Maximum Medical Improvement Guide


Maximum Medical Improvement

After you are injured, your body's condition may improve or get worse.  This improvement in your injury or the worsening of the injury may change back and forth.  It may seem like you are getting better for a while, but then your condition may get worse.  Each body is different.  Someone else's body may heal more quickly or more slowly than yours.  

Maximum medical improvement is the point at which your injury improves the most that it will improve.  This does not mean that your body is completely well or that you are able to work.  Some people initially get better but then lapse out of maximum medical improvement.  If your condition becomes worse, and there is a medical treatment that helps your condition become better, then you are said to have lapsed out of maximum medical improvement and to have reached maximum medical improvement again following the treatment and your condition getting better.  

If you are not at maximum medical improvement, you should receive temporary income benefits based on your inability to work your regular duty job.  Once you are certified as being at maximum medical improvement, your temporary income benefits will stop.  You may receive impairment income benefits, depending upon your impairment rating.

Trying to Work Before Being Maximum Medical Improvement is Certified

There is often a rush to certify you as having reached maximum medical improvement after you have been released to work in some capacity.  You should discuss with your doctor giving you time to see if you can do the work before certifying you as being at maximum medical improvement.  

Disputing the Certification of Maximum Medical Improvement

If you are certified as being at maximum medical improvement before you think that you are ready, you should dispute the maximum medical improvement certification with the Texas Workers Compensation Commission.  There is a specific process for this and it should be done within 90 days of the date of certification.

The rules technically say 90 days of the date that you receive the certification, but there are deeming rules on receipt of documents that may adversely affect you if you wait to file the dispute.  If you are outside the 90 day time period, you may still be able to reopen the maximum medical improvement certification if you have sustained a substantial change of condition or if other exceptions apply to your case. 

There have been some changes in the designated doctor exam process.  For more information on these changes, click here.

How Spinal Surgery Affects Maximum Medical Improvement

Spinal surgery may extend the date of your maximum medical improvement beyond your statutory date of maximum medical improvement.  For more information regarding this, please contact our office.


Effects of Maximum Medical Improvement Certification

Being certified as being at maximum medical improvement can affect your ability to receive medical treatment for your injuries.  The insurance company authorizes medical treatment based on medical treatment guidelines adopted by the state agency.  The medical treatment guidelines can stop almost all medical treatment once you are at maximum medical improvement, even though the law says that you have lifetime medical treatment for your injuries.  Your doctor must fight to prove why your condition still needs treatment even though you have been placed at maximum medical improvement.  He must show why the guides don't apply to your condition so that he can obtain the authorization to treat you.  If you have been placed at maximum medical improvement and received an impairment rating prematurely, your ability to get the medical benefits and income benefits you need can be greatly damaged.  
For more information, please see the effects of the impairment rating in the Impairment Income Benefits Guide.

Common Issues

Common issues regarding maximum medical improvement that we see include:
  • whether you are at maximum medical improvement
  • your doctor and the insurance company's doctor or employer's doctor disagree about whether you are at maximum medical improvement
  • your doctor states that you are no longer at maximum medical improvement, but the insurance company refuses to pay you a weekly check
  • whether you have lapsed out of maximum medical improvement
  • whether you have had a substantial change of condition affecting whether you are at maximum medical improvement
  • you have had surgery and need to extend your date of maximum medical improvement to give you time to heal
  • the insurance company refuses to follow your doctor's statements regarding your maximum medical improvement.
If you are unable to work and are not receiving a check, please contact our office right away so we can help you.

We can help with these situations and provide advice and assistance to you regarding your workers compensation claim. We have 25 years of experience handling Texas workers compensation cases.  If you have any questions, we are here to help you. 

Contact Us

For more information, please contact our office to discuss your claim. Our phone number is (817) 921-3220.  We are here to provide legal help to you.