- June 19, 2020
- Tucker Law
- Work Injury
If you’re receiving workers’ compensation payments, you’ll have to undergo continual medical analysis and treatment. At a certain stage in this process, your doctor will examine you and decide that you have reached maximum medical improvement, or MMI. This may cause you to wonder, “What happens after I reach MMI under New York law? How are my workers’ comp benefits affected?”
If your doctor says you’ve reached MMI, this means they think your condition has improved to a point at which further treatment is unlikely to improve your symptoms. Your physician will give you a disability rating, which will dictate what kind of benefits you’ll be entitled to going forward and what kinds of work you might be able to do.
This is a very important step in the workers’ compensation journey, and it can have disastrous results if it doesn’t go well. For this reason, it’s important to seek expert legal help before undergoing an MMI evaluation.
What Happens to Workers’ Comp Benefits after Reaching MMI in NY?
The time it takes to reach MMI after an injury or illness varies widely, but it takes effect automatically once you’ve been injured for two years. Once this happens, you will no longer be entitled to temporary disability payments from workers’ compensation.
This is why it’s so important to get help with your workers’ comp claim if your doctor thinks you are getting close to reaching MMI. A skilled New York workers’ comp attorney will work to help ensure that you don’t have a break in benefits. Additionally, if you disagree with your physician’s opinion about your MMI status, you have the option to dispute the decision with the help of a lawyer.
What Benefits Can You Get After You Reach Maximum Medical Improvement?
After you reach maximum medical improvement, you might get permanent partial disability benefits or permanent total disability benefits through workers’ comp, depending on the nature and severity of your condition.
PERMANENT PARTIAL DISABILITY BENEFITS
If it’s determined that you are partially but permanently disabled, your cash benefits will be calculated based on two-thirds of your average weekly wage multiplied by your disability percentage. So, for example, if your weekly wage is $900 and you are 50% disabled, the calculation will look like this: 2/3 x $900 x 50% = $300.00.
The duration of your benefit entitlements depends on the body part affected. There are “scheduled loss of use awards” and “non-scheduled loss of use awards.” Scheduled loss of use awards are for injuries to the extremities (arms, fingers, legs and feet) and loss of eyesight or hearing. Non-scheduled loss of use compensates those who have suffered injuries to the spine or pelvis or to organs such as the brain or lungs.
The calculation of these benefits is highly technical and can be difficult for the average person to understand. Benefits may be paid in a lump sum or in regular payments. It’s best to speak with an attorney to understand what award you might be entitled to.
PERMANENT TOTAL DISABILITY BENEFITS
If you are permanently and entirely disabled, you will receive two-thirds of your average weekly wages. So, if you earned an average of $900 prior to your illness or injury, you would receive a weekly benefit of $600. There’s no limit on how long you can receive these cash benefits.
The MMI Evaluation Process in New York
The specific steps involved in an MMI evaluation will depend on the nature and severity of your disabling condition. However, the process must adhere to the permanent impairment guidelines set out by the New York Workers’ Compensation Board.
Broadly speaking, the road to MMI involves the following stages:
Ongoing Medical Treatment
After first developing a workplace illness or injury, you’ll undergo treatment until your condition stabilizes and a longer-term plan can be put in place for you. Throughout this phase, your physician or workers’ compensation doctor will carry out regular assessments to monitor your progress and adjust the approach to treatment as required.
Functional Capacity Evaluation (FCE)
Once your worker’s compensation doctor believes you’re getting close to the point at which treatment will stop yielding improvements in your condition, they may recommend a functional capacity evaluation (FCE). This comprehensive assessment tests your ability to perform specific tasks and helps determine the extent of any permanent impairments. Specialist functional capacity evaluators (often occupational therapists or other professionals with specific training in the area) carry out these assessments and send their recommendations to your workers’ compensation doctor.
A functional capacity exam can have components related to strength, coordination, cognition, and other capabilities; the specific make-up of the exam will depend on the kinds of tasks you might be expected to carry out in the workplace, as well as the body part you’ve injured.
