What is a Maximum Medical Improvement Report?

A Maximum Medical Improvement (MMI) Report is a report written by the primary doctor providing treatment to a patient/injured worker during the workers’ compensation claim (sometimes referred to as a PTP, Primary Treating Physician).

When a doctor finds that a patient/injured worker has reached Maximum Medical Improvement, it basically means the worker will not continue to get better, regardless of continued treatment. This MMI Report is usually one of the final and most important factors in determining a worker’s Permanent Disability (PD) benefits, and will be completed by the doctor at the end of the worker’s treatment phase.

An MMI Report will usually include the history of the patient/worker’s injury or illness, a review of the worker’s past history, treatment provided, any tests or studies performed, conclusions and recommendations regarding the worker’s current, and/or future impairment. This report will also assign a Whole Person Impairment (WPI) to each specific body part that was treated, in addition to apportionment (the sharing of disability to any other causes besides the on-the-job injury), and future medical care.

The MMI Report could also include various other aspects of the worker’s medical case, such as the doctor’s discussions with the worker, job description, current occupation, physical examination, and review of any medical records from other doctors. Get more information from your local WCAB Information and Assistance Officer, or contact us to guide you through the red tape of workers’ compensation forms and procedures.

The MMI report should describe:

• Specific medical problems, like how much you can move the injured parts of your body and how much pain you have. These are called Objective and Subjective Factors.
• Limits on the work you can do. These are called Work Restrictions.
• Impairment status of your injured body parts. These are called AMA Impairment Ratings.
• Causes of injury. These are called Causation/Apportionment.
• Medical care you may need in the future for your injury.

Your MMI report will affect your future benefits. You have a right to receive a copy of it. Be sure to request in writing that the claims administrator or your doctor provide you with copies of all medical reports.

What if I don’t agree with the MMI report?

Sometimes different doctors have different opinions about a worker’s disability. You have a right to question or disagree with the MMI report. Your attorney can get a second medical opinion from another doctor, including:

• QME (Qualified Medical Evaluator) – a doctor certified by the state Industrial Medical Council and selected by either your attorney or the claims administrator
• AME (Agreed Medical Evaluator) – a doctor agreed upon by your attorney and claims administrator.

Your attorney should choose the QME or AME carefully. The legal-medical report will affect your benefits. In most cases, you won’t be allowed to see another QME or AME.