Maximum Medical Improvement (MMI) in Georgia Workers' Compensation

What is Maximum Medical Improvement (MMI)?

Maximum Medical Improvement (MMI) is the point when:

• Your medical condition has stopped changing
• More treatment won’t make you much better
• You’ve stopped getting better
• Your doctor can rate any lasting damage you have

Who Determines When You Reach MMI?

Your Treating Doctor

Your treating doctor is the one who decides when you reach MMI:

• They check your recovery progress
• They decide if more treatment will help you improve
• They note MMI in your medical records
• They usually give you an injury rating at MMI

Not the Insurance Company

The insurance company cannot declare you at MMI on their own:

• They may ask your doctor about your MMI status
• They may send you to an Independent Medical Examination (IME)
• But your doctor’s opinion usually wins out

Disputing MMI Determination

If there’s a fight about whether you’ve reached MMI:

• The insurance company’s IME doctor may disagree with your doctor
• You can ask to change doctors if you disagree with yours
• These fights may need a hearing before a workers’ comp judge
• Medical proof from both sides will be looked at

Why MMI Matters in Your Workers’ Comp Case

1. Switch from Temporary to Lasting Benefits

MMI changes what type of benefits you get:

Before MMI:

• Temporary Total Disability (TTD) - If you can’t work at all
• Temporary Partial Disability (TPD) - If you’re working less or earning less
• Focus on healing and treatment

After MMI:

• Permanent Partial Disability (PPD) - Based on your injury rating
• Permanent Total Disability (PTD) - If you can’t work at all anymore
• Focus on long-term care and adapting to your injury

2. Injury Rating

When you reach MMI, your doctor usually:

• Gives you a rating for your lasting injury
• Uses the AMA Guides (5th Edition) to measure your injury
• Rates what percent of your body is hurt for good
• This rating decides how much PPD benefits you get

3. Medical Treatment Continues

Important: Reaching MMI does NOT cut off your medical treatment.

Under Georgia law (O.C.G.A. § 34-9-200), employers must provide:

• Medical treatment needed to give you relief
• Treatment to help you return to work
• Ongoing care even after MMI

Examples of treatment after MMI:

• Pain management
• Physical therapy to help with symptoms
• Medications
• Follow-up doctor visits
• More surgery if your condition gets worse
• Assistive devices or equipment

4. Change in Condition

Even after reaching MMI, your condition can change:

If you get worse:

• New symptoms show up
• Your injury gets worse
• You need more treatment
• You may be able to restart TTD benefits or get a higher PPD rating

If you get better:

• You improve in ways no one expected
• New treatments become available
• This is rare, but it can happen

Timeline: When Does MMI Usually Occur?

How long until you reach MMI depends on your injury:

Minor Injuries

• Soft tissue injuries: 3-6 months
• Simple broken bones: 3-4 months

Moderate Injuries

• Herniated disc (no surgery): 6-12 months
• Joint injuries: 6-12 months
• Injuries needing surgery: 6-18 months

Severe Injuries

• Spinal fusion surgery: 12-24 months
• Bad fractures: 12-18 months
• Amputation: 12-24 months
• Severe burns: 18-24+ months

What Happens at Your MMI Appointment?

When your doctor decides you’ve reached MMI, they will:

1. Write Down Your MMI Status

• Note in your medical records that you’ve reached MMI
• Write the date of MMI
• Explain why they believe you’ve reached your best recovery

2. Give You an Injury Rating

• Check your lasting injury using AMA Guides 5th Edition
• Rate the damage to specific body parts or your whole body
• Give you a written report with the rating and how they got it
• Example: “15% lasting injury to the right arm”

3. Set Work Limits That Last

• Write down any work limits that won’t go away
• Say what you can and cannot do at work
• List what your body can’t do anymore
• Example: “No lifting over 25 pounds, no reaching overhead with right arm”

4. Plan Your Future Medical Care

• Name the ongoing treatment you’ll need
• Suggest care to manage your condition
• Talk about possible future procedures
• Plan how to manage your symptoms

Common MMI Scenarios

Scenario 1: MMI with No Lasting Injury

Some workers reach MMI with no lasting injury:

• You’ve fully healed from your injury
• No limits that last on what you can do
• Rating of 0%
• Result: No PPD benefits, but your medical care was covered

Scenario 2: MMI with a Lasting Injury

Most workers with serious injuries have some lasting injury:

• You’ve improved but you’re not back to normal
• You have limits on what you can do that won’t go away
• Rating of 1-100%
• Result: You get PPD benefits based on your rating

