Workers’ Comp has different laws for each state. In North Carolina, maximum medical improvement or MMI does not determine when a worker is fully capable of returning to work and being released from doctor’s care. MMI is the term used to proclaim that the worker’s condition has leveled off and will not get better or worse. The Workers’ Comp doctor determines the patient’s status for this situation and makes the call. In many situations, this is the point when the insurance may try to drop your case, and it leaves the critical point where you have no other option but to seek legal action and hire an attorney. Once you reach MMI in NC, the case will become hectic.
When Workers’ Comp Drops an Employee After Reaching MMI Status
One of the most frustrating and difficult times that a worker will experience is when they are injured. Injuries can disrupt your life, but you have rights guaranteed by Workers’ Comp to help make up for lost wages and medical bills. In many cases, once an injured worker has reached MMI status, their employer may try to drop their case because, at this time, no further treatment or care is necessary. This means that if you think your employer will stop paying benefits at this stage of your injury, then it is best to seek legal action as soon as possible. An experienced attorney will review each case individually and determine the possibility of a successful outcome for you after reaching MMI status.
For those injured on the job and who have reached MMI status, the risk of losing their Workers’ Comp benefits does exist. The insurance company handling your case will try to stop making payments as soon as they can because this is the point where workers are not expected to get better or worse. This is why it is so important to hire legal representation if you think you may be in danger of losing all compensation for your injuries. An attorney will review every aspect of your case and ensure that no stone goes unturned when it comes to fighting for what you deserve.
You should not delay seeking legal action because once you reach MMI status, your employer may try to drop your case before paying all money owed for past or current medical bills or lost wages. You can’t win if you don’t fight, so contact an experienced attorney as soon as possible if you think your Workers’ Comp case may be in jeopardy of being closed.
For those injured on the job and who have reached MMI status, this is not the time to give up hope that you will receive all payment for medical bills or lost wages. You can keep fighting your case by seeking legal representation.
Examples of MMI Cases Dropped by Workers’ Comp in North Carolina
When an employee reaches MMI, they may no longer be eligible for workers’ compensation benefits like Temporary Total Disability (TTD) and wage loss. This article aims to provide employees with information about what you should do if you reach MMI in your workplace injury case because it’s important to know what could happen after someone reaches Maximum Medical Improvement before that happens.
The following are a few examples of Maximum Medical Improvement (MMI) cases and situations where employees found themselves in these situations.
1.) “My right leg just broke three months ago, but I have already reached maximum medical improvement.” – A Claimant
2.) “I can’t go back to work three months after surgery, but the doctor says I’ve reached MMI.” – A Claimant
3.) “My surgery is not complete until next year. When will I reach Maximum Medical Improvement?” – A Claimant
4.) “The state told me that reaching Maximum Medical Improvement means that my benefits are cut off because I can do any job now.” – A Claimant
These benefits stopped upon the status of MMI by the Workers’ Comp physician, and you can always ask the doctor to re-examine and reevaluate you because reaching Maximum Medical Improvement (MMI) is not a fixed point in time: it depends on each person’s condition and how the injury progresses over time.
Therefore, if an employee has reached MMI and wants to still be eligible for workers’ compensation benefits like TTD or wage loss, simply asking for this medical treatment could change their status from “Maximum Medical Improvement” back to “temporary total disability.” This article aims to provide employees with information about what you should do if you reach MMI in your workplace injury case because it’s important to know what could happen after someone reaches Maximum Medical Improvement before that happens.
What Can An Attorney Do If You Lose Workers’ Comp Benefits Due to MMI Status?
If an employee has reached MMI, their attorney will research the law and make a case with supporting evidence about why they should be eligible for Workers’ Comp benefits. For example, the employees may still experience some symptoms in some cases. Still, they aren’t bad enough to interfere with their ability to do less than sedentary work and would not otherwise qualify for full disability benefits.
You can reach Maximum Medical Improvement by:
1.) Reaching maximum medical improvement on any body part gives you the right to be paid TTD and wage loss until you return to work or until your condition gets worse. Workers’ comp insurance companies try very hard to prove that someone’s injury has improved so much that they shouldn’t receive workers’ comp benefits anymore.
