Our mission is to be trusted advisors and effective advocates for our clients.

  1. Home
  2.  » 
  3. Workers' Compensation Defense
  4.  » What maximum medical improvement means for self-insured companies

What maximum medical improvement means for self-insured companies

New York allows employers who meet certain standards to self-insure for the purposes of workers’ compensation coverage. These businesses have the right to set aside resources to cover work-related injuries rather than paying a premium for insurance coverage, which can save them money – as long as there are no substantial claims against the company.

Unfortunately, once a worker gets hurt and needs benefits, self-insurance can prove to be more expensive than paying a workers’ compensation policy premium. In some cases, workers could claim to have permanent, disabling medical conditions that require ongoing wage replacement benefits and expensive medical care.

Understanding the rules that apply in such a situation can help your business respond appropriately.

Not all workers fully recover from their injuries

If someone suffers a severe electrical shock, falls from a great height or otherwise suffers a severe injury on the job, the consequences of their injury could last indefinitely. They may heal somewhat but still never be able to resume the work they once performed for your company.

Injured workers may experience a permanent reduction in their earning potential or ability to work. Still, there are limits to the coverage you have to provide and the care they can demand. A finding that the employee has achieved maximum medical improvement (MMI) typically means limitations for workers’ compensation medical coverage.

Generally, medical professionals cannot declare that a worker has achieved their MMI until at least six months after their diagnosis or the date of their injury. Workers could still qualify for palliative care or additional treatment when symptoms flare up, but they will no longer need ongoing treatment because there is little reason to expect any additional improvement of their condition. 

What does a finding of MMI mean for your company?

If the doctor overseeing the worker’s care believes they have achieved MMI, that will likely mean that your medical expenses for the worker will decrease in the near future. You may also be able to have them return to work if their improvement is enough to return to the same job responsibilities. If someone achieves MMI while still being physically unable to work a job, you may have permanent obligations in the form of disability benefits.

Recognizing the obligations you have as a self-insured employer can help you handle major claims against your company.