It’s possible to appeal the findings of a functional capacity evaluator if you think they did not accurately reflect your level of disability. However, it’s not a good idea to be dishonest regarding your abilities when you take the test. The professionals carrying out these exams are trained to give accurate assessments, and if they suspect you of trying to deceive them, you could end up losing all your workers’ comp benefits. You might even be charged with a criminal offense.
Interaction with Workers’ Compensation Insurance
The documentation from your FCE and your other medical appointments is shared with your employer’s workers’ compensation insurance provider. The insurance company may agree with the MMI determination or request further evaluation, possibly including an independent medical examination (IME).
Your Right to Dispute
It’s important to note that both you and your employer have the right to dispute an MMI determination. This can be done through the New York Workers’ Compensation Board, where a judge will review the case, consider all available medical evidence, and make a final determination.
Remember, your MMI status isn’t set in stone. If your condition changes, it may be possible to reverse an official finding of MMI. This is one of the reasons why it’s crucial to keep accurate and up-to-date medical records.
Getting Legal Help When You Reach MMI
Reaching MMI is a critical point in the workers’ compensation process. It is the time when your employer’s insurance company will probably try the hardest to get you off their books. Lowering your disability rating, or establishing that you’re not disabled at all, saves your insurer money, so the company will do whatever it can to make this happen. That’s why it’s so important to work with an experienced attorney while undergoing this process.
You Can Challenge the Impairment Rating the Doctor Gives You
Your impairment rating has a huge impact on whether you’ll be entitled to continue receiving workers’ comp benefits, and on the amount you receive. If you don’t agree with the rating you’re given, you have the right to challenge it; if you decide to do this, it’s advisable to do so quickly, before the rating becomes part of your permanent record.
Employers’ insurance companies sometimes challenge the ratings doctors hand out. In these cases, insurance companies can force injured workers to undergo an independent medical evaluation by a doctor of their choice. The New York Worker’s Compensation Board will then review both reports and make the final decision.
Workers’ compensation is complex, as is the process of challenging a workers’ comp doctor’s rating. Our New York workers’ compensation lawyers have in-depth knowledge of the law and what it takes to successfully challenge impairment ratings. We’re also well-equipped to take on big insurance companies and their attorneys.
Our New York Workers’ Comp Attorneys Will Fight for You After You Reach MMI
At Tucker Lawyers PC, our workers’ compensation attorneys know New York law. We don’t want you to worry about paying the bills when you have been injured on the job. We will fight for you.
Call our workers’ comp attorneys or personal injury attorneys in Manhattan at (516) 399-2364 for a free consultation.
When you’ve been injured on the job and can’t work, your medical expenses and a portion of your weekly wages are typically paid through workers’ compensation. But at some point, your doctor will examine you and decide that you have reached maximum medical improvement, or MMI. This may cause you to wonder, “What happens after I reach MMI under New York law?” How are my workers’ comp benefits affected?
Reaching MMI means that your doctor thinks you are as improved from your work-related injury or illness as you are going to get. He or she will give you a disability rating. The disability rating assigns a percentage that you are found to be permanently disabled. You might be assigned a work restriction. Or the doctor may decide that you aren’t impaired or disabled at all. You could be forced to go back to work even if you don’t feel physically able. Or the rating may mean you can work in a job that is not as strenuous as the one you left, but that doesn’t pay as well either.
What Happens to Workers’ Comp Benefits after Reaching MMI in NY?
The time it takes to reach MMI after an injury or illness varies for each individual case. It can take months but no longer than two years. After reaching MMI in NY, your temporary disability payments from workers’ comp will end. Temporary income benefits can no longer be paid once you reach maximum medical improvement. There is the scary possibility that you could be left without an income. This is also when your employers’ insurance company may try hardest to keep you from getting additional benefits.
