How maximum medical improvement impacts a workers’ comp claim in South Carolina
If you’ve ever been diagnosed with a medical illness or injury, your doctor probably explained how the condition was likely to progress over the coming days, weeks or months and when you could expect to feel like your normal self again.
Unfortunately, after some work injuries, full recovery is not always possible, and many South Carolina workers experience permanent impairments or disabilities following their on-the-job accidents.
Instead of fully recovering, some injured workers eventually reach what doctors refer to as maximum medical improvement (MMI). What that means and how it impacts a workers’ compensation case is detailed below.
What is maximum medical improvement?
Maximum medical improvement (MMI) refers to the stage in a patient’s recovery from an injury or illness in which their doctor concludes that there’s no further medical care or treatment that will lessen the patient’s degree of impairment.
Some patients may need continued treatment after reaching MMI to maintain their current level of functionality (such as pain medication or physical therapy), but the treatment is not expected to reduce the patient’s degree of physical impairment.
Reaching MMI means that a worker’s temporary disability wage loss benefits (which compensate the worker for lost wages while they’re recovering from their injury or illness) will be terminated. If the worker reaches MMI but remains totally or partially permanently disabled, the worker will be awarded permanent disability benefits.
How does MMI affect my ability to receive workers’ compensation benefits?
Workers’ compensation benefits in South Carolina include:
- Reasonable and necessary medical expenses,
- Wage loss benefits, and
- Death benefits for certain dependents
Reaching MMI does not typically impact your ability to receive payments for reasonable and necessary medical expenses. To put it another way, if you reach MMI but still require medical treatment, your workers’ compensation insurer may be on the hook for those expenses.
Reaching MMI does impact your wage loss benefits. If you were receiving temporary disability wage loss benefits when you reached MMI, those benefits will stop. Your physician will then need to determine if you’re totally permanently disabled or partially permanently disabled.
Permanent total disability (PTD)
If you’re totally and permanently disabled, you may be eligible to receive permanent total disability (PTD) wage loss benefits.
PTD wage loss benefits are equal to 66 percent (two-thirds) of your average weekly wages prior to your injury. In most cases, you’ll receive these benefits for up to 500 weeks. However, you may receive these benefits for life if your injury has made you a paraplegic or quadriplegic or if you suffered severe brain damage.
You will automatically be considered totally and permanently disabled if, as a result of your workplace accident, you lost both hands, arms, shoulders, feet, legs, hips, your vision in both eyes, or any 2 of these (e.g., 1 foot and 1 arm).
Permanent partial disability (PPD)
If you suffer a permanent injury but you’re able to return to work in some capacity, you may be eligible for permanent partial disability wage loss benefits (PPD).
PPD wage loss benefits are equal to 66 percent (two-thirds) of the difference between your average weekly wages before your injury and your average weekly wages after your injury.
The length of time you can receive PPD benefits depends on the schedule created by the South Carolina legislature.
You can find the complete schedule in Section 42-9-30 of the South Carolina Code, but here are 3 examples:
- Loss of a thumb = 65 weeks
- Loss of an index finger = 40 weeks
- Loss of an arm = 220 weeks
For the lost use of other parts of your body not included in the schedule (such as your neck), your physician will assign an impairment rating.
The impairment rating will be based on the American Medical Association Guides to the Evaluation of Permanent Impairment. In determining your impairment rating, your doctor will look at your injury and assign a percentage based on how much your injury has reduced your functional abilities.
Some factors your doctor might consider when assigning this rating include:
- The procedures you’ve had (surgeries, etc.)
- Your work restrictions
- Any ongoing pain issues you’re experiencing
- Your range of motion and muscle strength
Once your physician has determined your impairment rating, the South Carolina Workers’ Compensation Commission will consider the rating, along with several other factors, to determine the length of time you can receive PPD benefits.
Can a workers’ comp attorney help with your MMI rating?
If you suffered a serious injury while working in South Carolina that prevents you from returning to the same job you held or any type of job, you need an experienced workers’ comp attorney to help you get the money you need to provide for yourself and your family.
It’s important to understand that you have the legal right to challenge your physician’s designation of maximum medical improvement. You also have the legal right to challenge your physician’s impairment rating if you believe the rating isn’t fair or accurate.
However, disputing these things can be complicated, so you’ll need an attorney well-versed in workers’ comp disability cases who can investigate your case and consult medical experts to evaluate your injury and provide a second opinion.
While this process may seem daunting, an experienced workers’ comp attorney will ensure you get a fair medical evaluation so you can receive maximum compensation for your injuries.
At the law firm of Chappell, Smith & Arden, P.A., our experienced workers’ comp attorneys have more than 30 years of experience negotiating with employers and insurance companies to get injured South Carolina workers the maximum benefits to which they’re entitled. Contact us today for a free consultation of your case.