According to the National Safety Council, there are over 4.5 million workplace injuries annually. When people get hurt at work, workers’ compensation benefits include payment of their medical expenses and wage replacement benefits if their injuries keep them out of work. Those temporary wage loss benefits can continue until the injured worker reaches maximum medical improvement (MMI).
What Is Maximum Medical Improvement?
Maximum medical improvement refers to the point during recovery from an injury after which your condition will no longer improve, even with additional medical treatment. For some people, that means they are completely healed and are as fit as they were before the injury. For others, that means the impairment they suffered due to the injury will not get any better, no matter how much additional treatment they receive.
MMI is important in workers’ compensation cases. Some workers’ compensation benefits pay in proportion to the degree of impairment the injured worker suffered. Additionally, if the injured worker reaches MMI and still cannot return to work in an unrestricted capacity or must change their line of work because of the injury, they may obtain permanent disability benefits.
Who Determines MMI?
A doctor is the only person who can determine you have reached MMI for your condition. Generally, at some point during your treatment, your workers’ comp insurance company will request a medical examination with a state-licensed independent physician.
If you are currently receiving temporary partial disability benefits or temporary total disability benefits, the workers’ comp insurer may be able to terminate your benefits once you reach MMI. Once a doctor has determined you have reached MMI and that you can return to regular unrestricted work duties, the insurance company will stop paying any temporary disability benefits.
MMI and Permanent Impairment Ratings
If the doctor determines you have reached MMI but you still have work restrictions, they will assign you a permanent impairment rating. Impairment ratings are percentages that reflect your current functional ability compared to your pre-injury state. The higher the percentage, the greater the impairment.
For example, an impairment rating of 30% for your hand means that your hand lacks about 30% of the functional ability that it had before the injury or condition. Impairment ratings matter because they determine how much compensation you receive for the condition.
If you have reached MMI and are still unable to return to unrestricted work, if your employer can accommodate your restrictions and offers you a job, you must take it according to state law. Failure to do so could jeopardize your benefits.
If you reach MMI and are unable to return to your previous job and your employer cannot accommodate your new restrictions, you can file a claim with the workers’ comp insurer to request retraining or education to enable you to pursue another line of employment.
Like in many other states, physicians in South Dakota use impairment ratings as laid out in the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition.
How Long Does It Take to Reach MMI?
Every person and every injury is different, so there’s no set period for reaching MMI. If the injury is minor, such as a broken bone or a case of carpal tunnel that requires surgery, a person can reach MMI in a few months. On the other hand, if the injury is catastrophic, such as a traumatic brain injury or a spinal cord injury, it could be many months or a year or two before the condition stabilizes and MMI occurs.
Maximum Medical Improvement and Permanent Disability Benefits
If you have reached MMI and have suffered permanent impairment to a portion of your body or to your overall function, you may be able to apply for permanent disability benefits. These benefits are not wage loss benefits. Rather, they’re payment for the permanent harm your work injury has done to your body.
South Dakota workers’ compensation law includes a section establishing the value in numbers of weeks of most parts of the body. For example, a hand has a value of 150 weeks. An arm has a value of 200 weeks. A leg has a value of 160 weeks.
To calculate permanent disability benefits, you multiply the impairment rating of the specific body part by the total weeks of compensation. You then multiply that number by two-thirds of your average weekly wage. There are limits on the average weekly wage in South Dakota. The upper limit is $1,066, and the lower limit is $533.
For example, say you harmed your foot at work, and a physician assigned you a 30% permanent impairment rating after you reached MMI. Because a toe has a value of 125 weeks, you would multiply that by your impairment rating of 30% to reach a total of 37.5. If your average weekly wage was $600, you would use two-thirds of that to calculate your permanent disability benefit: 37.5 weeks x $400 = $15,000. Your benefit for the impairment to your foot would be $15,000.
If you are completely unable to work after reaching MMI, and your doctor has provided a 100% impairment rating, you may be entitled to permanent total disability benefits for the entire period of your disability. These disability benefits may also be subject to periodic cost of living adjustments, as well as periodic review by the Department of Labor and Regulation.
Call an Experienced Workers’ Comp Lawyer Today
Handling workers’ compensation insurance claims is a complex process that can be confusing for the uninitiated. If you don’t know what benefits to claim, you could miss out on money you deserve. Your best option is to work closely with a seasoned workers’ compensation attorney who can help you fight for all the benefits you’re entitled to.
Contact the Watertown workers’ compensation attorneys of Turbak Law Office, P.C. online or call us today at 605-886-8361 for a free case consultation with one of our workers’ compensation attorneys. If we don’t get money for you, you won’t owe any legal fees. Call now.