North Carolina’s workers’ compensation system offers substantial benefits to help you recover after a work-related injury or illness. However, there are also complicated rules governing these benefits and how much compensation you can receive. One crucial concept to know is maximum medical improvement, or MMI, in workers’ comp claims.
What Does Maximum Medical Improvement Mean?
Maximum medical improvement (MMI) means your work-related injury or illness has healed as much as it’s probably going to. You’ve either fully recovered or your condition has stabilized. At this point, your supervising doctor doesn’t expect significant changes in your condition, even with more treatment. However, they may continue to treat ongoing conditions, such as chronic pain.
Reaching MMI is a key milestone in a North Carolina workers’ comp case because of how it can affect your lost wage benefits. Once you reach maximum medical improvement, your wage-replacement benefits may change. Your doctor may also assign a permanent impairment rating or work limitations if your condition affects your ability to work in the long term.
How Is MMI Determined in North Carolina Workers’ Comp Cases?
Your treating physician will decide when you’ve reached MMI. Your doctor shouldn’t make this decision based on a set timeline. Instead, they should base their diagnosis on your progress and whether additional treatments are likely to improve your condition. Your doctor will review several factors to make that call, including:
- Your medical records – Your doctor may examine all your treatment notes, test results, and specialist reports to assess how your condition has changed over time.
- Response to medical treatment – If physical therapy, medication, or surgery are no longer improving your condition, that may be a sign you’ve reached MMI.
- Functional limitations – Your doctor may conduct physical or cognitive examinations to see what limitations, if any, you still have from your injury or illness.
- Independent medical exams (IMEs) – Sometimes, the insurance company may request that another physician conduct a second opinion exam to confirm whether you have reached MMI (C.G.S. § 97-27).
- Diagnostic testing – Imaging results, such as X-rays or MRIs, may help show whether healing has stopped or if any further recovery is possible.
- Your input – The doctor may also ask how you feel and whether you’ve noticed any recent improvements or setbacks.
The Impact of MMI on Your Workers’ Compensation Benefits
Once your authorized treating physician believes you’ve reached MMI, your workers’ compensation claim enters a new phase. Up to now, you may have been getting temporary disability benefits while you couldn’t work. After reaching MMI, those benefits may end, especially if your doctor believes you can return to work in some form.
Your case isn’t finished, though. The focus now shifts to whether you’ve suffered any lasting harm. Your doctor will assess any permanent limitations from your injury or illness and may assign a permanent disability rating or permanent work restrictions. Your employer and their workers’ comp provider use this rating to calculate permanent partial disability (PPD) benefits, which compensate you for lasting loss of function in a specific body part.
Under N.C.G.S. § 97-31, the amount and duration of your PPD benefits depend on your disability rating and what parts of your body are affected by your injury or illness. You might qualify for partial wage loss benefits if you can only return to work in a reduced capacity. If you can’t return to work at all after reaching MMI, you may qualify for permanent total disability (PTD) benefits, or ongoing temporary total disability benefits. (N.C.G.S. § 97-29). Just because you are at MMI doesn’t mean that you are at maximum vocational improvement.
MMI is also often a trigger for employers and insurance companies to start discussing a settlement. Before agreeing to any lump-sum settlement, it’s wise to speak with a workers’ comp attorney to make sure you’re not giving up future benefits you may need.
What to Do If You Disagree with an MMI Determination
Doctors can make mistakes. Your doctor may decide you’ve reached MMI when further treatments might still help your recovery. Here’s what to do if your doctor says you’ve reached MMI but you disagree:
- Talk to your doctor. Ask for clarification on why they believe you’ve reached MMI. There may be a misunderstanding, or your doctor may be missing crucial information.
- Request a second opinion. You can seek an independent medical examination (IME) from another doctor to get a fresh perspective on your condition (C.G.S. § 97-25).
- Keep medical records and notes. Document your symptoms and any ongoing limitations to support your position.
- Speak with an attorney. These are all substantial and complex steps to take on your own. An experienced workers’ compensation lawyer can explain your rights, work to get a second doctor authorized, and argue on your behalf for the benefits you deserve.
Contact Younce, Vtipil, Baznik & Banks for Help with Your Workers’ Compensation Claim
At Younce, Vtipil, Baznik & Banks, P.A. of Raleigh, our North Carolina workers’ compensation attorneys understand what reaching MMI means for your benefits. We’ve also seen many workers lose the financial support they need because of inaccurate permanent restrictions or disputes with their employers.
With over 90 years of combined experience, our attorneys know what evidence to look for in these cases and how to build a persuasive case. We’ve secured millions of dollars for injured workers across North Carolina, including a $2.625 million workers’ compensation settlement.
We’re also proud of the positive feedback we receive from our clients and our impact on their lives. Here’s what one recent satisfied client said about their experience with us:
“I don’t know how to begin to thank you for all of the hard work you did on my worker’s compensation case. From day one you had this ease about you. I was able to relax knowing that my legal situation was being handled. If at anytime I or anyone I know need legal counsel, I will be sure to contact your firm.” – Monique S.
With our extensive knowledge and resources, state-of-the-art case tracking system, hands-on attention, and fluent English- and Spanish-speaking staff members, you can trust we’ll do everything we can to care for you.
Don’t risk the benefits you need to rebuild your life after a workplace injury in North Carolina. To learn more about MMI and workers’ compensation, call Younce, Vtipil, Baznik & Banks, P.A. in Raleigh at 919-661-9000 now or complete our contact form for a free consultation.
About the Author
David E. Vtipil
David Vtipil is an attorney at Younce, Vtipil, Baznik & Banks, P.A. and concentrates his law practice on personal injury and workers' compensation. David E. Vtipil was selected by his peers for inclusion in the 21st Edition of The Best Lawyers in America in the field of Workers’ Compensation Law.
