Why is Maximum Medical Improvement Important in a New Jersey Workers’ Compensation Claim?

Legally reviewed by Lisa J. Pezzano, Esq. - Laddey Clark & Ryan Pezzano Law Group Division

If you are filing a workers’ compensation claim in New Jersey, continue reading to discover the importance of Maximum Medical Improvement (MMI). Work with a knowledgeable Warren County workers’ compensation lawyer today.

What is Workers’ Compensation?

Workers’ compensation is a no-fault insurance system in New Jersey that provides financial and medical protection for employees who are injured or become sick as a result of their job duties. Because it is a no-fault system, injured workers are generally entitled to benefits regardless of who caused the accident or issue, as long as it occurred within the scope of employment. In exchange for these guaranteed benefits, employees typically forfeit the right to sue their employer for negligence.

What Benefits Are Available?

Workers’ compensation is designed to cover four main types of benefits:

• Medical care: Necessary and reasonable medical care is covered, such as doctor visits, hospital stays, prescriptions, and physical therapy.
• Temporary disability: Wage replacement payments for time taken off work while recovering. These benefits are paid at 70% of the employee’s gross average weekly wage, including overtime, up to the state maximum.
• Permanent disability: If an injury results in a permanent impairment, the employee may receive benefits for permanent partial or permanent total disability. Benefits are calculated based on the severity of the impairment, the year of the accident, and the average weekly wage.
• Death benefits: In cases resulting in death, dependents of the deceased worker may be eligible for funeral expenses and weekly dependency benefits.

What is Maximum Medical Improvement?

Maximum Medical Improvement (MMI) is an important milestone in an individual’s recovery process. It is the point at which a doctor determines that an injured worker’s condition has stabilized to the extent that it is not expected to improve significantly with further medical treatment.

Does MMI Mean You Are Fully Healed?

No, it’s important to note that reaching MMI does not necessarily mean that the individual has fully recovered or returned to their pre-injury state. Rather, it signifies that the healing process has plateaued. Many workers continue to experience pain, limitations, or permanent impairments after reaching MMI.

Why is Maximum Medical Improvement Important in an NJ Workers’ Compensation Claim?

Once a treating physician declares that a patient has reached MMI, if the injured worker has not retained a workers’ compensation attorney, the insurance carrier will generally close the claim and fail to advise the individual of their right to pursue benefits for permanent disability. If the injured worker retains an attorney to file a Claim Petition, then permanency evaluations will be scheduled to estimate the extent of any permanent impairment. These assessments are vital for obtaining an award of partial or permanent total disability benefits. If an individual has ongoing symptoms or functional limitations, these factors will be considered when the independent medical experts provide their estimates of disability.

Does Reaching MMI Terminate Workers’ Compensation Benefits?

Once an injured worker reaches MMI, the carrier will automatically terminate temporary disability benefits, unless it is absolutely clear that the worker is totally, permanently disabled (such as being wheelchair bound). The focus of the claim shifts from acute medical treatment to managing long-term outcomes and assessing permanent work capacity. Understanding this status is essential for navigating the next steps of your claim, as it sets the stage for final settlements and permanent disability determinations.