What Happens After I Reach MMI Under NC Law?

Our Charlotte Workers’ Comp Lawyer Can Help You Get a Maximum Settlement After You Reach MMI

North Carolina workers’ comp insurance is intended to provide medical, rehabilitation and income benefits for workplace-related injuries and illnesses, but confusion often occurs as to what will happen after you reach maximum medical improvement (MMI). MMI is the term used by your workers’ comp doctor to indicate that your physical state has reached the point where you are unlikely to have additional significant improvement or worsening of your condition. It does not necessarily mean that you have recovered completely, are back to normal, or are capable of doing the job you did before, or any work at all.

When it comes to determining what will happen when you reach maximum medical improvement, every person and injury is different. It is natural for you to have concerns that your workers’ comp case will end when you are at MMI and wonder what will happen to your benefits and medical care thereafter. Often your employer and their insurance carrier will attempt to reduce or terminate your benefits, whether you are able to work or not and whether you are really at MMI or not.

You do not have to deal with this alone. Since the settlement process is often just getting started when you reach MMI and you may be receiving a disability rating that will affect your future, it makes sense to get advice and help from an attorney experienced with workers’ compensation laws and benefits. Our Charlotte workers’ comp lawyers at the Sumwalt Anderson Law Firm know North Carolina law and will fight to get you get the maximum benefits to which you are entitled.

Why It’s Important to Have a Lawyer When You Reach MMI

North Carolina workers’ comp laws are complicated regarding MMI. Mistakes can be costly and affect your future.

According to the North Carolina Workers’ Compensation Act, when you reach MMI, your treating doctor can assign a permanent partial disability rating, whether or not you have returned to work. Once you get your rating assigned, you can request a lump sum payment for your permanent impairment based on the rating assigned, and you can still have your employer’s insurance company pay your medical bills.  However if you accept this payment, you will no longer be entitled to weekly workers’ compensation benefits if you are unable to return to work.

What happens when you reach MMI has a role in determining many things that affect your future, including:

  • Whether you can return to the work you did before your injury
  • Whether you have permanent restrictions that limit you to light duty work at a different pay level
  • The type of work that is considered suitable under North Carolina law
  • Your level of permanent impairment and whether you will be able to receive permanent partial disability benefits
  • Whether you will need future treatment and for how long
  • The types of workers’ comp benefits you will still be entitled to
  • What the settlement value of your case will be.

Our attorneys understand the importance of taking appropriate actions when your doctor assesses you are at your MMI. We will examine your situation and determine what needs to be done accordingly.

Specific Ways Our Attorneys Can Help If You’ve Reached MMI

Getting Your Doctor’s MMI Report and Permanent Impairment Rating

When you reach MMI, an authorized treating doctor may assign you a Permanent Partial Disability (“PPD”) rating, which is an estimate of the permanent impairment to the body part that was injured. We will help you determine whether to accept payment based on the PPD rating or to pursue a second opinion.

You have two years after accepting a rating payment to file a claim for a change of condition with the North Carolina Industrial Commission (NCIC). The NCIC is the state agency that handles workers’ comp claims, and we can help you file a claim to seek additional benefits with that agency. If you do not file on time, you may risk losing all future wage replacement or disability benefits.

Reviewing Your Permanent Work Restrictions

When you are at MMI, the doctor will assign appropriate permanent work restrictions that affect the kind of work you will be able to do and what will be considered “suitable employment.” To be suitable, employment must consider preexisting and injury-related physical and mental limitations, work skills, education and experience, and be within 50 miles your home. Our attorneys will compare your permanent restrictions to your pre-injury job duties to determine if there are job tasks you are no longer able to perform because of your work injuries.

Helping You Take on Insurers

Our attorneys are familiar with games insurance carriers and adjusters play to avoid fairly paying claims. We can handle communications and negotiations with insurers, and we will work to protect and enforce your rights to hold the insurance carrier and employer accountable to act quickly and per the requirements of the law.

Determining Whether You Should Settle Your Workers’ Compensation Case

Once you reach MMI, you should know your permanent work restrictions and what kind of future medical treatment will be needed and may want to settle your case. In North Carolina, a full and final workers’ compensation settlement is called a “clincher” agreement. It resolves all issues, including your medical treatment and wage benefits for the future. Our attorneys will help determine whether you should accept such an agreement or would be better off receiving wage replacement and medical benefits from the insurer and coordinate these with other public and private benefits, such as social security disability (SSD) and Medicare.

Hiring Experts to Calculate a Fair Settlement Value

If necessary, our attorneys will hire expert witnesses, such as doctors and therapists, to evaluate your permanent impairment and a life-care planner to estimate the future cost of your medical needs.

Rely on our skill and experience to help you navigate the workers’ comp process in North Carolina. Our attorneys understand the factors that impact when you are designated as reaching MMI, and how you can challenge this determination. Call us for help today at (704) 377-3770.

Who Decides When I Reach MMI?

A medical doctor (MD) or osteopathic doctor (DO) can determine whether you are at maximum medical improvement for your work-related injury. Usually, this doctor is the authorized treating physician you have been seeing and who was chosen by your employer or its insurer.

Sometimes, however, determination is made by a doctor that examines you for an Independent Medical Examination (IME). This is a one-time medical appointment with a physician chosen by the insurance carrier. These doctors do lots of work for insurers, so they often will come up with a report that is unfavorable to your claim and find that you have reached MMI even if your treating physician disagrees.

What If You Don’t Think You’ve Reached MMI?

If you have been told you are at MMI and you don’t agree, you don’t have to accept it. You can always seek additional medical care after your doctor declares you at MMI, if your case has not yet been settled. Let our attorneys examine your situation and determine the best way to move forward.

If you disagree with an opinion that you are at MMI, you can ask for a second opinion. The insurance carrier does not have to pay for a second opinion – unless the authorized treating doctor refers you for one. Our attorneys can recommend doctors who are familiar with litigation if a workers’ comp hearing is necessary. We will advise you as to whether to go for a second opinion based on the medical evidence, your benefits, and what can be accomplished by doing so.

Call Our Workers’ Comp Lawyers with Your Concerns about Reaching MMI

At Sumwalt Anderson, we know the workers’ compensation system. We also know the tactics employers and their insurance carriers use when you reach MMI. We are fully prepared to answer questions, help you make decisions, and fight for your rights and a fair settlement. Act now to discuss your options, before you are left without your full benefits.

Call us today for a free initial assessment at (704) 377-3770.

Attorney Mark Sumwalt

Mark Sumwalt is a native of Rock Hill, South Carolina who has practiced law in Charlotte since 1981, primarily in the field of worker’s compensation. He has litigated hundreds of cases to decision all over the state and handled many significant appeals to the North Carolina Court of Appeals and the North Carolina Supreme Court, particularly in the area of attendant care. [ Attorney Bio ]


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