Maximum Medical Improvement in Louisiana Workers Compensation

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What Is Maximum Medical Improvement in Louisiana Workers Compensation?

In Louisiana workers compensation, Maximum Medical Improvement - or “MMI” for short - is generally defined as the point at which the injured employee's medical condition has stabilized and is unlikely to improve any further.

In other words, Maximum Medical Improvement means that the injured worker has reached a state where his or her medical condition cannot be improved any further, or that a treatment plateau in the employee's healing has been reached.

Of course, just because the injured employee worker has reached Maximum Medical Improvement does not mean that he or she is 100% fully healed.

Instead, Maximum Medical Improvement simply means that the injured worker's medical condition is generally "as good as it is going to get."

So in this sense, Maximum Medical Improvement could be a state reached both by an injured employee who is 100% fully healed, and a different injured employee who is not healed at all.

Despite the fact that physicians often refer to Maximum Medical Improvement as the goal of medical treatment, it is frequently the case where an injured employee reaches Maximum Medical Improvement, but this employee still suffers pain, symptoms and impairments.

In fact, unfortunately, an injured employee could be at Maximum Medical Improvement, even though his or her medical condition might deteriorate or get worse. 

But, a determination of Maximum Medical Improvement can be positive for an injured employee, because it can signal that the employee's workers compensation claim is near an end and that settlement is likely to occur soon.

Who Determines Maximum Medical Improvement in Louisiana Workers Compensation?

In Louisiana workers compensation, Maximum Medical Improvement in generally determined by the treating physician of the injured worker.

Really, this is because no other individual or party is in a better position to determine whether or not the employee has reached the point at which the injured employee's medical condition has stabilized and is unlikely to improve any further.

However, the workers compensation insurance company will often request that its own doctor conduct a Second Medical Opinion (SMO) - or a third doctor conduct an Independent Medical Examination (IME) - to determine if the injured employee is truly at Maximum Medical Improvement.

If the employee's treating physician and the insurance company's SMO or IME doctor are in disagreement, the matter will often be presented to the OWC workers compensation Judge for a hearing and determination.

Finally, it is important to recognize that an injured employee can be determined to be at Maximum Medical Improvement by one of his or her physicians, but not by another different of his or her physicians. 

For example, an injured employee's pain management doctor may determine that the employee is at Maximum Medical Improvement, while the employee's spinal surgeon may find that the employee requires surgery and therefore is not at Maximum Medical Improvement. 

Why is Maximum Medical Improvement Important in Louisiana Workers Compensation?

In Louisiana workers compensation, a determination of Maximum Medical Improvement will be important for a number of reasons.

Again, Maximum Medical Improvement means that the injured worker has reached a state where his or her medical condition cannot be improved any further.

First, if an employee's treating physician finds that the employee has in fact reached Maximum Medical Improvement, then this may have an effect on the injured worker's eligibility for certain types of lost wage (indemnity) benefits.

For example, if an injured employee reaches Maximum Medical Improvement, but remains totally disabled, it is very likely that this employee will be eligible to receive Permanent Total Disability (PTD) benefits.

Also, if an injured employee reaches Maximum Medical Improvement, but remains partially disabled, it is very likely that this employee will be eligible to receive Permanent Partial Disability (PPD) benefits, or Supplemental Earnings Benefits (SEBs).

And, if an injured employee reaches Maximum Medical Improvement, it is extremely unlikely that this employee would be eligible to continue receiving Temporary Total Disability (TTD) benefits, since the employee's disability is no longer temporary in nature because the employee's condition has stabilized or plateaued. 

So in this sense, a determination of Maximum Medical Improvement - particularly when the injured employee is able to return to some type of work - can often mean less future lost wage (indemnity) benefits. 

Second, because of the ramifications that a determination of Maximum Medical Improvement can have on a workers compensation claim, it is not uncommon for either the injured employee or the workers compensation insurance company to challenge a determination of Maximum Medical Improvement.

Additionally, once a treating physician makes a determination of Maximum Medical Improvement, the workers compensation insurance company will often begin the vocational rehabilitation process - in order to reduce or eliminate an employee's lost wage benefits - if the employee cannot return to full employment.

Finally, a determination of Maximum Medical Improvement often creates a situation where it is an ideal time to attempt settlement negotiations, since the employee's medical situation will no longer be changing or improving.

The workers compensation insurance company will likely be eager to pursue settlement negotiations at this point, and ideally the employee's attorney should already have presented a settlement demand in the matter.  

Settlements and Maximum Medical Improvement in Louisiana Workers Compensation

Typically, in a Louisiana workers compensation claim, settlement most frequently occurs once a determination of Maximum Medical Improvement has been made by the injured employee's treating physcian.

Again, Maximum Medical Improvement means that the injured worker's medical condition is generally "as good as it is going to get" and not going to improve.

And because the employee's medical condition is generally not going to improve, both the employee and the workers compensation insurance company should be able to properly evaluate the settlement value of the employee's claim, since both sides should be able to estimate and predict the employee's future lost wage (indemnity) benefits and future medical expenses.

Timing in Workers Compensation Settlements 

So, once an injured employee reaches Maximum Medical Improvement, the employee's workers compensation claim is prime (or ripe) for settlement. 

But if either the injured employee or the workers compensation insurance company fails to recognize that the employee has reached Maximum Medical Improvement, then unnecessary costs, expenses and time can be added to a workers compensation claim.

And on the flip side, settling an employee's workers compensation claim too soon is rarely in an injured worker's interest, because the workers compensation insurance company at that point will assume that the employee needs little to no more medical treatment, and thus will undervalue the employee's claim.

So by settling a claim too early (which usually means for too little an amount), the injured worker could be left uncompensated for future medical expenses, which the employee will likely have to pay for out-of-pocket, without any opportunity to reopen his or her claim.

But at the same time, an injured employee should always be proactive regarding settlement negotiations and should never wait for the workers compensation insurance company to make the first move when it comes to settling a workers compensation claim.  

For these reasons, an injured worker should always be represented by an experienced licensed workers compensation attorney, especially prior to any settlement negations.

Nonetheless, a determination of Maximum Medical Improvement remains a very important event in the course of any Louisiana workers compensation claim, and the injured employee and the employee's attorney must recognize this determination as a prime opportunity to reach a full and final settlement with the workers compensation insurance company.

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