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Table of contents
- What Does “Maximum Medical Improvement” Mean?
- How MMI Affects Your Workers’ Compensation Benefits
- Who Decides When You’ve Reached MMI?
- What Happens After You Reach MMI?
- Serving Injured Workers Across New Jersey
- Meet Our Workers’ Compensation Attorney: Gary E. Adams
- Frequently Asked Questions About MMI in New Jersey Workers’ Compensation Cases
- Contact a New Jersey Workers’ Compensation Attorney Today
If you have been out of work due to a job injury, then no doubt you have heard your doctor, the insurance adjuster, or your attorney refer to the concept of maximum medical improvement, or MMI for short. In New Jersey workers’ compensation cases, the issue of MMI is often a critical factor in the case of an injured worker, which can have a bearing on the payment of wage replacement benefits, on the issue of a permanent disability award, and on the injured worker’s overall strategy in the case.
Here is what to expect. At Pellettieri Rabstein & Altman, we have been representing the rights of injured workers for nearly a century. In almost every case, the issue of the injured worker being at maximum medical improvement comes up.
What Does “Maximum Medical Improvement” Mean?
MMI is the date your treating physician or an evaluating doctor believes that you have reached the highest level of medical improvement possible, and your condition has stopped getting better with additional treatment. Although you may be suffering from pain, impaired function, or even permanent impairment, the doctor believes that you have reached a point where you can safely return to work or that you can perform with your current physical limitations.
MMI is a medical determination and can have serious legal and financial consequences for injured workers under New Jersey’s workers’ compensation laws.
How MMI Affects Your Workers’ Compensation Benefits
New Jersey ties several categories of benefits to the determination of MMI for the reasons outlined below.
- Temporary disability benefits cease when a worker reaches MMI: The payment of temporary total disability (TTD) benefits, which can be as much as 70% of the worker’s average weekly wage when he or she is totally disabled from work, will cease when the worker reaches MMI. Payment of such benefits are typically made on a weekly basis until the worker reaches MMI or 400 weeks, whichever occurs first.
- New benefits start at MMI: Benefits for permanent disability are started with the permanency evaluation. This is for both the claimant and the insurance carrier. The results of this evaluation determine if the worker is eligible for permanent partial disability (PPD) benefits or permanent total disability (PTD) benefits.
- Your doctor’s report as to your MMI may list work restrictions: These restrictions in turn could affect whether or not you go back to your old job, whether or not you are expected to do light duty work and whether or not, in the event that no suitable work is available to you, you are entitled to job displacement.
Disputes often arise as to whether or not a worker has, in fact, reached MMI, and when he or she did reach MMI. Such disputes often center upon the differing opinions of the treating physician and the insurance company’s doctor as to when the worker had, in fact, reached MMI.
Who Decides When You’ve Reached MMI?
Most initial MMI determinations are made by the authorized treating physician (ATP) for the employer/insurance carrier. As you can guess, this can create many problems for the injured worker. The ATP is chosen and paid by the insurance company, not by the injured worker.
If the doctor makes an initial determination of MMI that you disagree with, or the insurance carrier is trying to cut off benefits to you prior to a full and fair determination of MMI, you have the right to have your doctor evaluate you and present evidence and argument to the workers’ compensation judge to challenge the determination of MMI made by the authorized treating physician. This is where an independent medical examination (IME) is often needed and where an attorney who practices workers’ compensation law can be of greatest assistance to you.
What Happens After You Reach MMI?
In closing, reaching MMI for your case is not the end of your case. As mentioned above, depending on the extent of the injury, you may be entitled to several different types of workers’ compensation benefits.
- You could receive a permanent partial disability (PPD) award to be paid at the rate established by statute on a schedule corresponding to the body part(s) affected by percentage(s) of impairment.
- Permanent total disability (PTD) benefits: Where an injured worker suffers an injury that prevents him or her from returning to work in any capacity. Payments will continue for the balance of the worker’s life.
- Right to reopening of a workers comp claim: New Jersey law allows injured workers to petition to reopen a workers’ compensation award if their condition later worsens (commonly referred to as a Section 22 reopener), which is different than an Order Approving Settlement under Section 20 that resolves a claim on a final basis.
- Job displacement or vocational benefits, if you are permanently disabled and unable to return to work at your prior job, and there is no light work available.
- An MMI finding that undervalues your permanent injury, or which is entered too early in your case, can result in you receiving compensation that is far less than what you are truly owed. Such determinations are reviewed by our attorneys before any settlement is finalized.
Serving Injured Workers Across New Jersey
For nearly 100 years, PR&A has represented the rights of injured workers from all areas of the state including from Hudson and Union County’s refineries and ports, to the warehouses and distribution centers of the turnpike corridor in Middlesex and Burlington County. In addition to representing workers against their employers, PR&A also represents hospital, school and municipal employees in workers’ compensation matters against self-insured public employers in Mercer, Essex and Morris County.
