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Decoding Maximum Medical Improvement for New Jersey Injured Workers in NJ

Maximum Medical Improvement (MMI) is when an injured employee has a medical condition that will not improve with time or further treatment.  It effectuates a change for those receiving workers’ compensation because it directly affects the benefits they will receive.  It also influences their eligibility to receive ongoing medical treatment.  Because it has a direct effect on the benefits and medical treatment they will receive, it is imperative for those who have suffered a work-related injury to understand what MMI means and its implications on their recovery and benefits in New Jersey.

MMI Sets the Stage for Compensation Decisions

MMI is when an employee’s workers’ compensation benefits end or change.  It is the status of an injured worker whose condition is probably not going to make substantial improvements with the passing of time or further medical treatment.  This does not mean that periodic medical treatment or medication will not be needed for the best possible quality of life.

MMI is used to assess the injured party’s disability, affecting the level of compensation they will receive.  It will determine the lasting effects of the injury on the employee’s ability to work and their possible future earnings.

Determinations and Disputes that Define Worker Benefits

The treating physician monitors the employee’s progress, playing a pivotal role in the decisions made regarding the workers’ compensation process.  It is a critical point in the worker’s recovery that affects the future benefits or the ability to work.  MMI requires a comprehensive understanding of the injury or illness and any residual limitations experienced by the individual.

Insurance companies and employers may request an independent medical examination (IME) to confirm or challenge the treating doctor’s opinion.  The IME is usually conducted by a physician chosen by the employer’s insurance company.  They review the medical condition, medical records, and other critical aspects of the worker’s treatment and prognosis.  IMEs are often used when there is a dispute about the treating doctor’s conclusions.

MMI disputes are common, especially when the treating physician’s opinion conflicts with the IME doctor’s.  Workers have the right to request a second opinion.  In most cases, your workers’ compensation attorney can request an independent panel of medical experts to review your case.  Conflict resolution may also be done through mediation or litigation before a workers’ compensation judge.

MMI as the Catalyst for Benefits and Career Adjustments

Once MMI is determined, the types of benefits available to the employee can be affected.  Temporary disability benefits are designed to provide medical care and a portion of lost wages during recovery.  These benefits are for those who are injured and miss work for more than seven days.  They only apply when the employee cannot work and is under active medical care.  When the worker has reached MMI, these benefits may be reduced or terminated.  Permanent partial or total disability benefits are assigned to individuals whose condition affects their ability to work either in part or entirely.  The benefits are based on the extent of the impairment. 

MMI shows the level of the disability that the worker will have moving forward.  Medical benefits may continue as needed to treat the injury.  They can shift from curative to palliative care aimed at managing symptoms and maintaining functional stability, such as ongoing medications, physical therapy, and periodic medical exams.  (Hanrahan v. Township of Sparta,1996). The employer is responsible for providing treatment, whether or not labeled “palliative,” so long as there is a showing that the treatment is reasonably necessary to cure or relieve the effect of the injury.  Palliative treatment is not limited to total disability cases.)

Reimagining Work Potential After MMI Stages

Understanding Maximum Medical Improvement in Workplace Injury Claims in New Jersey

The employee may have the possibility of returning to work after the MMI.  Their employer is required to offer their former position or the next one that becomes available.  If the employer cannot make any accommodations (if necessary), the injured employee can be let go.  A frequently used benefit of workers’ compensation is vocational rehabilitation.  Employees continue to receive benefits while training or academic courses to boost their employability.  A vocational rehabilitation counselor is assigned to the worker and applies various cognitive, aptitude, and psychological evaluations.  They discuss the injured worker’s medical history, limitations, strengths, and work-related interests.  The counselor constructs a plan that includes technology and tools the individual can use for work, training, and interview skills.

MMI Doesn’t Define Your Workers’ Comp Rights. Our NJ Attorneys can Assist You in Recovering Your Full Benefits

An on-the-job injury can be overwhelming, especially when others count on you to maintain a household.  The MMI determination can impact your workers’ compensation benefits, ultimately affecting your ability to keep the lights on.  By hiring a skilled New Jersey workers’ compensation lawyer at Cohen & Riechelson, you can protect your rights.

Insurance companies frequently use Independent Medical Examinations (IME) to contest the treating physician’s opinion regarding your recovery.  Our experience has taught us how to ensure the IME is conducted objectively by someone who is qualified and unbiased.  We will not allow your right to benefits to be unfairly denied.  We will scrutinize the reports for inaccuracies and challenge findings that do not reflect credible medical evidence.

A determination of MMI can have significant consequences. If it is made prematurely, it can limit your access to the benefits you need to support yourself and your household. We can challenge the insurance company’s decisions regarding your care and benefits.  We will review all medical evidence and have the resources to seek a second opinion or independent medical review.  Our experienced attorneys will build your case with strong medical and legal arguments to protect your rights to receive the workers’ compensation benefits to which you are entitled.

Our job is to advocate on your behalf. The insurance company needs to minimize their losses and may not have your best interests at heart. Your benefits affect their bottom line. An MMI ruling does not have to mean a loss or decrease in benefits when your case is handled correctly. You need someone in your corner to negotiate or litigate and provide the best possible outcome for your case. If you need assistance navigating a claim for work-related injuries in Woodbridge, Perth Amboy, Hopewell, Somerset, Metuchen, Burlington, Carteret, and throughout New Jersey, our experienced attorneys are here to help. If you have questions or concerns about Maximum Medical Improvement (MMI), and your workers’ compensation or personal injury benefits, call us today for a free consultation at (609) 528-2596  or contact us online to discuss how we can help you.