Understanding Maximum Medical Improvement and Its Impact on Your Injury Claim

One important term to know regarding your injury claim is MMI, meaning maximum medical improvement. MMI refers to the point where an injury victim has recovered from their injuries to the fullest potential, as determined by the treating physician.

MMI does not necessarily mean the injury victim has completely healed. MMI refers the point where an injury victim won’t recover any further, even after additional medical treatment.

MMI is important in personal injury cases because the true value of these cases cannot be determined until MMI is reached.

Physicians determine when MMI is reached based upon comprehensively evaluating your medical history, the findings of your physical examinations, and how you respond to treatment. Physicians will assess if your condition stabilizes and if further medical treatment will likely improve your condition. The metric may be different in different types of injury cases. For example, the metric for determining MMI may be different between a car accident case or a case involving exposure to dangerous chemicals such as paraquat & Roundup.

While MMI can only be determined by the treating physician, in workers’ comp cases, employers may also ask for an independent medical examination with a doctor of their choice.

The Significance of MMI in Personal Injury Cases

MMI is important in personal injury litigation because when people are injured due to negligence, the negligent party is financially liable for their injuries. This means the negligent party is liable for things like future medical bills, loss of the use of parts of the body, pain and suffering. These things can often not be quantified until MMI has been reached.

MMI can affect a personal injury case’s timing. While people typically wish to get litigation out of the way and put it behind them as quickly as they can, sometimes it’s best to be patient. When you wait until you reach MMI before reaching a settlement or going to court, it’s possible to more fully understand your condition so a proper value can be given to your case.

As an example, what if you reach MMI yet still can’t stand on your injured leg for a long period of time, and this prevents you from returning to work? You would then have more lost wages that you would be entitled to recover compensation for. You may be unable to recover these wages if you settle or go to court before reaching MMI in this situation.

MMI impacts personal injury cases by:

• Finalizing medical expenses: Reaching MMI lets you calculate the total medical expenses you incur, including future and past treatments which relate to your injuries.
• Determining long-term effects: Once you reach MMI, your injuries’ lasting effects can get assessed. This is critical for calculating potential compensation and long-term needs.
• Establishing pain and suffering compensation: Understanding the potentially permanent nature of disabilities or injuries once you reach MMI helps to place a value on your pain and suffering.
• Affecting settlement negotiations: Your position regarding settlement discussions with insurers can be strengthened by knowing your injuries’ full extent when you reach MMI.
• Setting the stage for a lawsuit: If you need to file a lawsuit, a strong foundation for that lawsuit is provided by reaching MMI. Your attorney will be able to file a lawsuit armed with a full understanding of the injuries you’ve suffered.

How MMI in Workers Comp Influences Settlement Negotiations

Workers’ compensation insurance companies use MMI to evaluate your workers’ compensation claim.

MMI will be a benchmark in your workers’ comp claim. It indicates that your medical condition is stabilized. An injured worker having their condition stabilized allows for future costs and needs to be more clearly assessed, and this is critical for settlement discussions.

MMI is a basis for negotiations for injured workers. Settlements often get negotiated based upon the disability rating given to an injured worker after they have reached maximum medical improvement. Determining MMI as well as any assigned ratings of disability can provide a foundation for determining the value of a settlement. For example, while injured workers can receive temporary disability benefits prior to reaching MMI, if they’re still unable to work once reaching MMI, this may increase the value of the settlement.

When you reach maximum medical improvement, this allows for the costs of ongoing medical care in the future to be more accurately predicted. This is vital for determining the value of a settlement. This will include costs for medical equipment, medications and ongoing treatment.

Once you reach MMI, an experienced workers’ compensation lawyer can use the information about your condition provided by your physician to get the most compensation possible for you, including possible disability benefits such as permanent partial disability benefits.

When To Settle Your Injury Claim

Injury claims can take a long time to settle properly. However, it’s a bad idea to settle before reaching maximum medical improvement.

It is important to wait until you reach MMI before settling your injury claim because:

Your claim can’t be accurately valued prior to reaching MMI: Under California law, if someone else’s negligence injured you, you’re entitled to financial compensation for pain and suffering, lost wages, future and past medical expenses and more. Your physician can’t know what future treatments you’ll need and how your life will be affected by your injuries until you reach MMI. This may affect the ability you have to work in the future as well as the pain and suffering you’ll need to go through for the rest of your life.

Also, an injury lawyer won’t be able to accurately place a value on any future damages which can be recovered from an insurance company until you reach MMI and your physician gives you a final prognosis. If you wish to recover all the money you’re entitled to, you need to wait to reach MMI so you know the true value of your claim.

