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How Maximum Medical Improvement (MMI) Works in a Texas Workers' Compensation Case

Let's cut to the chase, Maximum Medical Improvement (MMI) is the destination or goal of a Texas Workers' Comp case. You start off with an injury, the Workers' Compensation system provides you with medical attention, and once you've become as well as can be expected, they give your file a stamp of approval and say that you've achieved MMI. It's almost like saying that you have graduated from phase one of your Workers' Comp claim.


Questions Answered on This Page:

  • What is "maximum medical improvement" under Texas workers' comp?
  • How do I know when I've reached maximum medical improvement?
  • Who determines whether or not I've achieved maximum medical improvement?
  • What happens when I've reached MMI?

Correcting Some of the Misunderstandings of MMI

We know MMI can be confusing to those who don't deal with these laws on a daily basis. One of the best ways to explain the underlying concepts of MMI is to cover some misconceptions.

  • Myth: When I obtain MMI, my Workers' Compensation case is completely over.
  • Fact: Not exactly. Here's an analogy to help explain: Bob has a million dollars in the bank, and that million dollars gets stolen. The police work diligently to track down Bob's million dollars, and they recover 100% of it. Two things have happened here, Bob achieved maximum financial recovery (the best the cops were able to do) and that maximum financial recovery just so happens to be all of his money.Alternatively, let's imagine Bob's millions get stolen, the police track down his money and they recover as much as they can but not all of it. They have still gotten Bob his maximum financial recovery, that is to say, they recovered the best that could be expected, but that was since the rest of it was already spent, the maximum financial recovery possible under the circumstances is less than 100% of his million dollars.

    The same thing happens in a work injury case. For most minor injuries, when a person obtains MMI, they have improved to their maximum, and their maximum happens to be a complete recovery. But you can also be injured and obtain MMI (as good as you're going to get) yet you've only got 75% of your health back. For workers who make a full recovery, yes MMI is the end of the case. However, for workers who never make a full recovery, MMI just means that you're as good as you're going to get, but there's still a whole other phase to your WC case. In short, MMI just means that you've gotten as well as can be expected, not that you are completely well.

  • Myth: I can get a settlement based on my MMI rating.
  • Fact: This is wrong for two reasons. First, there is no such thing as an "MMI rating." Instead, once you reach MMI, you're issued an Impairment Rating (More information can be found here on Impairment Ratings). Based on your Impairment Rating, you do get paid additional compensation, but it's not actually a settlement. Sometimes it's paid as a lump sum payment that seems kind of like a settlement, but, legally speaking, that's its only similarity to a settlement, and it really is not a settlement.
  • Myth: Once I reach MMI, I can no longer receive medical attention.
  • Fact: No. MMI really just means you've gotten as well as you can get, it means you're not going to get any better, but it doesn't necessarily mean you won't need continuous treatment. Here's an example: Steve falls and breaks both of his legs. He also suffers nerve damage that causes severe pain. Steve undergoes surgery and lots of physical therapy, and his legs heal as well as they ever will. Meaning he can walk, but he'll always have a limp. Since he'll never get any better no matter how many extra procedures they may perform, the workers' comp carrier would determine that Steve has reached MMI. But, due to his nerve damage, he will need to take pain medicine for the next several years. Even though he's reached MMI, the insurance carrier will continue to pay for his pain medication. In a practical sense, reaching MMI means that you've probably obtained most of the medical procedures that you need, but it doesn't necessarily mean that you've obtained all of the medical treatment.
  • Myth: Once I reach MMI, I will no longer get paid for lost wages.
  • Fact: This one's a little tricky. Workers' Compensation doesn't exactly pay for lost wages. Instead, Workers' Comp provides Income Benefits, of which there are four different types. Chronologically speaking, the first type you receive are Temporary Income Benefits, and, yes, those Temporary Income Benefits do indeed stop being paid to you at the point you reach MMI. However, once you reach MMI, that opens the door for you to obtain some of the other types of Income Benefits: such as Impairment Income Benefits. You can read more about these four types of Income Benefits.

We're here for you if you would like any further clarification.

More questions? Reach out to us. We know the law, and we've helped clients get through their workers' comp cases without feeling like they're stumbling around in the dark. Our phone line is: (855) 326-0000.


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