The Texas Workers’ Compensation Act defines maximum medical improvement (MMI) as the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated. That sounds pretty clear, but we’ve been arguing about what that means for years. Here’s what you need to know about maximum medical improvement in Texas as you try to sort out your claim.
Maximum medical improvement is expressed as a date. A doctor has to certify the date that you reached your maximum medical improvement. Once this date is determined, then you get an impairment rating. An impairment rating is a measurement of the permanent damage to your body that resulted from your work injury. Once you reach MMI, you are no longer eligible to receive temporary income benefits to cover your lost wages. That’s why there is so much argument over MMI.
What Insurance Companies Say About Maximum Medical Improvement in Texas
Insurance companies (also called carriers) have a very narrow perspective on maximum medical improvement in Texas. It’s in the carriers’ best interests for MMI to be close to the date of injury. This limits how much money they have to pay on a claim. They want to interpret MMI as the point in your recovery where you got as good as you were going to get.
Imagine that you got injured a year ago. You have gotten medical treatment regularly ever since. Initially, physical therapy helped a little bit. After about six weeks, you didn’t get any better. You tried injections, had surgery, more therapy and none of that helped. An insurance company would argue that you reached maximum medical improvement six weeks after your injury occurred. That’s because you haven’t gotten any better since then – you reached your maximum improvement way back then. Even though you had surgery after that time! Too many designated doctors share this narrow view of maximum medical improvement in Texas.
What Texas Workers’ Compensation Law Says About MMI
The Legislature has charged the Appeals Panel with interpreting the statutes and rules about maximum medical improvement in Texas. We can look at Appeals Panel rulings to understand how MMI should really be determined. And it’s nothing like insurance companies would have you believe. The Appeals Panel has stated that we can’t overlook the last phrase in the definition of MMI. That statute says that further improvement “can no longer reasonably be anticipated.” We can’t ignore that phrase. It has to mean something.
In Appeals Panel Decision 072242, the panel stated that the question for MMI is not whether you actually recovered, but whether or not further recovery could reasonably be anticipated. That is a very broad view of MMI. This means that if your doctor provided treatment because he thought it would help you improve, then you were not at MMI.
So, in the example above, how could you have been at MMI prior to the surgery? The doctor didn’t do surgery to make you worse! Your surgeon performed that surgery intending to help you. So, you would not be at MMI until after your recovery from surgery. Maximum medical improvement in Texas is not about looking backwards in time to find the date where you stopped getting better. It’s about looking forward from the time your doctor prescribed treatment to determine whether or not there was a reasonable chance at improvement with that care. If there was a reasonable chance at further improvements, then you couldn’t have been at MMI until after that treatment was provided.
You can find additional information about maximum medical improvement in Texas in our FREE book. Click the link to get your copy of The Ultimate Survival Guide For Texas Injured Workers.
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