Key Takeaways
- Maximum Medical Improvement (MMI) is a turning point in a Georgia workers’ compensation claim, but it doesn’t mean you’re fully healed or that your benefits automatically end.
- Your authorized treating physician determines when you’ve reached MMI after evaluating your recovery, medical records, and overall condition.
- After MMI, your claim may shift toward an impairment evaluation, changes to weekly income benefits, and discussions about Permanent Partial Disability (PPD) benefits.
- The impairment rating scale helps calculate PPD benefits, but future medical expenses, wage loss benefits, and other issues can also affect the value of your claim.
- If you disagree with an MMI determination or impairment rating, you may be able to seek a second opinion or challenge the evaluation through Georgia’s workers’ compensation system.
- Before accepting a settlement after MMI, understand how it may affect your future medical benefits and speak with a Georgia workers’ compensation attorney about your legal rights.
If you’ve been injured on the job in Georgia and are now receiving workers’ comp benefits, you’ve probably heard the term ‘maximum medical improvement,’ or MMI. But how is it determined? And once you’ve achieved it, does it mean that your workers’ compensation claim is ending and your weekly checks are about to stop, along with medical benefits?
You may wonder if your weekly checks are about to stop, if your doctor can still treat you, or if your workers’ comp claim is ending. Those are reasonable concerns because an MMI determination changes the direction of your claim in several ways.
Under Georgia workers’ compensation law, reaching MMI doesn’t necessarily mean you’ve fully recovered or that your case is over. Instead, it marks the point when your authorized treating physician believes further medical treatment isn’t expected to improve your condition. From there, your claim usually shifts toward evaluating any permanent impairment, determining what benefits may still be available, and deciding how the claim will move forward.
At Perkins Studdard LLC, we’ve helped injured Georgia workers through this stage of the workers’ compensation system for many years. In this guide, we’ll explain what maximum medical improvement is, how doctors make that decision, what happens to your benefits afterward, and what you can do if you disagree with the doctor’s opinion.
What Is Maximum Medical Improvement?
Maximum medical improvement (MMI) means your treating physician believes your work injury has improved as much as it’s expected to. At that point, further treatment isn’t expected to restore more function or reduce the lasting effects of the injury.
No single test determines when you’ve reached MMI. Instead, the physician does an overall evaluation and decides that your condition has stabilized. Reaching MMI doesn’t mean you’ve fully healed, however. You may still struggle with pain, reduced mobility, permanent work restrictions, or lasting impairment. Some workers return to their previous jobs after reaching MMI, while others can only do different work or can’t rejoin the workforce at all.
Please note: Your doctor’s instructions may include continued medical attention, such as prescription medication, follow-up appointments, medical equipment, and physical therapy. If that treatment is related to your work injury and otherwise authorized under Georgia’s workers’ compensation system, it may still be available after you’ve reached MMI.
What Changes After You’re Placed at MMI?
The MMI designation changes the direction of your claim. Instead of focusing on recovery, your doctor begins evaluating any permanent impairment caused by the injury. Often, the doctor may order a functional capacity evaluation to determine what permanent restrictions you have from your work injury.
This functional capacity evaluation often is extremely important to your workers’ compensation claim. The report of the evaluator can affect the amount of future weekly benefits you receive including wage loss benefits and Permanent Partial Disability benefits. It can also influence settlement discussions if you and the insurance carrier decide to resolve the claim through settlement.
Your Weekly Income Payments May Change
If you’re receiving Temporary Total Disability (TTD) or Temporary Partial Disability (TPD) benefits, reaching MMI doesn’t automatically end those weekly checks. Your eligibility depends on your ability to work, any medical restrictions that remain, the type of income benefits you’re receiving, and the time limits established under Georgia workers’ compensation law.
Some injured employees continue receiving weekly wage loss payments after reaching MMI because they still can’t go back to work or have returned to a lower-paying job. Others stop receiving those payments because they’ve found suitable employment at their preinjury earning capacity or reached the maximum benefit period allowed by law. The MMI determination is one part of that evaluation, but it isn’t the only factor.
Your Medical Care May Change
After MMI, the type of care your doctor recommends may change. Instead of trying to improve your condition, treatment may shift toward managing ongoing symptoms and preserving your current level of function.
Depending on your injury, your doctor may recommend prescription medication, follow-up visits, injections, vocational rehabilitation, physical therapy, or other necessary treatment related to your work injury. Your treating doctor also might refer you to a different doctor for management of your ongoing symptoms.
Your Doctor May Assign an Impairment Rating
Once your condition has stabilized, your doctor may determine that your injury has caused permanent loss of function. If so, they may assign a permanent impairment rating. That disability rating measures the lasting effects of the injury and serves as the basis for determining the amount of money you receive to compensate you for that permanent loss of function under Georgia law.
Because the impairment rating can affect the benefits available after MMI and play a role in settlement discussions, it’s important to review the rating carefully. If you believe it doesn’t accurately reflect your condition, you may have options to challenge it, which we’ll discuss later in this guide.
What Is a Permanent Partial Disability (PPD) Rating?
Once you’ve reached Maximum Medical Improvement, your authorized treating physician may determine that your work injury has caused a lasting loss of function. If that’s the case, they will normally perform an impairment evaluation and assign a percentage based on that loss. Georgia workers’ compensation law uses this percentage to determine Permanent Partial Disability (PPD) benefits for eligible injuries.
