What Does Maximum Medical Improvement Mean in a Workers’ Compensation Case?

After a work-related injury or illness, many people wonder what their workers’ compensation claim is worth. This is especially true for injured workers in North Charleston and across South Carolina, where delays, denials, or confusing medical updates, like reaching Maximum Medical Improvement (MMI), can make the process feel overwhelming. Some workers question whether filing a claim was worth it at all, especially if they suspect they’re being offered less compensation than they’re owed or aren’t being paid for things that workers’ comp should cover.

Every injury is unique, as is the value of every South Carolina workers’ compensation claim. Factors like how fully you heal after an injury or illness, how severely certain body parts are affected, and your average weekly wage all play a role in determining the compensation you’re entitled to. If you need help finding the full, fair value of your claim, talk to our experienced attorneys today. The team at the Steinberg Law Firm helps injured workers in North Charleston and beyond navigate their workers’ comp claims with confidence.

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

“Maximum medical improvement” or MMI is the point at which additional medical treatment won’t make your health any better. 

Reaching MMI doesn’t mean you’re cured. It doesn’t mean that your injury or illness has disappeared. Many injuries and illnesses change the body permanently. For example, a severe burn may leave scars or problems with nerve sensations. A neck injury may cause ongoing pain, even after trauma to the neck has healed. A broken bone may still impact or limit movement.

Reaching MMI means you have healed as much as you are likely to heal. The American Medical Association advises doctors to base a determination of “maximum medical improvement” on their clinical findings that an injury has stabilized and the patient will not recover further. At this point, an injury or disability is considered permanent. 

To determine whether you have reached MMI, a doctor may use diagnostic tests and physical examinations to evaluate whether your health has improved. A patient who isn’t showing improvement from treatment may have reached MMI. 

When a patient reaches MMI, doctors shift their focus from helping a patient recover to helping the patient manage any impairments that remain. An employer may request a functional capacity evaluation (FCE) to see whether and how well you can do work-related tasks. 

How MMI Affects Workers’ Comp Settlements in South Carolina

South Carolina workers’ compensation law bases some compensation decisions on damage to or loss of particular body parts. For example, Section 42-9-10(B) of the workers’ compensation code states that “the loss of both hands, arms, shoulders, feet, legs, hips, or vision in both eyes, or any two thereof, constitutes total and permanent disability” and must be compensated accordingly. 

MMI plays a key role in determining how an injury affects your workers’ compensation settlement. Once you reach MMI, additional medical treatment that focuses on medical recovery won’t change your situation. If you have permanent impairments once you reach MMI, workers’ compensation may provide additional benefits. 

Reaching MMI is a key milestone in determining what your workers’ comp case is worth. When you reach MMI: 

• Your employer can seek to terminate your temporary disability benefits. Because you’ve reached MMI, it’s time to determine if you can return to work – and if so, in what capacity.
• You can seek benefits for total or partial permanent disability if your injuries qualify after reaching MMI.

What if your doctor thinks you’ve reached MMI, but you disagree? Speak to an experienced attorney who can help you get an additional qualified medical opinion. 

How Does MMI Affect the Calculation of My Workers’ Compensation Benefits?

Once you reach MMI, your doctor, your employer, and the workers’ compensation insurer shift their focus. Instead of focusing on restoring your health, they examine whether or not you can return to work. If you can, it’s important to evaluate what work you can do. If you cannot work, it’s time to discuss an additional settlement for the support you need to live with your disabilities. 

While a worker is healing, workers’ compensation provides temporary disability benefits. These benefits cover medical bills and a portion of lost wages.

After a worker reaches MMI, a new question arises: Does the worker have a permanent disability? If so, permanent disability benefits may be available. Permanent disability benefits may include compensation for some future lost wages, as well as future medical costs. 

Permanent disability benefits can only be evaluated once a person reaches maximum medical improvement. At that point, the worker, their attorney, and workers’ compensation can discuss what the injured person will need in the future, based on the knowledge their current medical condition will not improve with additional treatment. 

In some cases, workers’ compensation insurers may disagree with your doctor about whether or not you’ve reached MMI. Here, an independent medical examiner (IME) may assess your health and review your records. An attorney can help you navigate the IME process. 

Permanent Impairment vs. Permanent Disability: What South Carolina Workers Need to Know

When you reach MMI, your treating doctor may assign a permanent impairment rating. This percentage is based on the degree of lasting physical loss to a specific body part or function. However, it’s important to understand that a permanent impairment rating from your doctor is not the same as a permanent disability rating under South Carolina law.

Attorney Adam Greene explains:

“The permanent impairment rating assigned by your doctor is not the same thing as permanent disability. For example, your doctor might give you a 5% impairment rating for your injury, but based on your age, education, whether you have permanent work restrictions, and your work history, the Workers’ Compensation Commission could ultimately award you a 15% permanent partial disability to a body part.”

This means that while your doctor’s opinion is important, it’s just one factor in how your disability and final benefits are determined. The Workers’ Compensation Commission looks at your whole situation: your ability to return to work, job skills, and any permanent restrictions, before deciding what your permanent disability award should be.

If you have questions about your impairment rating or believe your disability benefits don’t reflect your true situation, reach out to our experienced workers’ compensation attorneys for guidance.

What If I Disagree With the Valuation of My Claim? 

Employees have the right under South Carolina workers’ compensation law to contest the valuation of their claims. If you’ve been injured at work in North Charleston, Goose Creek, or anywhere in Charleston County, don’t guess what your case is worth. Contact the experienced workers’ comp attorneys at Steinberg Law Firm for a free consultation. We’re proud to serve injured workers across South Carolina. The attorneys at the Steinberg Law Firm bring a wealth of knowledge and experience in helping injured workers get the benefits they need and deserve.