Scenario 3: MMI but Can’t Work

Some workers reach MMI but still can’t work at all:

• Your condition has stabilized but you can’t work
• You may qualify for Permanent Total Disability (PTD)
• Benefits continue at the TTD rate forever
• Result: PTD benefits instead of PPD

Scenario 4: Working When You Reach MMI

You can be working (even full-time) when you reach MMI:

• Working doesn’t stop you from reaching MMI
• You may have learned to work with limits that last
• You still get PPD benefits if you have a lasting injury
• Result: PPD benefits paid while you work

Challenging an MMI Determination

Why You Might Fight an MMI Decision

You may disagree with an MMI decision if:

• You think you’re still getting better with treatment
• Other treatments haven’t been tried yet
• Your condition is still changing a lot
• Your injury rating seems too low

How to Challenge

Option 1: Talk with Your Doctor

• Explain why you think you haven’t reached MMI yet
• Show proof that you’re still improving or your symptoms are changing
• Ask for more treatment
• Ask your doctor to think again about the MMI decision

Option 2: Ask to Change Doctors

• File form WC-240 to change doctors
• Pick a new doctor from your employer’s posted panel
• Get a second opinion on MMI
• You can change doctors one time (with some exceptions)

Option 3: Request a Hearing

• File for a hearing with the State Board of Workers’ Comp
• Show medical proof that MMI is too soon
• May need an expert doctor to testify
• A workers’ comp judge decides

MMI and Settlement Negotiations

When Settlements Usually Happen

Most workers’ comp cases settle after MMI because:

• Everyone knows how badly you’re permanently hurt
• PPD benefit amounts can be figured out
• Future medical needs are clearer
• Less guessing about what the claim is worth

Settling Before MMI

Sometimes cases settle before MMI:

• Usually means larger settlement amounts (to cover the unknown)
• You give up future medical benefits in most settlements
• Higher risk—you don’t know your final impairment rating yet
• Usually not a good idea unless the settlement is big

Insurance companies may pressure you to settle quickly. Here are 5 signs they’re lowballing your settlement.

What to Think About

Before settling after MMI:

• Have you gotten all your PPD benefits?
• Do you need future medical care?
• Are there fights about your rating?
• Have you talked with a lawyer?

Your Rights About MMI

Right to Keep Getting Treatment

You have the right to:

• Keep seeing your doctor after MMI
• Get ongoing medical care
• Get treatment when symptoms flare up
• Have more procedures if your condition gets worse

Right to Challenge MMI

You have the right to:

• Question your doctor’s MMI decision
• Ask to change doctors
• Ask for more treatment
• Fight an MMI that’s too soon at a hearing

Right to a Fair Injury Rating

You have the right to:

• An injury rating based on AMA Guides 5th Edition
• An explanation of how your rating was figured out
• Fight a rating that’s unfair or wrong
• An independent medical exam if you disagree

Right to PPD Benefits

You have the right to:

• Get PPD benefits based on your injury rating
• Get paid even if you’re working
• Get full payment of all weeks you’re owed
• Fight PPD benefits that were denied or cut

Frequently Asked Questions

Does MMI mean I’m fully healed?

No. MMI means your condition has stopped changing and won’t get much better. You may still have pain, limits, and lasting injury.

Can I still get medical treatment after MMI?

Yes. Georgia law says employers must provide medical treatment even after MMI. This includes ongoing care, pain management, and treatment if your condition changes.

What if my condition gets worse after MMI?

You can ask for a “change in condition” to reopen your claim. If your injury gets worse, you may get more benefits and treatment.

Can I work after reaching MMI?

Yes. Many people work after MMI, often with limits that last. Working doesn’t stop you from getting PPD benefits.

How long after MMI do I get PPD benefits?

PPD benefits usually start after your temporary benefits (TTD or TPD) end. The timing depends on when your doctor gives you your injury rating and when the insurance company handles your claim.

Can the insurance company force me to MMI?

No. The insurance company can’t declare you at MMI on their own. Your doctor makes that decision based on medical proof.

Questions About MMI?

Understanding Maximum Medical Improvement and how it affects your workers’ comp case is key to protecting your rights and getting the most benefits.

Call Bourne Law Firm at (770) 886-3030 for a free talk about your case.

Related Articles

• Permanent Partial Disability (PPD) Guide - Benefits after reaching MMI
• Temporary Total Disability (TTD) - Benefits before MMI
• Temporary Partial Disability (TPD) - Partial benefits before MMI
• Functional Capacity Evaluation (FCE) - Assessment of work capabilities
• Change of Physician Rights - How to change doctors