the insurer determine the value of the injured worker’s final award (called a permanent disability award).
At the time of MMI, there are several possibilities with respect to future benefits:
- No future benefits. If a treating physician places an injured worker at MMI with no impairment and no recommendation for future care, the claim is over with no additional benefits payable (unless action is taken to contest the physician’s opinion, as discussed below).
- Maintenance care benefits. In some circumstances, while a doctor determines that the injured worker has plateaued and therefore reached MMI, they may also recommend “maintenance” care, intended to keep the worker’s condition from deteriorating. These medical benefits are usually minor and only last for a few months or years.
- Permanent partial disability. Permanent partial disability is payable when the injured worker has been assigned an impairment rating but is capable of returning to work. While the word “disability” is in the name, it doesn’t mean that they have permanent restrictions. It’s simply the name for a monetary benefit payable at the conclusion of the claim to make up for any ongoing issues they have as a result of their injury.
- Permanent total disability. These benefits are paid for life if the worker is no longer able to work as a result of their occupational injury. Obtaining permanent total disability benefits in Colorado is difficult, and almost always requires attorney assistance.
How to contest an MMI determination
Injured employees who are unhappy about an MMI determination or the benefits payable following MMI can request a “Division Independent Medical Examination,” also known as a DIME. This process allows another doctor to provide a second opinion about whether MMI has been reached, the need for ongoing maintenance care, and any applicable impairment.
Insurance carriers also have the right to request a DIME. They do not usually do so in response to the MMI determination itself, but they may do so because they think an impairment rating is too high.
A DIME doctor can be selected by the parties to a claim, or through a state-assisted, partially random selection process. Insurance carriers will recommend a doctor whom they wish to perform the DIME. In almost every circumstance, attorneys don’t recommend agreeing to the doctor suggested by the carrier, as they are usually doctors who are known to be sympathetic to the insurer’s side.
If the parties do not agree on a DIME doctor, then they can petition the Division of Workers’ Compensation for a “DIME Panel.” The DIME panel is a list of 3 doctors who have been certified to perform DIMEs. The insurance company and injured worker each have the right to strike one name off the list, leaving the remaining doctor to carry out the exam.
The opinions of the doctor who performs the DIME are binding, barring a future hearing resulting in the decisions being overturned. Only “clear and convincing evidence” will cause the disability rating and MMI date determined by the DIME to be reversed.
The importance of a Final Admission of Liability
If an insurance carrier agrees with the treating physician or DIME physician’s recommendations, they will file a pleading called a Final Admission of Liability. The Final Admission of Liability indicates the final benefits being paid to the injured worker, and if it is not responded to within 30 days, it serves to close the claim. Injured workers have the right to contest the benefits awarded by the final admission of liability, but only if a formal objection is filed within the 30-day timeline.
Once an objection is filed, the case either proceeds to a DIME, or to an administrative hearing, depending on the circumstances. During an administrative hearing, an administrative law judge hears the facts concerning the case. Both parties can present evidence and call witnesses to testify, and then the judge makes a determination regarding what benefits are due.
Why consult a Colorado workers’ comp attorney
Once you’ve been put at MMI, time is not on your side.
Injured employees need to act as soon as possible if they disagree with the MMI determination or the benefits awarded through a Final Admission of Liability. Again, failure to respond to a Final Admission of Liability within 30 days bars any further objection or request for benefits.
If you are uncertain about how to proceed with your workers’ compensation claim or concerned about the MMI process, get in touch with an attorney who specializes in Colorado workers’ compensation cases.