What is Maximum Medical Improvement (MMI)?
Maximum Medical Improvement (MMI) is a term used by physicians to indicate when an injured worker has reached a treatment plateau or that their condition will not improve any further. This does not mean no future medical treatment will be needed; but, that the worker’s medical condition has stabilized and further functional improvement is unlikely. Any treatment that occurs after a condition has reached MMI is considered palliative, meaning it will only relieve pain or symptoms associated with the cause of the condition rather than cure it.
Workers’ compensation law states that MMI be established 104 weeks from the date the injured worker began to accrue income benefits. The Texas Department of Insurance – Division of Workers’ Compensation (TDI-DWC) can order an extension of the statutory MMI date, under special circumstances. Although employers in the State of Texas are not required to carry workers’ compensation insurance, insurance companies will often send a claimant to a designated doctor or independent medical examiner with the goal of classifying their injuries at MMI.
Once a medical condition has reached MMI, the physician will assign an impairment rating. This measures the permanent physical damage caused by the injury. In order to ensure the rating is comprehensive, a physician may also recommend a functional capacity evaluation (FCE).
What is the Official Disability Guidelines (ODG)?
The Official Disability Guidelines (ODG) is a comprehensive report of medical treatment and return to work guidelines. By utilizing more than 10 million cases and ongoing medical research, they quantify injuries and appropriate courses of action for those injuries.
When you are being treated for a medical condition, insurance companies will often use the ODG to track your course of treatment. Today, the ODG is widely used by insurance companies to determine MMI, helping them cut off income benefits before a claimant has fully recovered. The ODG does make exceptions to their guidelines when injuries are coupled with other problems. Certain factors can impact the amount of time it takes an injury to heal. If these factors are properly considered, it can significantly increase the time and resources you are given to recover. An experienced work injury attorney can help ensure you do not lose any benefits when filing a personal injury claim.
Insurance Companies Use of MMI and the ODG to Cut-off Benefits
While the intentions of the creators of Worker’s Compensation Insurance and the Official Disability Guidelines were good, unfortunately, terms like Maximum Medical Improvement and the guides like the ODG have been widely misused to deprive both Worker’s Compensation claimants and personal injury victims of the right to receive necessary medical care. This is because insurance companies often retain biased doctors to ignore the factors and circumstances that clearly justify an injured victim receiving continued beneficial medical care. Instead, these doctors will arbitrarily apply what has been self-defined as “guidelines” as if they are hard deadlines that apply in every single case. The absurd application of guidelines as if injury victims can be treated with set cookie-cutter treatment plans serves only one goal—to save insurance companies money by cutting YOU–the injured victim–off from receiving reasonable and necessary medical care.
If you or a loved one has been severely injured due to the negligence of others, contact us today to learn more about your rights. Before you let an insurance company control your medical care and deprive you of needed care, at least get a free consultation from us: (713) 932-0777.