Understanding MMI Workers’ Compensation in Georgia
The unfortunate reality for many workers injured on the job is that they often never see the accident coming. However, what’s more surprising is how long the recovery can take. You may think you’ll be back to work in a week or two, but months later, your injury isn’t healing as fast as you would like. In some cases, full recovery may never happen and you reach a point where “you’re as good as you’re going to get.” When that occurs, your doctor may declare that you’ve reached Maximum Medical Improvement (MMI) and release you to return on a “as needed basis” or “PRN status” (latin for “pro re nata” or as the situation dictates).
In this guide, our Georgia workers’ compensation law firm will explain what reaching MMI means and how it impacts your workers’ compensation claim. If you need immediate help accessing your workers’ compensation, we encourage you to call Ramos & Law at (770) 637-0105 for a free consultation to discuss your options.
What Does MMI Mean?
Maximum Medical Improvement (MMI) refers to the point where an injured worker’s condition has stabilized and is unlikely to improve with further treatment. In Georgia, reaching MMI doesn’t necessarily mean that you no longer need medical treatment. Many workers may continue to require rehabilitation, therapy, or pain management even after their condition has plateaued.
What is Maximum Medical Improvement (MMI) in Georgia Workers’ Compensation?
In Georgia, the definition of MMI is usually determined by a medical professional known as the authorized treating physician who concludes that the injured worker that while he or she has not fully recovered from their work-related injuries, his or her condition is not likely to improve appreciably even with added medical care. That isn’t to say that workers who have reached their Maximum Medical Improvement don’t require any medical treatment. Even though your condition may not improve with treatment, most workers who fall under Georgia’s MMI workers’ comp definition may still require regular treatment such as rehabilitation or physical therapy, medication, pain management, and routine follow ups with various medical professionals to prevent their work related condition from getting worse.
The Role of MMI in Workers’ Compensation Claims
The very basic goal of workers’ compensation is to provide financial and medical support to a worker who has been injured on the job. If you are eligible for workers’ comp, you are entitled to your benefits throughout the recovery process. If you are deemed fully recovered, you will no longer have access to these benefits, and you will be expected to return to work.
However, in more serious cases, you may not reach a full recovery and may suffer long-term or even lifelong impairments as a result of your workplace injury. When your doctor considers you to have reached your Maximum Medical Improvement, your worker’s comp benefits should be restructured to apply to long-term treatments for your condition. If you are no longer able to return to your previous job or seek regular employment, then you may also be entitled to continued indemnity or even lifetime benefits depending on the nature and severity of the work injury.
Why is MMI Critical in Determining Workers’ Comp Benefits?
If you are considered to have reached your Maximum Medical Improvement, it usually means that your recovery has plateaued and there is nothing more the doctors can do for you other than basic monitoring. A small fracture or sprain can put a worker out for a few weeks or months, but in most cases, they can eventually return to work with no issues. However, more serious injuries such as traumatic brain injury or neck injury can permanently disable a worker to the point where they may not be able to return to the same job position or even work at all.
At the beginning of your recovery period, it may be assumed by the workers’ comp insurance company that you will eventually make a full recovery and return to work. However, once your injuries stop improving, it’s the workers’ comp insurance company’s aim to control its medical costs. In many cases, a workers’ compensation lawyer will be required to assert your rights to adequate medical care, continued income benefits, or eventually a fair and equitable settlement.
Understanding Maximum Medical Improvement Payout and Impairment Rating
Once you have reached your MMI, the next step in the process is to receive an impairment rating as defined by the AMA Guides to Impairment, 5th Edition.. This rating is a medical evaluation that quantifies the extent of permanent damage or loss of function you have sustained due to your injury. The impairment rating is expressed as a percentage, and the higher the rating, the more severe the impairment. It directly impacts the type and amount of benefits you are entitled to receive under Georgia workers’ compensation law.
If you have sustained a permanent or long-term disability in a particular area of the body, the insurance company may attempt to offer you a settlement that is likely well below what the claim is worth. Remember, the insurance “adjusters” is to adjust your claim away from full value. At this juncture, it is imperative that your contact an experience workers’ compensation firm such as Ramos & Law to protect you from these adjusters.
What Factors Affect MMI Payouts in Georgia?
Your MMI payout amount will depend on several factors including:
- The severity of your injuries
- The location of your injury
- The impact on your ability to work
- Your pre-injury income
- How your injury affects daily life
How Impairment Ratings Influence Payouts in Workers’ Compensation
Some injuries are more serious than others. For example, a repetitive motion injury is typically much less serious than a broken spine. Impairment ratings are based on the area of your body where your injury was sustained. The more serious the injury, the higher the MMI payout. However, it’s important to remember that the insurance company assigned to your workers’ comp case may try to dispute the impairment rating determined by your authorized treating doctor in order to pay you less. If this happens, it’s crucial that you speak with a lawyer right away. A workers’ compensation lawyer can work on your behalf to protect your right to fair compensation.
How Long Does It Take to Reach Maximum Medical Improvement?
It may take several weeks or months before you will find out if you’ve reached your Maximum Medical Improvement. The MMI timeframe depends on how serious your injury is and how your body responds to your treatment plan. Once your doctor has applied your treatment plan long enough to reasonably suspect you’ve reached your MMI, the workers’ comp process will move into the next phase of assigning you an impairment rating.
Factors Affecting the Time to Reach MMI
- Severity and type of injury
- The effectiveness of your treatment plan
- Your body’s natural recovery process
What Happens After MMI?
