What is Maximum Medical Improvement? A Lawyer Explains

Updated on: 3/21/2019

maximum medical improvement

One common point of confusion for accident victims is determining when it might be a good idea to settle a personal injury claim with an insurance company. 

While the length of a personal injury case can vary depending upon the specific facts of the matter, the one commonality in all personal injury cases is that the victim should reach Maximum Medical Improvement (MMI) before settling or resolving their case.

The American Medical Association gives the following definition for MMI: "a condition or state that is well stabilized and unlikely to change substantially in the next year, with or without medical treatment." Essentially, MMI is “a treatment plateau at which no fundamental, functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures.”

MMI is a medical term means that the physical state cannot be changed either positively or negatively, and that a move in either direction will likely not occur. 

Why Is Medical Treatment Important?

If you have been injured in a car accident or are pursuing a personal injury claim for some other type of legal matter, the most important thing you need to do is get medical attention for your injuries. This is arguably the most important step in your personal injury case, as it creates documented evidence that you have been injured and that a doctor or other type of medical professional has provided treatment you for those injuries.

Without documented medical records to serve as evidence and proof of the causation of your injuries, making a personal injury claim with an insurance company may be difficult. One of the most important factors affecting how insurance companies handle claims is the amount of evidence there is to support the claim. 

Without sufficient medical evidence, the insurance company is unlikely to feel any pressure to take your claim seriously and offer you fair compensation for your injuries and other damages.

Once you begin medical treatment, your doctors and other medical providers will track your progress and evaluate your recovery to determine how much more treatment you might need to heal. Doctors may also prescribe additional types of treatment such as chiropractic, physical therapy, and possibly even surgery in extreme cases. 

The medical records for all of your treatment, when analyzed by an attorney and his or her team of medical experts, can paint a complete picture of the before-and-after of your car accident or personal injury case.

Reaching Maximum Medical Improvement

The ultimate goal in receiving medical treatment for your injuries is to return your physical and psychological health to the state it was before the accident occurred. In legal terms, this is called being made whole. 

If you are injured in an accident which was caused by someone else’s negligence, the law dictates that you have the right to be made whole, which is the purpose of filing a personal injury claim against the at-fault party and his or her insurance company.

How long does it take to reach Maximum Medical Improvement? Well, the more severe your injury, the longer it may take to reach MMI. In some cases where the injured victim has suffered more serious injuries, the time of recovery can either be very long, or difficult to determine. In very extreme cases, it is possible that an accident victim may not be able to fully recover – or be made whole – at all.

Reaching Maximum Medical Improvement (MMI) for injuries resulting from an accident means that the injured person has either fully recovered, or has recovered to the fullest possible extent based on a medical doctor’s expert opinion. In cases where a person has reached MMI but will not fully recover from his or her injuries, the pain and suffering component of their claim is usually much more significant and could result in a larger settlement, depending upon the availability of insurance coverage and other factors.

Before a victim reaches MMI, a settlement or payout would be extremely hard to determine as there remains the potential for more treatment, and thus, more potential costs associated with the case.

An Example of Maximum Medical Improvement

While driving home from work one evening, Jason is involved in a bad car accident involving a semi truck. Jason’s vehicle is totaled, and he suffered multiple broken bones, a concussion, and a herniated disc in his back. After two months in the hospital, Jason is allowed to go home. 

After a year of rehabilitation, Jason can walk normally again and can return to his job as an auto mechanic. He continues to visit his doctors, and they tell him that he will never be without pain and a small limp in his right leg. The doctor gives Jason pain medication, but because no other medical treatment is available to help him, Maximum Medical Improvement has been reached.

What Happens After Maximum Medical Improvement?

Once a victim reaches Maximum Medical Improvement, a doctor will likely recommend a Functional Capacity Evaluation (FCE). This evaluation determines the victim’s capacity to perform work-related activities in his or her line of work. 

The FCE will compare the victim’s health status and body functionality to the demands of the job and work environment. An FCE may be beneficial for someone that was injured on the job, or someone that suffered a serious injury or illness outside work and wants to return to their job. 

FCEs have always measured a person’s ability to perform the physical demands of a job, but only in recent years have the tests begun to evaluate the cognitive demands as well. This is particularly relevant for accident victims who have suffered a concussion or other type of traumatic brain injury.

Workers’ Compensation and Maximum Medical Improvement

When a worker is injured on the job and begins to receive workers’ compensation benefits, there are several things they should know about the timeframe they have to recover. Sometimes injuries don’t recover on a fixed schedule, and benefits don’t always cover a full recovery. Maximum Medical Improvement may occur too soon, giving workers few options for continued recovery.

States have different guidelines when it comes to MMI. When your doctor determines you have reached MMI, he or she will examine you for any permanent physical or cognitive damage and write a Maximum Medical Improvement report. If the injury or condition is past normal healing, it will be assigned an impairment rating. 

Each state uses its own Maximum Medical Improvement rating chart to denote the level of permanent damage. The Permanent Disability Rating System will determine how money you get in permanent disability.

When you receive a letter from the insurance company explaining you are at MMI, it is important to contact an attorney. Note: Davis Law Group does not take workers’ compensation cases. 

Why Hiring An Attorney Can Help

The process of identifying and proving Maximum Medical Improvement (MMI) for a car accident or other type of personal injury case can be difficult for the average person. If you do not have a complete understanding of your legal rights, navigating the personal injury claims process on your own can be very challenging and there are many common mistakes that accident victims regularly make.

If you or a loved one has been injured in an accident and you are unsure about how to handle the claim, it may be in your best interests to consult with an attorney who is experienced in handling serious personal injury claims. The award-winning personal injury attorneys at Davis Law Group work on a contingency fee basis, and we offer free case evaluations to anyone who has questions about their own personal injury case.

Call our office at (206) 727-4000 today to discuss your legal rights with our award-winning team, or simply enter your case details in the confidential contact form on this page. 

Chris Davis
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Christopher M. Davis is principal attorney and founder of Davis Law Group, P.S. in Seattle, WA.
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