This is why it’s so important to get help with your workers’ comp claim if your doctor thinks you are getting close to reaching MMI. A skilled New York workers’ comp attorney will work in your interests to help ensure that you don’t have a break in benefits. Additionally, in spite of what your doctor said, if you don’t feel that you are close to or at MMI, you can potentially dispute that decision with the help of a lawyer.
What Benefits Can You Get After You Reach Maximum Medical Improvement?
After you reach maximum medical improvement, you might get permanent partial disability benefits or permanent total disability benefits through workers’ comp. What you could get depends on your level of disability:
Permanent Partial Disability Benefits
If it’s determined that you are partially but permanently disabled, your cash benefits would be calculated based on two-thirds of your average weekly wage multiplied by the percentage you are disabled. So, for example, if your weekly wage is $900 and you are 50% disabled, the calculation would look like this: 2/3 x $900 x 50% = $300.00.
How long you would get cash benefits depends on the body part affected. In complex workers’ comp lingo, there are both “scheduled loss of use awards” and “non-scheduled loss of use awards.” Scheduled loss of use includes disabilities to the extremities, such as arms, fingers, legs and feet, and loss of eyesight or hearing. Non-scheduled loss of use includes injuries to the spine or pelvis or to organs such as the brain or lungs.
This area gets very complex when it comes to understanding how much money you could get and for how long. It’s best to speak with an attorney to understand what cash award you could receive. Benefits may be paid in a lump sum or in regular payments.
Permanent Total Disability Benefits
If you are permanently and 100% disabled, you will receive two-thirds of your average weekly wages, up to the current maximum. So if you earned an average of $900, you would receive a weekly benefit of $600. There’s no limit on how long you can receive these cash benefits.
After MMI, you will also continue to receive medical benefits if you are partially or totally disabled.
It is Smart to Get Legal Help When You Reach MMI
Reaching MMI is a critical point in the workers’ compensation process. It is the time when your employer’s insurance company will probably try the hardest to get you off their books. If they can find that you are not disabled at all or give you a lower disability rating than you need, it saves them money. When you reach MMI or are close to it, it’s in your interests to speak with a New York workers’ compensation attorney.
You Can Challenge the Impairment Rating the Doctor Gives You
The impairment rating you’re given has a huge impact on your workers’ comp benefits…including how much you may get or whether you’ll continue to get any at all. If you don’t agree with the rating you’re given, you have the right to challenge it. But be sure to do it quickly before it becomes part of your permanent record.
A workers’ comp attorney in New York can advise you about the process for challenging your rating. Additionally, you should know that sometimes employers’ insurance companies challenge the ratings given by doctors. In these cases, the insurance company can force injured workers to have an independent medical evaluation by a doctor of its choice. The New York Worker’s Compensation Board will then review both reports and make the final decision.
Workers’ compensation is complex, and so is the process of challenging a workers’ comp doctor’s rating. Experienced New York workers’ compensation lawyers have in-depth knowledge of the law and what it takes to successfully challenge impairment ratings. We also are well-equipped to take on big insurance companies and their attorneys.
Our New York Workers’ Comp Attorneys Will Fight for You After You Reach MMI
Big insurance companies make more profits when they can stop paying benefits to workers who have reached MMI. But when you have a workers’ comp law firm on your side that understands insurance companies and the legal intricacies of the workers’ comp system, your chance of continuing to receive adequate benefits greatly improves.
At Tucker Lawyers PC, our workers’ compensation attorneys know New York law. We don’t want you to worry about paying the bills when you have been injured on the job. We will fight for you. Call our workers’ comp attorneys or personal injury attorneys in Manhattan at (516) 399-2364 for a free consultation.
Managing Attorney John. J. Tucker, Esq.
John has personally handled thousands of clients who were victims of another’s negligence and fights relentlessly for their rights. John enjoys bringing closure to a client’s matter so that the injured party can move forward with their life. His background enables him to evaluate complex liability related claims and bring resolution to claims in a record time frame. [ Attorney Bio ]