Maximum Medical Improvement and Insurance: What You Need to Know

Maximum Medical Improvement and Insurance: What You Need to Know

Steven Schwartzapfel -Founding Partner Jun 22, 2022

For more than 35 years, Steven Schwartzapfel, the founding member of Schwartzapfel Lawyers P.C., has been one of New York’s most prominent personal injury attorneys. Steve represents clients in all types of personal injury cases. His experience, skill, and dedication have enabled Schwartzapfel Lawyers P.C. to recover hundreds of millions of dollars for their clients.

Workers’ compensation insurance and benefits can be lifesavers for injured workers in New York City and beyond. Hundreds of New York construction and other workers are injured each year, according to official statistics. Additionally, these injuries and fatalities often contribute to high medical expenses that can be difficult to pay for alone or by one’s family.

Fortunately, many workers’ compensation insurance claims are successful, especially those backed by knowledgeable legal representatives. Workers’ comp benefits, however, do not last forever, as you may find that your benefits have decreased or disappeared entirely upon reaching maximum medical improvement (MMI) status.

But that doesn’t have to happen. With the right legal representatives fighting for you, you can recover benefits for longer and prevent your finances from being devastated. For more information and a free consultation, contact workers’ compensation attorneys Schwartzapfel Lawyers at 1-800-966-4999.

What Is “Maximum Medical Improvement”?

Maximum medical improvement (MMI) is a benefits status. It means that, according to your doctor or another healthcare professional, you are as improved or healed from a work-related injury or illness as possible.

For example, imagine a circumstance in which a New York construction worker is injured on the job. They suffer a major injury to the knees, which limits their mobility. After several months of medical treatments and physical therapy, they are able to stand and move around somewhat, but they will not regain full mobility as they had once known.

According to their doctor, they will never regain full mobility due to their injuries. Reaching maximum medical improvement for work-related injuries can significantly affect workers’ compensation and other benefits.

How Long Does It Take To Reach MMI?

This answer depends on the nature of injuries sustained on the job. For instance, some injuries may only take several months for injury victims to reach MMI. Other, more serious or complex injuries, however, could take up to several years.

Note that MMI cannot take longer than (2) years under New York State law. Therefore, once (2) years have passed following your incident, if you have not reached MMI status, you do not need to worry about it affecting your insurance or other benefits (though they can still decrease or stop depending on other circumstances).

To speak with a member of our award-winning team of trial attorneys, call Schwartzapfel Lawyers today at 1-800-966-4999. Your consultation will be free and the advice provided to you invaluable in your legal decision-making.

MMI and Disability Ratings

Moreover, if you reach MMI after receiving treatment for an injury or illness, your doctor, physical therapist, or other healthcare professional may give you a disability rating.

In short, a disability rating gives you a percentage describing “how disabled” you are. For example, if you receive a 20% disability rating after reaching MMI, you are categorized as 20% disabled relative to a 100% non-disabled individual.

Disability ratings can affect insurance payouts, job duties, and many other financial and medical factors. For instance, a disability rating up to a certain level may prevent you from working at a job as strenuous as the one you had before. Or it may disqualify you from holding certain positions and/or performing certain tasks at your company. 

Workers’ Compensation Benefits and Maximum Medical Improvement

Maximum medical improvement can affect workers’ compensation benefits in a variety of ways, many of them negative. Nevertheless, if your benefits have been negatively affected by MMI, know that knowledgeable legal professionals can help you maintain insurance payments and keep your finances from being devastated. 

Permanent Partial Disability

Both permanent partial disability and permanent total disability benefits are awarded through workers’ compensation after you reach MMI.

Permanent partial disability benefits are awarded to individuals who are, as the name suggests, partially yet permanently disabled. For these benefits, cash benefits are typically calculated based on two-thirds of one’s average weekly wage. Then that number is multiplied by the disability rating percentage received.

For instance:

  • You have a weekly wage of $1,000
  • You have a disability rating of 30%
  • $660 X 30% = $198

In this example, you would receive cash benefits of $198 each week (though this may be paid out monthly instead of weekly). 

Additionally, your cash benefits could be affected by which body parts are affected by your disability. For example, insurance companies record scheduled loss of use awards and non-scheduled loss of use awards.

  • Scheduled loss of use awards include disabilities to any extremities, like the arms, legs, fingers, feet, eyes, and ears.
  • Non-scheduled loss of use awards include disability benefits to the pelvis, spine, or organs.