2.) Completing all medical treatment and getting healed completely; OR
You are unable to go back to work because of your injury or illness for at least 16 weeks (may vary in some cases) after the date when your last medical treatment ended. If you are still entitled to receive wage-loss benefits when you reach MMI, then your wage-loss checks should continue until you return to work or when there is a change in your condition that affects your level of disability.
3.) You can also end up MMI if it’s determined that you cannot return to light-duty work before reaching Maximum Medical Improvement, even though no further medical improvement is anticipated.
4.) The law also states that you will be found MMI when all of your medical treatment ends and either:
– You are still unable to do the same type of work you did when the injury happened; or
– You need further care or services to help prevent an impediment in your ability to find work; or
– You experience a change in your health condition that affects your level of disability, even though any of the considerations listed above are not valid for you. This means that if there is no longer any chance of further improvement with rest or additional surgery, you may reach Maximum Medical Improvement at some point during recovery where you can no longer receive Workers’ Comp benefits but only Social Security disability benefits.
Should You Return to Work if You Reach Maximum Medical Improvement?
While your injury or illness is healing, you may receive workers’ compensation benefits to replace the money you would have earned if it were not for your workplace injury. Suppose you return to work before reaching Maximum Medical Improvement (MMI). In that case, your employer may no longer be required to pay wage replacement benefits even if you are still unable to perform some or all of your original job duties due to the lasting effects of your injury or illness.
If someone reaches MMI status, they can return to their previous position with the same pay and benefits as long as this person has reached full medical improvement on every part of the body involved in their case against the Workers’ Comp insurance company. After reaching MMI status, North Carolina Workers’ Compensation benefits are over for this person, which means that the insurance company is no longer obligated to pay wage replacement benefits.
However, suppose someone has not reached full medical improvement at the time of MMI. In that case, they are still entitled to receive temporary total disability (TTD) or partial disability payments until they complete all medical treatment or agree with the insurance company about their TTD status. If you reach Maximum Medical Improvement before completing all necessary procedures for your injury, then your employer does not have to provide you with return-to-work accommodations related to your work environment because you are fully healed. Your compensation case ends when you reach Maximum Medical Improvement because it is no longer compensable. The law states that even though your case is over at this point, your employer must still provide return-to-work accommodations.
What if You are Physically Not Ready to return to Work?
If you reach MMI before returning to work, you will no longer be paid wage replacement benefits by the Workers’ Compensation insurance company. Therefore, your job duties taken away from you due to your workplace injury or illness may not be available anymore because the employer has no reason to pay any wage replacement benefit(s) if you are already healed and able to perform all of your regular job duties again. What happens in these situations?
Different factors determine whether or not someone reaches Maximum Medical Improvement (MMI) status after their workplace injury or illness. Suppose an injured worker is not physically ready to return to work. In that case, they may need more time off or physical therapy to reach MMI status and go back to work at their previous position with the same pay and benefits as before their injury.
For example, Mr. A was involved in a workplace accident and received medical treatment for his injuries several weeks after his accident. Once Mr. A’s physician releases him from all necessary medical care and medications related to his workplace injuries, this person has reached MMI status and will no longer receive wage replacement benefits from the Workers’ Compensation insurance company (WC). However, since Mr. A needs another month of physical therapy after reaching MMI status to return to work and resume his regular job duties, this person has not reached full medical improvement. Mr. A’s Worker’s Compensation case would still be open after reaching MMI status because he is not physically ready for return-to-work due to the lasting effects of his workplace injury or illness (i.e., need for physical therapy).
What If You Receive a New Injury at Work?
Sometimes an employee will continue receiving wage replacement benefits from the Workers’ Compensation insurance company after reaching Maximum Medical Improvement (MMI) status because they become injured on the job again and require new medical treatment and time off from work (i.e., reinjury).
