When you’re injured or suffer an occupational disease at work, getting better and returning to your job is the goal. But what happens when your recovery reaches a plateau? That’s what is called Maximum Medical Improvement (MMI), and it’s a turning point in your workers’ compensation claim that can also affect your wage and medical benefits.
Understanding MMI and its implications for your workers’ comp claim can help you address this challenging phase of your recovery. Many injured workers worry that an MMI determination means the end of their benefits, but that’s not always the case. With legal guidance from an Ohio workers’ comp lawyer, you can still access the medical care and financial compensation you need, even after reaching this milestone in your workers’ compensation case.
What Is Maximum Medical Improvement?
Under Ohio law, MMI is defined as a “treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures.”
In plain English, this means your condition has stabilized and additional treatment isn’t likely to improve your recovery. It doesn’t necessarily mean you’re completely healed or able to return to your previous job: it simply indicates that your condition isn’t expected to get substantially better.
When a doctor says you’ve reached MMI, they’re stating that your on-the-job injury has improved as much as can be expected with the available treatment options. Your condition has stabilized to a point where continued medical care won’t result in notable improvement.
It’s important to note that MMI isn’t about being pain-free or returning to your pre-injury status: many injured workers reach MMI but still struggle with chronic pain or have a permanent disability. An Ohio workers’ compensation attorney can help by arguing that ongoing treatment may be necessary to improve your quality of life.
How Is MMI Determined in Ohio?
There are three main ways MMI can be determined:
- Your Treating Physician: Your doctor may decide that you’ve reached a treatment plateau. If this happens, they’ll inform the Bureau of Workers’ Compensation (BWC) or your self-insured employer, who will then terminate temporary total disability benefits as of the date indicated by your doctor.
- Independent Medical Exam (IME): If you’re sent for an IME and the examining doctor determines you’ve reached MMI, this report is sent to the BWC. The BWC will then ask your treating doctor if they agree with the IME findings. If your doctor agrees, your workers’ compensation benefits will be terminated.
- Ohio Industrial Commission (IC): If your treating doctor disagrees with the IME findings, the BWC will send your case to the Industrial Commission for a final determination. A hearing will be scheduled and you’ll receive notification of the date.
Your treating physician is the doctor who has been managing your care through the workers’ compensation system. They have a full understanding of your work-related injury and recovery progress. When they determine you’ve reached MMI, their opinion carries substantial weight. However, the BWC or your self-insured employer may require an IME with a doctor they select. This doctor will review your medical records and examine you during a one-time appointment.
Sometimes their assessment differs from your treating physician’s opinion, which can lead to a disagreement about your MMI status. If this happens, the BWC refers the case to the Industrial Commission, which schedules a hearing where both sides can present medical evidence. This hearing allows you to contest an MMI finding that you believe is premature.
What Happens to Your Workers’ Compensation Benefits at MMI?
When you reach MMI, your temporary total disability (TTD) benefits will stop. This can be concerning if you aren’t ready to return to work, but it doesn’t mean all workers’ compensation benefits end.
Even after reaching MMI, you may still be eligible for:
- Medical Benefits: You’ll still receive medical expense coverage needed to maintain your condition and prevent it from worsening.
- Wage Loss Benefits: If you return to work but earn less than before your injury, you may qualify for wage loss compensation.
- Future Temporary Total Disability: Despite being found MMI, you may again be eligible for TT if there are new and changed circumstances. Examples of new and changed circumstances are a surgery through your claim or a new condition being added to your claim.
- Permanent Partial Disability (PPD): This award compensates you for permanent partial impairment resulting from your work injury.
- Permanent Total Disability (PTD): If your injury is severe enough that you can’t return to any form of employment, you might qualify for these ongoing benefits.
- Vocational Rehabilitation: You may be able to access programs to help you return to the workforce in a capacity that accommodates your limitations.
TTD benefits provide income replacement while you’re healing, but they’re not meant to be permanent. They typically pay two-thirds of your average weekly wage, with the first 12 weeks sometimes paid at a higher rate.
After MMI, if you can’t return to your former position but can perform other light-duty work, you might qualify for wage loss compensation, which pays two-thirds of the difference between your pre-injury and post-injury earnings. This income helps bridge the gap if you must take a lower-paying job due to your limitations. For catastrophic injuries, you may receive permanent partial disability compensation, which is calculated based on the percentage of impairment to the injured body part or your whole person.
What to Do If You Don’t Agree With an MMI Finding
If you don’t agree with a determination that you’ve reached MMI, you have several important options to pursue:
- Participate in the IC Hearing: If your injury claim has been referred to the Industrial Commission after a disagreement between your treating doctor and the IME doctor, it’s important to participate in this hearing with your attorney. Bring all helpful medical evidence supporting your position, including recent treatment notes, test results, and statements from your doctor explaining why ongoing treatment would be beneficial.