Your settlement is final: Once you reach a settlement with an insurance company, it will represent a final, full settlement of your claim. You won’t be able to reopen the claim or file a new claim if you discover later on that your injuries were worse than first thought. By settling your claim too early, you might lose out on money required to pay for medical treatment or replace income you will lose if you can’t work.

Exceptions to the MMI Rule

There are a couple situations where it may be beneficial to accept a settlement offer prior to reaching MMI.

The first situation is when you have suffered serious injuries and it’s clear that the insurance policy limits are not going to cover the full value of your claim. As an example, say you suffered a severe traumatic brain injury in a car accident. The driver who caused your accident only has a policy limit of $100,000. In this situation, if the insurance company offers you the policy limit, a lawyer may recommend that you accept the settlement offer prior to reaching MMI since the true value of your claim is likely to exceed the policy limit.

Another situation where it may be beneficial to accept a settlement offer prior to reaching MMI is when your injuries are minor and may not require a ton of medical treatment. However, before you accept an offer, you need to be sure you won’t suffer additional health complications. Talk to your doctor regarding your injuries as well as how they may affect you in the future. You can accept settlement offers in this situation if your injuries won’t lead to further complications needing medical treatment in the future. Even if you wish to accept a settlement offer before reaching MMI in a situation like this, you should consult with your lawyer first so they can negotiate with the insurance company for a fair settlement. Early offers from insurance companies are often intentionally small because insurance companies expect lawyers to value cases higher so fair compromises can be reached.

The Role of a Personal Injury Lawyer in MMI Determinations

A personal injury lawyer can:

• Interpret medical reports: A lawyer can analyze expert opinions and medical reports to understand your injuries’ true extent and if you have reached MMI or not.
• Seek second opinions: A lawyer may recommend that you receive a second medical opinion in order to challenge an MMI determination which is disputed.
• Communicate with medical providers: A lawyer can maintain open communication with your treating physicians to make sure your condition and your progress towards MMI is documented.
• Protect your rights: A lawyer can make sure that the process of determining MMI is done fairly and that your rights get protected.
• Provide legal guidance: A lawyer can give you legal guidance so you understand the implications of reaching MMI.

Why You Should Consult a Lawyer Before Accepting Settlement Offers

First of all, lawyers can evaluate whether your settlement offer is fair based on MMI. An experienced personal injury law firm will have extensive knowledge of how to place an accurate value on an injury case.

The value of your case is based upon the damages you suffered. A lot of these damages can be little things that an average layperson would overlook. Experienced injury lawyers know all of the damages, no matter how obscure, you are entitled to compensation for in your injury case, and will take all of them into consideration when determining if a settlement offer is fair or not.

Second, if you don’t have a lawyer, unless you’re being offered a policy limits settlement, you can guarantee that your offer from the insurance company is not a fair one.

When people injure other people via negligence, their insurance companies are obligated to pay the injury victims up to the policy limits. However, this obligation can only be enforced in civil court via a lawsuit. What this means is that if you can’t sue an insurance company over a low ball offer and win, you can’t force them to pay you what you’re entitled to. And, if you don’t have a lawyer, you can’t win a lawsuit.

So, if you don’t have an attorney, the insurance company knows you don’t have any way to force them to pay you what you’re entitled to. So, obviously, they’re just going to offer you low ball offers, knowing you can’t make them offer you any more money.

Studies show that injury victims recover a lot more financial compensation for their injuries once they hire lawyers. This is even after attorney fees are taken into account. The reason for this is because once lawyers get involved, insurance companies would usually rather offer fair settlement offers than pay expensive legal fees just to lose a court battle. Almost all of our injury cases settle out of court for this reason.

Having a lawyer by your side during settlement negotiations is the best way to make sure you recover fair compensation for your injuries.

Protecting Your Rights After Reaching MMI

Once you reach MMI, the next appropriate step to take is to have your lawyer negotiate with the insurance company for a settlement. If negotiations fail, then the next step is to have your lawyer file a lawsuit against the insurance company.

It’s also important to document any ongoing symptoms or limitations post-MMI. You should keep a journal of your everyday experiences once you reach MMI. Be sure to note any ongoing symptoms or limitations you experience in this journal. Also, be sure to discuss these ongoing symptoms or limitations with your doctor so these symptoms and limitations can be documented in your medical records. This documentation can be important during settlement negotiations or at trial.

Be sure to follow your treatment plans dutifully and do what your doctors tell you to do. Be sure to attend any and all followup appointments. If you fail to dutifully follow treatment plans or attend all followup appointments after reaching MMI, insurance companies will be able to claim that your failures are responsible for your ongoing symptoms or limitations, and this can hurt your chances of recovering maximum compensation for your injuries.