For example, Ms. B has reached MMI status but has not returned to work. One month after reaching MMI status, Ms. B injures her back again while lifting heavy objects at work and requires medical treatment for this new injury. This woman would still be entitled to receive her normal wage replacement benefits from the Workers’ Compensation insurance company even if she reaches Maximum Medical Improvement because she received a second injury at work (i.e., reinjury).
What If You Return to Work Before Reaching Maximum Medical Improvement?
You could suffer more injuries or illnesses during your time working that may only worsen your limitation(s) and debilitation(s) caused by your workplace injury or illness (i.e., make your condition(s) worse). For example, if Mr. A reaches MMI status (he is deemed fully healed and able to return to work with no restrictions but still decides to continue receiving wage replacement benefits from his employer) and returns to work at his previous job duties for a month before reinjuring himself on the job again. This person would not be entitled to receive any pay or benefits (i.e., lost wages, medical treatment, etc.) because he voluntarily returned to work under MMI status without limitations and while still receiving full wage replacement benefits after treating him as totally disabled for several weeks.
What Makes MMI Different in North Carolina?
In North Carolina, workers’ compensation cases remain open after an injured worker reaches Maximum Medical Improvement because they are physically unable to return to work due to the lasting effect(s) of their work injury or illness (i.e., physical therapy). In other states, this person’s case would be closed.
How Can an Injured Worker Receive MMI?
An injured worker receives Maximum Medical Improvement when all reasonable treatment options have been exhausted. The injured worker is not medically capable of returning to their pre-injury work duties due to a permanent injury or illness. Two doctors must make this determination during a medical examination for the injured worker to receive MMI.
How each state handles “Maximum Medical Improvement” varies from state to state as every workers’ compensation system has unique sets of rules and regulations that govern it. This article will explain those differences by comparing North Carolina’s workers’ compensation systems with those of Florida, Georgia, Kentucky, Texas, and California.
In North Carolina, an employee who wishes to receive compensation for an injury must report the injury to their employer within 30 days of when it happened. Suppose they fail to do so and wish to receive compensation. In that case, they will not be permitted to pursue claims against their employers or anyone else covered by workers’ compensation insurance (i.e., third-party insurers).
Once an injured worker is reported as having sustained an injury, they become entitled to medical treatment at no cost under North Carolina’s Workers’ Compensation system. This includes any required medical examinations and tests and reasonable and necessary treatments that a doctor prescribes.
Finding an Attorney to Handle Your Workers’ Comp Case Concerning MMI
The North Carolina Industrial Commission [IC], which decides worker benefits, has a very narrow interpretation of what constitutes an MMI. There are findings that this is true with their vague definition of ‘permanent impairment.’
Since the IC oversees worker’s comp cases in North Carolina, they also have control over deciding if your case should be labeled MMI or not. This gives them the power to determine what injuries are permanent and whether or not you’re entitled to ongoing benefits after being out for more than seven days or 30 days consecutively, whichever comes first.
An attorney specializing in these cases can fight for you against the state’s determination if they deem your injury permanent. An MMI designation tends to preclude you from continuing receiving benefits after a specific time frame [usually seven or 30 consecutive days in the state of North Carolina].
An attorney can help determine whether or not an MMI designation is in order in your case and how long you could be expected to receive worker’s comp benefits.
Types of Injuries That May Label a Worker Reaching MMI
North Carolina law places their employment on hold when an injured worker reaches MMI. While the worker has reached MMI, NC employers cannot terminate or discipline them without first giving them a second chance at treatment.
Reaching Maximum Medical Improvement is not permanent, though. If an employer wants to fire you while you’re at MMI, they must contact your doctor and request that they remove you from Workers’ Compensation benefits altogether. Your doctor will work with your employer’s insurance provider to determine whether or not this is possible. Still, it is ultimately up to your doctor whether or not they think you are healthy enough for employment again.
If your doctor decides that you can return to work, they will re-examine you and determine the extent to which you can return to work.
Getting To MMI: Reaching Maximum Medical Improvement
MMI is a process and not a status. Once an injury has healed enough for the injured worker to no longer need medical attention, getting to “MMI” can take weeks or months. If an injured worker were initially seen by a physician within two days of their injury but has not been seen for two years post-accident, it would be impossible for them to reach MMI as it takes an average of 30 days from the time of seeing a physician until reaching MMI. Furthermore, if the injured worker is cleared to return to work part-time after seeing a doctor, they will not be considered “MMI” by NC law.