As you can see, disability benefits after MMI can be very complex and tricky to understand. Legal professionals can help you navigate this area successfully. Schwartzapfel Lawyers is well-equipped and ready to assist with your workers’ compensation benefits even after MMI, so contact us today for a free case evaluation at 1-800-966-4999.

Permanent Total Disability

Permanent total disability benefits are only awarded to individuals who are both permanently disabled and have disability ratings of 100%. These benefits are calculated as two-thirds of average weekly wages up to your current standard maximum.

For instance, if you previously earned $1,000 per week, you would receive weekly benefits of approximately $660. For permanent total disability benefits, there are no limits on how long you can receive these cash awards.

Reduction in Benefits/Payments

It is important to note that MMI does not always lead to permanent cash benefits for injured workers. In some instances, in fact, MMI may cause your temporary disability benefits from workers’ compensation insurance to end. Under such circumstances, injured workers can be thrown into financial disarray and left reeling. 

Also worth noting here is that even if you cannot return to work, you may be disqualified from further benefits since you have “recovered” as much as possible. Sadly, the system can be cold and unempathetic to many injured workers.

What if MMI Compromises Your Finances?

After a workplace injury, injured workers oftentimes rely on the disability benefits from workers’ compensation to survive. But in some cases, even after they are as recovered as possible, they are still unable to return to work or earn a living enough to maintain their finances.

Many injured workers find that the total disability benefits they receive after MMI are not enough to pay for their bills and ongoing medical expenses. Under these circumstances, experienced workers’ compensation lawyers may be able to help.

For example, workers’ comp attorneys in New York can help you challenge your impairment or disability rating. If you receive a disability rating that is too low to pay for your medical bills or that you feel does not accurately reflect your level of disability, you could get it changed with the right legal professionals. Additionally, some workers’ compensation insurance companies challenge disability ratings from doctors. They may cause your disability rating to decrease lower than it should be, costing you needed benefits in the process.

Legal professionals can also help in these cases and more. They can negotiate with insurance companies, fight for you in court, and make sure that your benefits are not unfairly curtailed or decreased, which may cause you increased financial stress.

Dial 1-800-966-4999 and allow Schwartzapfel Lawyers the honor and privilege of assisting you with your case today!

What To Do After Reaching MMI

In most cases, you will simply be informed by your doctor that they need to file your case as MMI. They’ll give you a heads-up and inform you about any potential benefits reductions.

If you reach MMI and receive a disability rating that is too low for your financial needs, you should contact workers’ compensation attorneys right away. Furthermore, you should:

  • Gather all the evidence possible that could help your case, including notes from your doctor, records from your insurance company, and any other relevant information.
  • Collect evidence cataloging your disability and how it affects your day-to-day life. Photos, videos, and even journal entries can help immensely on this point.
  • Present this information to qualified legal representatives sooner than later.

The right workers’ compensation attorneys can look at the evidence and persuade the court or order a disability reevaluation. Alternatively, they can help you file a claim for a higher disability rating with your insurance company. Even if your claim is initially denied, lawyers can help you through the claim appeals process.

As experienced workers’ compensation attorneys, Schwartzapfel Lawyers can assist with your disability benefits case and explain MMI in more detail in-person or over the phone. Our client testimonials page shows that we’ve assisted injured workers like you in New York City for many years. With more than 150 years of collective experience, we know everything there is to know about the workers’ compensation and disability rating systems, as well as how insurance companies operate. More importantly, we know how to use this information to win!

Contact Schwartzapfel Lawyers Today

Ultimately, maximum medical improvement is the end state for most workplace injuries. In some cases, maximum medical improvement may lead to permanent disability benefits. But if you are one of the many New York workers whose benefits have suffered as a result of MMI, Schwartzapfel Lawyers can help you recover the money and benefits you are entitled to.

As experienced and knowledgeable New York workers’ compensation attorneys, we are well-equipped and ready to assist with your case. We can negotiate with insurance companies on your behalf, challenge benefits reductions if you require more benefits to pay for bills and medical expenses, and so much more.

Furthermore, we can provide you with practical legal advice for all of your litigation moves going forward. So, please, don’t wait another day. Instead, contact Schwartzapfel Lawyers at 1-800-966-4999 for more information and a free case evaluation!



Schwartzapfel Lawyers, P.C. | Fighting For You 

Workers’ Compensation Guidelines for Determining Impairment |

Fatal Occupational Injuries in New York City — 2020 |

What Is Maximum Medical Improvement in a Workers’ Comp Claim? |

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