Requesting Maximum Medical Improvement MMI Status From the Adjuster

Requesting Maximum Medical Improvement (MMI) Status from the Adjuster

Follow up and documentation are key components to managing workers’ compensation costs. If time goes by on a specific injury case, it is up to the company to find out if your employee may have healed as much as possible for such an injury. This is called “maximum medical improvement”. In most cases, it is recommended allowing a period of no more than four moths, or 120 days, to lapse without MMI determination.

Occasionally, an injury will indeed be so severe the employee cannot return to former duties. This is unfortunate, but still, it is critical to thoroughly document such a case.

The injury coordinator is the person responsible for the communiqué, which may be emailed. A form for your use in documenting the injury can be found at Workers’ Comp Kit (http://www.workerscompkit.com/), but if you are writing your own, here are some things to include.
1. Be sure to include the claim number and name of injured employee.
2. Carbon copy the communication to your supervisor.
3. Give the employee’s name.
4. Note the employee’s injury.
5. List the amount of time the employee has been under the care of the treating physician.
6. Note what little progress has been made.

Explain to your adjuster your company needs to know if transitional duty needs to be extended, or if this employee has perhaps reached MMI and will not be able to resume the original position. If this is the case, let the adjuster know your company will transfer the issue to the human resources department to ensure compliance with legal requirements such as the Americans With Disabilities Act.

Ask your adjuster to contact the doctor to establish:
1. Is the employee improving?
2. When will the injured worker be able to return to regular duties?
3. Will the worker have permanent job restrictions?
4. Will the worker ever be able to return to work full-time and full-capacity?
5. Has the employee achieved MMI?

Thank your adjuster for being helpful and request a phone call in response.

Editing Note: Use gender neutral descriptions. Say: “Will the employee, injured worker, worker . . .” instead of: “Will he/she . . .” or worse, using the plural “they” as in: “He/she . . . and “they”. . . .

Author Robert Elliott executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: [email protected] or 860-786-8286.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.

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