What Happens After I Reach MMI Under Pennsylvania Law?

June 17, 2020

If you are currently receiving workers’ compensation, you may wonder “What happens after I reach MMI under Pennsylvania law?” If you have been receiving workers’ compensation benefits in Pennsylvania and your doctor has determined that you have reached maximum medical improvement (MMI), you are probably worried about how it will affect the disability payments you have been receiving after your injury.  Since reaching MMI does not mean you are completely healed, and there are always chances that your condition could deteriorate and require more care in the future, you want to do everything possible to make sure your benefits and medical treatment can continue.

How to Determine What Happens After You Reach MMI Under Pennsylvania Law

Your treating doctor is the one who determines whether you have reached MMI — the point at which your doctor believes that your condition has improved as much as it ever will. You may be healed, or it may mean that your medical condition will not change much in the future.

When you reach MMI, the insurance company will likely make you a settlement offer. It will also want you to be examined by one of its own physicians for an independent medical examination (IME) to determine whether you have really reached your MMI.

Insurance companies are out for their own profit and will try tactics to get you to accept the lowest settlement possible. You do not have to accept this offer. Accepting a settlement offer is permanent and will affect your benefits in the future, so before signing anything, it will benefit you to seek guidance from a workers’ comp lawyer.

The experienced Pennsylvania workers’ compensation attorneys at Wapner Newman are available to examine the facts of your workers’ compensation situation and help you evaluate your options and negotiate a settlement that covers any future medical expenses and lost wages. We know how to deal with doctors and insurance companies and can take your case to court if necessary. We will take the burden off you by handling the legal details and paperwork. We offer a free, no-obligation case evaluation, so don’t delay.

Call Wapner Newman at (215) 569-0900 for a free consultation today.

After Reaching MMI — How Is Maximum Medical Improvement Determined?

Only your physician can determine that you have reached MMI. This is done after a thorough examination to determine whether your disability or condition has stabilized and no further recovery will take place.

However, even if your doctor says your disability is permanent, the insurance company may decide to dispute this decision, or your employer can a request an Independent Medical Examination (IME) by a qualified physician to determine whether you have really reached your MMI.

After You Reach Maximum Medical Improvement — Impairment Rating Evaluations

In Pennsylvania, reaching MMI is a prerequisite for the performance of Impairment Rating Evaluations (IREs). When workers have been getting workers’ comp benefits for 104 weeks, a medical impairment rating is needed to verify the extent of workers’ injuries and whether they can return to the workplace. If you are not at MMI at this time, the IRE would not be valid.

The impairment rating is determined by assessing the loss of physical function. If an IRE determines that an employee has an impairment of less than 35%, then wage loss payment benefits will be capped at a maximum of 500 weeks.

Pennsylvania courts have ruled that IRE physicians must use the American Medical Association (AMA) Guides, 6th Edition in making their evaluations. The AMA Guides say that MMI “refers to a status where the person is as good as he/she is going to get from the medical and surgical treatment available to him/her.”

If you have reached MMI, and your IRE determines that you are healthy enough to return to work, your benefits will stop and you will return to your job.

If the IRE shows that your medical condition is not likely to change, and you are left with a lasting medical problem that prevents you from going back to work at all or only lets you work part-time or on a limited basis, you may then qualify for benefits that include:

  • Permanent Total Disability – If your injuries are so severe that you will not be able to ever return to work, you may be able to receive permanent benefits.
  • Permanent Partial Disability – If your injury causes permanent partial disability, you may receive benefits based on the percentage of permanent partial disability caused by the injury.

Under Pennsylvania law, there is no limit on how long an injured employee can receive total disability payments. To receive permanent disability benefits, you will have to go through a medical and legal process to show that:

  1. Your medical condition is not likely to change, and
  2. The condition prevents you from working or limits your ability to work and earn money.

If your doctor and the IME doctor do not agree on your condition, you do not have to accept the determination of the IME doctor, and your attorney can negotiate for further benefits. If both physicians agree that your MMI has been reached but you will have an ongoing disability, your attorney can help you reach a settlement with your employer’s workers’ compensation insurance company.

After You Reach MMI, You May Be Offered a Settlement

When you reach MMI, you may be offered a settlement that can take two forms:

  1. A lump-sum settlement. In Pennsylvania, in return for releasing your employer and their insurance company from paying any future workers’ compensation benefits for either lost wages or medical bills, you will receive a one-time payment as a settlement. After you sign a release, you will not receive any further funds even if your injury grows worse.
  2. A structured settlement — You will receive payments on a schedule that you and the insurance company have agreed on. A structured settlement makes sense if you are worried about the tax implications of a lump-sum payment or that it will not last or be sufficient if your injuries get worse.

Always speak to an experienced workers’ compensation attorney before agreeing to a settlement to make sure you are receiving an appropriate amount of compensation or a structured settlement that will meet your needs.

Contact Our Attorneys to Explore Your Options

Workers’ compensation laws are complicated, and making a mistake can affect the rest of your life, so if you have reached MMI, you should not try to negotiate a settlement on your own. The Pennsylvania workers’ compensation attorneys at Wapner Newman know the law and how to deal with employers’ insurance companies and their lawyers and can negotiate effectively to get you the best settlement possible. Don’t sign away your future.

Call Wapner Newman at (215) 569-0900 for a free consultation today.