- Appeal the Decision: If the IC decides you’ve reached MMI and you disagree, you can appeal the decision to the next level. This must be done using form IC-12 or through the online ICON system within 14 days of receiving the order. Make sure to clearly state the reasons you believe the MMI determination is premature.
- Consult a Workers’ Comp Attorney: The appeals process can be complicated. An experienced attorney who handles Ohio workers’ compensation cases can help you document your medical history, prepare you for hearings, file appeals correctly and on time, and make persuasive legal arguments on your behalf.
- Request a Rebuttal Report from Your Treating Physician: If your treating physician disagrees with the MMI finding, speak with them about your ongoing symptoms and ask if they would provide a detailed statement explaining why further improvement is possible. Their opinion carries substantial weight, so their support can be instrumental in challenging an MMI determination.
If your treating physician disagrees with the IME doctor’s MMI determination, make sure they provide a detailed explanation in writing. This explanation should include:
- Ways your condition could still improve with continued treatment;
- Any diagnostic test results that show ongoing healing;
- Comparisons of your current condition to earlier examinations showing progress;
- Recommended treatments that could lead to functional improvements;
- Medical literature supporting their opinion about your recovery potential.
Challenging an MMI determination means showing that additional medical treatment could reasonably be expected to improve your functional abilities. Focus your evidence on this potential for improvement rather than just describing your current symptoms.
Recent Changes in Ohio Workers’ Compensation Law
In March 2024, the Ohio Supreme Court proactively created a harm to injured workers when they issued a ruling regarding MMI determinations and benefit terminations that was a complete departure from well-established Ohio law. Without being asked to do so, the court decided that TTD benefits can be terminated on the date when any physician declares MMI, including state or employer-hired doctors.
This ruling in State ex rel. Dillon v. Industrial Commission reversed a practice that had been in place since 1998. Before this decision, TTD benefits would continue until the date of the termination hearing, even if an IME had found MMI months earlier. Now, if an IME doctor finds you’ve reached MMI, your benefits could be terminated as of that date, rather than continuing until your hearing. While this is a violation of your due process rights as defined by the Ohio Constitution, the Ohio Supreme Court nonetheless decided it is appropriate. If the hearing officer agrees with the MMI finding, you might end up with an overpayment that must be repaid from future benefits.
For injured employees, this emphasizes the importance of contesting an MMI finding promptly and having strong medical evidence from your treating physician if you believe you haven’t reached maximum improvement.
What is the Appeals Process for MMI Determinations?
The appeals process for MMI determinations follows these steps:
- District Hearing Officer (DHO): The initial appeal is heard by a DHO at your local Industrial Commission office. You’ll receive a written decision within a few days of the hearing.
- Staff Hearing Officer (SHO): If you disagree with the DHO’s decision, you can appeal to an SHO within 14 days. Again, a hearing will be scheduled, and you’ll receive a written decision.
- Commission Level: If you’re still not satisfied with the outcome, you can appeal to the three-member Industrial Commission within 14 days of the SHO’s decision. However, the Commission may choose not to hear your case, in which case the SHO’s decision stands.
The Industrial Commission hearings are less formal than court proceedings but still follow specific protocols. Hearings typically last about 15-30 minutes, during which both sides present their arguments and evidence. You’ll receive notification of the hearing date at least 14 days in advance and may be represented by a workers’ compensation lawyer.
After each hearing, the officer will issue a written order that explains their decision. These orders are usually mailed within 7 days of the hearing. If you want to appeal, be sure to note the deadline in your decision letter, as missing an appeal deadline can result in a final unfavorable decision.
Question About MMI? Talk to an Ohio Workers’ Compensation Attorney
At Plevin & Gallucci, our workers’ compensation lawyers have spent decades fighting for injured workers in Ohio. We recommend that clients begin working with us as soon as they know they may need to file a claim, so they can be properly and professionally represented at each step of the process.
We have extensive experience with the Ohio workers’ compensation system, including all the rules surrounding MMI, and we can help you gather the medical evidence needed to contest an incorrect finding. Our team works with healthcare professionals who can provide thorough medical evaluations and clear documentation of your condition.
If your treating physician disagrees with an IME finding of MMI, we’ll make sure their medical opinion is properly presented at your Industrial Commission hearing. We know how to effectively argue these cases and counter the employer’s evidence, so if you’ve been told you’ve reached Maximum Medical Improvement and aren’t sure what to do, call our law firm at 855-4PLEVIN, fill out our contact form, or click in the bottom right-hand corner of the page to chat with an agent now.