Getting to MMI can take months after an injury, but once you’re there, staying at MMI means that you’re unable (or at least extremely unlikely) to be fired or otherwise retaliated against, despite any history of discipline during your course of treatment. Workers should not let this process frighten them, however. Once an injury has healed enough for them to no longer need medical attention, sometimes workers should leave their job situation as it is rather than risk reinjury or other harm by returning under dangerous conditions to their current employer.
What Happens After You Win an MMI Case?
Once you win a case for workers’ comp benefits in North Carolina, it means that your injuries are permanent and stationary. Your condition will not worsen anytime soon, nor will it improve any time soon. But what happens to the workers’ compensation benefits? Can you lose them?
Length of Benefits in NC
The good news is that once you win an MMI case, you can receive weekly benefits for as long as your injuries prevent you from working at all. This means if both of your legs have been amputated because of a work accident, then yes, you can receive benefits forever! The bad news is that receiving these benefits is dependent upon continuing to provide medical evidence that proves that the injury has not improved or grown any worse. The insurance company or employer will most likely try to find a doctor who will say that your condition has improved, and this, of course, would help their cause immensely.
Insurance Company vs. Doctor
So what happens once you win an MMI case and the workers’ comp insurance company wants to challenge the decision? This is where things can get complicated because you will be forced into court and given a new judge with whom you must now prove your injury has not improved. The best chance of success in these types of proceedings is if you have prior medical evidence proving that you were injured as described, as well as recent (within one year) medical evidence showing why your injuries still prevent you from working at all. A great example is if you were scheduled for surgery and the insurance company decided to challenge your case. You could present two medical opinions from two different doctors, one saying that surgery is needed right away and another explaining why the surgery should be postponed.
Settlement Out Of Court
If you can’t produce enough evidence to prove that your injuries have not improved and the judge rules in favor of the insurance company, then that doesn’t mean all hope is lost. Your attorney can offer a settlement outside of court so long as this makes sense, given how much work you need to put in when it comes to trial (i.e., filing motions, taking depositions). Once again, good evidence such as medical reports will influence these negotiations in your favor, especially since the insurance company knows that trial preparation will be costly.
Settlement Inside Court
So what happens once you win an MMI case and the workers’ comp insurance company decides to challenge your benefits? Then you must take the case to court and prove why your disability has not changed. If both parties can’t agree on a settlement, then a judge must decide whether or not the injury has improved – which it never does so long as you continue seeing doctors who say that you still cannot work at all. This is why good evidence such as medical reports is needed because it helps show that medical treatment should continue for your condition to remain stationary.
Another thing to look out for in NC Workers’ Compensation cases is if the employer challenges your case because they want to stop paying out benefits. In this situation, you can file a motion to compel them to keep making these payments as required by law. Sometimes the employer decides to challenge your case to have more leverage for negotiations once it’s time to settle outside of court. But if you have good evidence, such as medical reports proving that your injury has not improved, then it would show that the injured worker should still receive weekly benefits.
North Carolina Workers’ Comp Settlements
When you win an MMI case, what happens next? How long do you have to wait before receiving benefits, and how much money will be put in your pocket after all is said and done? After winning an MMI case in North Carolina, you should expect to receive benefits just as if you were fired from your job. This includes permanent total disability (PTD), permanent partial disability (PPD), and temporary total disability (TTD).
Once an injured worker wins an MMI case in NC, their doctor must provide reports every six months proving that the injured worker is still unable to work due to their injury. These are called RFC or residual functional capacity assessments. The doctor will also say whether or not additional treatments are needed for the condition, usually medical procedures, surgery, or therapy. If these prove successful, this can help avoid having the insurance company challenge the ruling because they’ve seen proof that your injuries haven’t improved since initially sustaining them. Being aware that all insurance companies look out for only themselves is enough reason to get an attorney.