After you’ve reached your Maximum Medical Improvement and you’ve been assigned an impairment rating, the focus of your workers’ compensation will shift from temporary benefits and medical treatment to a longer-term care and compensation plan. Your doctor will submit a report to the insurance company assigned to your case detailing your treatment plan and the level of limitation you may be suffering. The insurance company will be required to make a decision on whether to approve, amend, or deny your doctor’s impairment rating.
If the insurance company accepts that you’ve reached your MMI and the impairment rating in the doctor’s report, they will begin paying your permanent partial disability (PPD) payments. If they dispute your rating, you will have the secure a second opinion and potentially bring it before a judge. If that administrative law judge rules against you, may have the right to appeal with the help of a workers’ compensation attorney in Georgia.
How Long Does It Take for a Workers’ Comp Settlement After MMI?
It can range from several weeks to several months for your workers’ compensation case to be settled after MMI. However, if your case hasn’t been denied, you should still be eligible to receive your temporary total disability workers’ comp payments until you receive your first PPD payments. Under Georgia workers’ comp laws, the insurance company must pay your approved indemnity payments within 21 days of an accepted work related accident. If during that time you do not receive any workers’ comp payments, you should call a workers’ compensation attorney for help.
Common Questions Regarding Workers’ Compensation in Georgia
Here are a few common questions our firm receives regarding workers’ compensation benefits in Georgia. If you don’t see your question listed here, give us a call at (770) 637-0105 for a free consultation.
How Long Can You Stay on Workers’ Comp in Georgia?
It depends on your specific case. Generally, the most you can receive is 400 weeks of income payments and medical treatment provided your injuries have not been catastrophically designated. However, your impairment rating may add income benefits to this time frame depending on when you reach MMI.
Understanding Workers’ Compensation Benefits and Timelines
To briefly recap everything our firm addressed in the sections above, workers’ compensation comes in many forms. When a workplace injury prevents an eligible individual from coming back to work, they will initially receive some or all of the following:
Medical Benefits: Workers’ compensation covers all authorized medical treatments medically related and necessary for an injured worker’s recovery. This includes doctor visits, hospital stays, surgeries, physical therapy, and prescription medications. These medical benefits may last for 400 weeks as long as the treatment is deemed necessary by a workers’ compensation-approved doctor. If the matter is really serious, these benefits may last for the injured worker’s lifetime. Reaching MMI is crucial in head injury cases. A brain and head injuries attorney ensures fair benefits.
Temporary Total Disability (TTD) Benefits: These are awarded if you are completely unable to work while recovering from an injury or if the employer is unable to accommodate your work restrictions. TTD benefits equal two-thirds of the worker’s average weekly wage up to a statutory maximum depending on your date of accident, and may be received for up to 400 weeks.
Temporary Partial Disability (TPD) Benefits: These are provided when you can return to work but at a reduced capacity or lower-paying job due to the injury. TPD benefits compensate for the difference between the pre-injury and post-injury wages, and they can also last for up to 350 weeks.
The Next Steps After Reaching MMI
The authorized treating physician (ATP) may determine that you have exhausted all traditional medical care and that your condition has plateaued. Hence, the ATP may have nothing left to offer you medically and may declare you to be at MMI.
Once you’ve reached MMI and you may be eligible for an impairment rating pursuant to the AMA Guides to Impairment, 5th Ed. It is logical that the more severe the injury, the greater the impairment rating will be. The ATP may request that you attend a functional capacity evaluation (FCE) to measure your physical limitations. Subsequently, the therapist will provide his recommendation to the ATP as to whether your injury has impaired you 1% or 99% under the AMA guidelines. This determination is very important, and it would be prudent for you to receive some advice from a trust workers’ compensation attorney before you engage in the FCE to determine your impairment rating.
Ultimately, this attorney will also advise you as to the workers’ compensation settlement process as the value of your case may be influenced by timing of these events. If you do not have a legal background and a thorough understanding of workers’ compensation law in Georgia, the insurance adjusters will take advantage of you every time. Remember, their job is to save the insurance company money at your expense.
Why Legal Guidance is Crucial After Reaching MMI
As we’ve discussed many times throughout this guide, having legal guidance (and sometimes representation) is crucial not only to receive the best chance a medical recovery but also to place you in the best position to maximize your monetary position. Workers’ compensation insurance representatives do not represent you; their one job is to save the insurance company money. As a result, they have been known to deceive you into saying or doing something that might disqualify you from receiving the compensation you deserve. If you think this might be happening to you, or even if your claim has already been delayed or even denied, we encourage you to contact Ramos & Law for a free consultation by calling (770) 637-0105.
Tips for Maximizing Your Workers’ Comp Settlement Post-MMI
- Secure a Favorable Impairment Rating: Your impairment rating plays a significant role in your settlement. If it seems too low, consider seeking a second opinion to ensure it accurately reflects your condition.
- Document Future Medical Needs: Keep detailed records of all treatments and future medical care you may need. Future costs, such as ongoing therapy or surgeries, can increase your settlement.
- Consider Loss of Earning Capacity: If your injury affects your ability to return to work or reduces your earning potential, make sure this is reflected in the settlement. Lost future wages should be considered when negotiating your payout.
- Get Legal Guidance: An experienced workers’ compensation attorney can help negotiate a fair settlement, ensuring your long-term medical and financial needs are addressed.
By following these steps, you can protect your rights and maximize your workers’ compensation benefits after reaching Maximum Medical Improvement (MMI). For more information or assistance, contact Ramos & Law at (770) 637-0105 for a free consultation.