Attorneys at PR&A regularly appear before workers’ compensation judges in hearings throughout New Jersey. Our firm of experienced workers’ compensation attorneys maintain offices in Cherry Hill, Lawrence Township, Morristown, Nutley, and Trenton. Therefore, injured workers from the southern part of the State, the central part of the State, and the northern suburbs can meet with a member of our team in person, by phone, or by video.
Our knowledge of the local Division of Workers’ Compensation offices, the insurance companies that typically represent parties in New Jersey workers’ compensation claims, and the tactics of certain employers to keep payments to injured workers to a minimum enable us to effectively represent our clients in all types of workers’ compensation cases.
Meet Our Workers’ Compensation Attorney: Gary E. Adams
In disputes regarding MMI determinations and in cases in which a carrier is attempting to terminate benefits of an injured worker too early, it is advisable to have the services of an attorney who has litigated such matters for his or her entire legal career.
Gary E. Adams, managing partner of the firm’s New Jersey office and Chairman of the firm’s workers’ compensation department, has been certified as a Workers’ Compensation Trial Attorney by the New Jersey Supreme Court. For his entire legal career, Mr. Adams has represented injured workers and union members in their efforts to receive the benefits to which they are entitled. He has considerable experience in the trial of occupational pulmonary and cancer claims as well as cardiac and other claims, including repetitive motion injuries. He has handled numerous workers’ compensation appeals in the Superior Court, Appellate Division as well as in the Supreme Court of New Jersey. He is a past Chairman of the New Jersey State Bar Association’s Workers’ Compensation Section.
In addition to advocating for his clients in the courtroom, Gary has also been actively involved in shaping the laws and policies affecting New Jersey’s injured workers. Gary has served as a primary witness before the New Jersey Legislature on numerous occasions and has been involved in the drafting of proposed legislation intended to increase benefits for injured workers who suffer hand and foot injuries in the course of their employment. As a result of his efforts and expertise, Gary has been named “Lawyer of the Year” for his work in the field of workers’ compensation law by Best Lawyers in America.
Frequently Asked Questions About MMI in New Jersey Workers’ Compensation Cases
Q: Does reaching MMI mean my workers’ compensation case is over?
A: No, reaching MMI in a workers’ compensation case does not mean that your case is over. Rather, it is the point at which temporary disability benefits will cease to be paid, and a permanency evaluation will be conducted in order to arrive at a permanent disability award, which is typically settled for a period of permanent partial disability.
Q: Can I still get medical treatment after I reach MMI?
A: Yes, in many cases an injured worker is entitled to on-going palliative or maintenance treatment to control a permanent condition that he or she has developed as a result of the workplace injury.
Q: What if the insurance company’s doctor states that MMI has been reached but the worker still feels unwell from their work related injuries?
A: The worker has the right to have their treating physician render an opinion and this can be challenged before a Workers’ Compensation Judge. In many cases, an attorney can set up an independent evaluation by the worker’s treating physician and present this evidence to the Workers’ Compensation Judge.
Q: How long does it take to reach MMI?
A: Reaching MMI is dependent on the injured worker’s progression and rehabilitation from their injury. It can take a few months for some injuries and even a year or more for others, especially those requiring surgical intervention and a long rehabilitation. The worker will receive temporary total disability benefits until they reach MMI, which can be up to 400 weeks.
Once your worker’s compensation case reaches MMI, you will no longer receive temporary total disability benefits. However, based on your specific injury, you may be entitled to receive permanent partial or even permanent total disability benefits. These types of awards are calculated in a different manner than temporary total disability benefits and often result in large compensation awards to injured workers.
Even after the case is closed and a Section 20 settlement has been reached, there are instances in which a worker can have their claim reopened to deal with a worsening of their injury. This would typically be by way of a petition to reopen a claim that was previously closed as a result of a Section 20 settlement or even a Section 22 award. Whether or not you have a right to have your case reopened will depend on the specifics of your situation as well as on the details of your settlement.
Contact a New Jersey Workers’ Compensation Attorney Today
The date of MMI is one of the most significant and controversial dates in the history of a New Jersey workers’ compensation claim. It is the date when the insurance company can stop paying for your treatment because they believe that you have reached the highest level of medical recovery possible for your injury.
Workers compensation attorneys, Pellettieri Rabstein & Altman, have been representing New Jersey injured workers in workers compensation cases for over 90 years. Our New Jersey workers compensation lawyers work on a contingency fee basis, which means you do not have to pay for our services upfront. Our fee is paid only from the proceeds of your case and then only if we are successful in obtaining benefits on your behalf.
To speak with a qualified lawyer during a free initial consultation, please fill out our contact form. Our Workers Compensation lawyers serve clients throughout New Jersey from our offices in Cherry Hill, Lawrence Township, Morristown, Nutley and Trenton.
