MMI is very tricky term, therefore people accept the insurance company’s definition of it.
“I’ll address it because I’ve had a lot of clients and potential clients calling me wondering what MMI means.”
Hi, I am Brian with Garfinkel Schwartz PA. Here are some tips about how to start a Defense Base Act claim and what to watch out for.
What does Maximum Medical Improvement (MMI) mean in a Defense Base Act or a Longshore case? I’ll walk you through it so you can understand it better.
Maximum Medical Improvement
What precisely is MMI, or Maximum Medical Improvement? Different people have different ideas about what MMI actually means. The insurance company and I obviously disagree on what MMI is. I’ll simply give you an example of what I hear on the phone.
Example No. 1 of MMI
“Hello. They placed me at MMI and the insurance company cut me off. They say I’m at MMI and that I can go back to work. I don’t think I can go back to work since I’m still in terrible pain.”
Why were you placed on Maximum Medical Improvement by your insurance company? That is because the insurance company has interpreted MMI (Maximum Medical Improvement) to suggest that you are ok. You’re done. You’re at maximum medical improvement. You do not require any more treatment. As a result, many adjusters who are not doctors nor attorneys utilize that word to persuade people to return to work.
MMI = Treatment With THAT Doctor is complete. Well, that’s not what that means. MMI doesn’t mean your treatment is finished and you can go back to work. What MMI means is there’s nothing else that a particular physician can think of that’s going to make you any better.
MMI Example No. 2
Let me give another example. I had a client who suffers from PTSD. He also broke his tailbone and has a lower back injury. He had a leg injury as well. Here, I’ll just focus on two. Well, the insurance company cut him off because his orthopedic surgeon said he was at MMI. All that means is the surgeon is basically saying. “I can’t think of anything more to help this person. He’s at maximum medical improvement.”, without saying “from an orthopedic standpoint.” The only thing that that doctor can testify to in court is anything orthopedically wrong with my client, nothing else. They use that and say, “Hey he can go back to work. He’s fine now.” Well no.
That’s not true. The only reason he’s at MMI is because there’s no surgery that can be recommended to help his cracked tailbone from this doctor. Surgeries are done, not Ongoing Health Care. This client is going to have to live with that. There’s no direct surgery that can be done. He’s already gone through all the conservative therapies in terms of physical therapy, epidural injections, and all that kind of stuff. The doctor just put up his hands and said there’s nothing more I can do for this gentleman. That doesn’t mean he’s still not in terrible pain. He’s going to need pain management for the rest of his life and he’s going to need injections basically on and off. He’s going to need a TENS unit.
Health Care doesn’t have to stop. These things are not necessarily medical in nature in terms of having to do surgery and other manipulations of your body. It certainly isn’t a fact that “Oh I’m at MMI, that means I’m ok.” And that’s the difference that we have in terms of that definition. Now in terms of that client, you’d wonder, “ok, well he’s at MMI orthopedically. He’s ok.” Well, what about his PTSD? He was off work because of his PTSD as well and there’s no MMI for that. He’s still being treated for that by a psychiatrist. MMI is a very tricky term and a lot of people don’t understand, and they just accept the insurance company’s definition of what MMI is.
You should not do that and you should definitely hire or talk to an attorney who can understand what the claimant’s definition of MMI should be and if it is or isn’t ok for you to go back to work.