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Maximum medical improvement is a term found in workers’ compensation law. It is defined as the point where the medical condition, created by a work-related injury, will no longer appreciably improve. This simply means a treating or evaluating physician does not expect any additional improvement at this stage of recovery. It does not mean the injured employee is free from the possibility that his condition could worsen or that he could be fully disabled.
When an employee is injured on the job, he may be entitled to workers' compensation benefits because of temporary total disability. When the employee has recovered enough to have reached maximum medical improvement, his temporary benefit is converted to a permanent settlement. Permanent partial disability benefits are calculated using a rating number or percentage of disability. At this stage, when temporary total disability benefits are converted to a permanent partial disability, most treatment options have been exhausted or at least changed from rehabilitative to palliative. At this point, the focus is less on treatment and more on a final resolution.
Consider the following example: A lift operator at a warehouse is injured when a tall stack of boxes fall on her, giving her a compound fracture on her ulna. This incident leaves her disabled for six months, during which time she receives temporary total disability payments. She eventually returns to work part-time doing paperwork for the warehouse office. Consequently, she begins to collect temporary partial disability benefits.
Eventually, her treating physician determines that she has reached maximum medical improvement. He establishes that she has a 20 percent permanent partial disability because of her injury. Having received her disability rating, the insurance company can then turn to a set schedule — published by the applicable state government — which states how much permanent partial disability benefit the insurer must pay over how many months.
Maximum medical improvement serves two fundamental purposes. First, it represents a defense to the payment of any additional temporary total disability benefits; these payments simply cease. Second, it represents the point where the injured employee’s permanent partial disability rating can finally be established. These two important issues determine how much of a total workers’ compensation benefit is available to the employee. For these reasons, many insurance companies will hire their own physicians to perform independent medical examinations to render their own opinion regarding maximum medical improvement.
A physician must consider several factors provided by the American Medical Association (AMA) when ascertaining whether the injured employee has reached maximum medical improvement. The primary source of this information is the AMA’s Guides to the Evaluation of Permanent Impairment. If the treating physician and the physician hired by the insurance company to evaluate the injured employee are in dispute, the issue is left to the workers’ compensation administrative law judge. This judge will consider certain factors, including the history of the patient’s condition, any pre-existing conditions, and the current and proposed treatment plans.