How Is the Evaluation Performed?
Your doctor performs this evaluation after determining you’ve reached MMI. In Georgia, the law requires physicians to use the Fifth Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment when assigning an impairment percentage in a Georgia workers’ compensation claim.
Depending on the injury, your doctor may evaluate range of motion, strength, nerve function, imaging results, surgical outcomes, and other objective medical findings. Some doctors refer injured workers to other medical providers to determine the appropriate impairment rating. After completing the examination, the physician assigns a percentage that represents the loss of function caused by the work injury.
What Does the Percentage Mean?
The percentage reflects the degree of permanent loss of function under the standards established by the American Medical Association Guides. For example, a shoulder injury and a knee injury are evaluated using different medical criteria. Likewise, two people with shoulder injuries may receive different percentages because the lasting effects of their injuries aren’t identical.
Georgia workers’ compensation law uses this percentage, together with the number of compensable weeks assigned to the injured body part under O.C.G.A. § 34-9-263, to determine Permanent Partial Disability benefits for eligible workers. If you believe the physician assigned the wrong percentage, you may challenge an impairment evaluation, which we’ll discuss.
How Does a PPD Rating Affect the Value of a Workers’ Compensation Claim?
The percentage assigned during your impairment evaluation can directly affect your compensation. For example, if 225 compensable weeks are allocated to your injured body part and your treating doctor assigns a 10% impairment rating, the calculation begins with 10% of those 225 weeks. Your weekly compensation rate is then applied under Georgia’s workers’ compensation rules to determine the amount of PPD compensation payable for that injury.
That calculation doesn’t determine everything you may receive through your workers’ compensation claim. It establishes the statutory PPD benefit, but other issues can also affect the value of a proposed settlement. These may include:
- Future authorized medical treatment
- Unpaid wage loss benefits
- Permanent work restrictions
- Future wage loss benefits
This is why injured workers should speak with a Georgia workers’ compensation attorney after receiving an impairment rating. A settlement may include issues beyond statutory PPD compensation, including future medical benefits and other rights that could be released as part of the agreement. It’s important to understand what you’re giving up in exchange for the payment being offered.
What If You Don’t Agree That You’ve Reached MMI?
Not every injured employee agrees that they’ve reached Maximum Medical Improvement. You may believe your condition is still improving or additional care could restore more function. In some situations, another doctor may conclude that your recovery hasn’t reached its maximum point and that more treatment could help.
If you disagree with your MMI determination, you may be able to seek a second opinion that addresses questions like the following:
- Has your recovery reached its maximum point?
- Could additional care improve your condition?
- Are your work restrictions appropriate?
- Does the impairment evaluation accurately measure your permanent loss of function?
Depending on the situation, this may involve an Independent Medical Examination (IME), or another physician’s evaluation.
This is one of the stages where many injured workers ask an attorney to review their case. A workers’ compensation lawyer can help schedule a second opinion, evaluate the doctor’s report, review the impairment evaluation, and explain the legal options available before you make decisions that could affect your remaining workers’ compensation benefits.
FAQs About Workers’ Comp and MMI
Can You Return to Work After Reaching Maximum Medical Improvement?
Yes. Reaching Maximum Medical Improvement doesn't prevent you from returning to work. Your ability to return depends on the work restrictions assigned by your medical specialists and the type of job available.
Some people return to the same position without restrictions, while others return with permanent restrictions or accept different duties. If your employer can't accommodate those restrictions, your workers' compensation benefits may be affected differently than someone who has returned to suitable employment.
Can Your Permanent Partial Disability Rating Change Later?
In some situations, it can. If your condition changes after an impairment rating has been assigned, another evaluation may become necessary. For example, additional surgery or a worsening condition could affect the degree of permanent impairment.
Any change depends on the medical evidence and how Georgia's workers' compensation laws apply to your claim. If you believe your condition has changed since your rating was assigned, it's a good idea to discuss your situation with an attorney before relying on the original evaluation. It is also important to know that there are time deadlines that may apply to seeking payment for additional permanent partial disability benefits.
Do You Have to Accept a Workers' Compensation Settlement After Reaching MMI?
No. Reaching Maximum Medical Improvement doesn't require you to settle your workers' compensation claim. Some injured workers decide to continue receiving benefits instead of accepting a settlement offer. Others negotiate a settlement after reviewing the value of their remaining benefits and future medical needs. Before accepting any agreement, it's important to understand which rights will continue and which rights you'll give up if the settlement is approved.
Talk to a Georgia Workers’ Compensation Attorney About MMI
Reaching Maximum Medical Improvement doesn’t mean you’re fully healed, and it doesn’t automatically end your workers’ compensation claim. Instead, it marks the point where your doctor evaluates any permanent impairment, your remaining benefits become clearer, and important decisions about your claim begin.
If you’ve been told you’ve reached or will soon reach MMI, don’t assume the doctor’s decision is the final word or that accepting the next step is your only option. At Perkins Studdard, we can review your claim, explain your rights under Georgia workers’ compensation law, and help you evaluate your options before you accept an impairment rating or sign a settlement agreement. To schedule a confidential consultation and case evaluation, call our law firm at (770) 285-0548.
