Maximum medical improvement (MMI) is an important term in workers’ compensation. You should understand what it means to reach MMI in your Greenville workers’ compensation case.

Our experienced Greenville workers’ compensation lawyer at Bobby Jones Law explains.

What Is Maximum Medical Improvement (MMI) in Workers’ Comp?

Maximum Medical Improvement (MMI) is both a term in workers’ compensation and a stage of a workers’ compensation case. It is the point at which the injured person has recovered from their injuries as much as they are medically likely to. Reaching MMI carries significance in a workers’ compensation case because it signals a change in case status and often a determination of final benefits.

MMI in workers’ compensation defined

Maximum Medical Improvement (MMI) means that a person’s medical condition has improved as much as it’s likely to. The S.C. workers’ compensation law doesn’t define MMI. But court cases have explained that it’s when a person’s medical condition plateaus such that no additional medical care will lessen the degree of impairment.

Who Determines When You’ve Reached MMI?

Usually, the treating physician decides if the injured worker has reached MMI. It’s a factual question. When it’s disputed, the commission decides. Whether a person has reached MMI is based on a reasonable degree of medical certainty.

If you disagree with the doctor’s opinion, there are things that you can do. You can ask for a second opinion or request a hearing before a workers’ compensation commissioner.

What Happens to Your Workers’ Compensation Benefits After MMI?

After you reach MMI, here’s what may happen to your workers’ compensation benefits:

Temporary disability benefits usually end.
You will be assessed for permanent impairment compensation.
Medical care may continue for health management, but it’s a separate determination.
This is often the point where the claim is valued for settlement.

Note: The law varies by state. Greenville workers’ compensation rules are set by South Carolina law. The South Carolina Workers’ Compensation Commission (SCWCC) administers the law in Greenville and throughout the state. In addition, the SC Court of Appeals hears appeals from the SCWCC and may rule on disputed cases.

MMI and the Form 21 stop payment request

When you reach MMI, you can expect the employer to file Form 21 to stop payment of temporary disability benefits. Reaching MMI doesn’t always directly correlate with returning to work. You may have already returned to work, so this may not apply to you.

Form 21 is the employer’s request to stop compensation. The form tells the Commission that the worker has reached maximum medical improvement. It allows the employer to request the termination of temporary disability benefits when the worker reaches MMI. The employer must attach a copy of a medical report.

There will be a hearing within 60 days of the request to terminate benefits. The employer may be credited back for weeks of temporary disability paid after the date of MMI. Any overpayment will be deducted from the disability award. The employer should file Form 21 within 30 days of the worker reaching MMI to receive the full back credit.

The worker may use Form 22 to respond to the employer’s Form 21. You may deny having reached MMI.

Can You Disagree with an MMI Determination in South Carolina?

Yes. If you disagree with your MMI determination in South Carolina, you can dispute it. You may respond to the employer’s request to terminate your benefits, or you may request a hearing before a workers’ compensation commissioner. A lawyer can represent you.

MMI and Permanent Disability: What’s the Connection?

When you reach MMI, the full extent of your permanent disability can be accurately evaluated. When you’re still improving medically, the determination of your permanent impairment because of your workplace injury may not be correct or complete. But when the worker reaches MMI, their medical condition is reasonably known. It’s time to evaluate the impairment of body parts and determine what the worker is entitled to in impairment compensation.

More From Bobby Jones Law: Permanent Impairment Settlement Amounts

How MMI Affects Your Workers’ Compensation Settlement Amount

MMI can affect your workers’ compensation settlement amount because it allows you to determine your impairment rating and your right to future medical care. These two factors are critical to calculating the correct workers’ comp settlement amount.

A determination of MMI is not an impairment rating. The impairment rating is done separately from the MMI determination using a rating guide. But the MMI determination means that it’s probably time to calculate impairment compensation.

It’s important not to settle a workers’ compensation claim too quickly. The injured worker has the right to the full medical benefits that they deserve under the law. In addition, they have the right to have their impairment rating valued fairly based on their full course of healing.

Should You Accept an MMI Rating Without Getting a Second Opinion?

Whether you should accept an MMI rating without getting a second opinion depends on the nature of the injury. If you’re still in pain, still need surgery or physical therapy, or it seems like your medical care providers are rushing your care, it can be worthwhile to get a second opinion. A second opinion can give you peace of mind to know that you’re receiving the full benefits you’re entitled to claim under South Carolina workers’ compensation law.

Why You Need a Greenville Workers’ Compensation Attorney After Reaching MMI

Insurance companies like to minimize workers’ compensation claims. The insurance companies pay healthcare providers, and they may want to minimize your care, too. A Greenville workers’ compensation attorney can determine if you should challenge a finding of MMI. They can assist you with valuing permanent impairment compensation and the right to continued medical care.

An experienced workers’ compensation attorney can assist you in responding to forms filed by the employer’s representative. They can file forms on your behalf and fight for your benefits.