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  1. #1
    Join Date
    Aug 2011
    Posts
    13

    Default What Happens After You Reach MMI

    As you all are aware I have injured my back and have just had my 1st ESI. I will follow up with my TP in 10 days to see how the injection has worked. I gotta say, I feel like a totally new person that can use their legs again. I am not a surgical candidate as I before stated and will NOT consider it. So, does this just leave me with oral meds and ESI's forever?? I suppose this is MMI? I know the Dr. will let me know this, but just some input is appreciated.
    Cheers

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: So I Am Reaching MMI

    MMI is determined by your Dr when your condition is stable, not expected to change better/worse in the next 12 months...with or without further treatment.
    So, does this just leave me with oral meds and ESI's forever??
    No... when you are MMI, the specie of benefits change... from TTD as you are no longer "totally disabled" to a PPD/Permenant Partial Disability indemnity, based on the %, a pre determined number of weeks. You continue to have access to medical care, based on reasonable need. The ER/IC has the ability to continue to control medical just as you have experienced during the open claim. l
    Your claim will move to some type of resolution..stipulations or C&R.

    The presumption at MMI is that you are capable of some type of gainful employment...whether you exercise that option or not...of course is up to you.

  3. #3
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: So I Am Reaching MMI

    Your benefits won't stop when you reach MMI, they will only change in character. Most likely, you'll be rated for a PPD (permanent partial disability). While the ER/IC is not required to offer a settlement and can continue to pay weekly benefits (which will actually end up being less than the TTD benefit) most eventually offer to settle. The amount of settlement is based on the AMA Guidelines for Permanent Disability Rating Edition 5 (in Georgia). The AMA came out with an Edition 6 in 2007 but Georgia has not adopted those guides yet.

    When you reach MMI, this means the Dr. will release you to work with certain restrictions, which may or may not return you to work in your former job or your former job type. MMI means you're as good as you're going to get with or without further treatment.

  4. #4
    Join Date
    Sep 2011
    Location
    Sandy Springs, GA
    Posts
    7

    Default Re: So I Am Reaching MMI

    That is not true in GA. MMI has nothing to do with entitlement to TTD in GA. It has everything to do with entitlement to permanent partial disability benefits (PPD). But you cannot receive PPD and TTD at the same time. If the doctor puts you at MMI it only means you have recovered as much as can be expected. You can always request a change in physician if you believe you have not fully recovered.

  5. #5
    Join Date
    Aug 2011
    Posts
    13

    Default Re: So I Am Reaching MMI

    I just had another injection to calm the nerve issue in my back that radiates horribly and I am suprised with the results. I can stand straight and walk as a normal person. I see the doc in 2 weeks. Fingers crossed,. thanks for your input Hal. Its awesome info.
    Lglegl, they have no work for me if I have any type of restrictions. Sad but true. So I guess I will continue TTD?

  6. #6
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: So I Am Reaching MMI

    Quote Quoting fuzziepup View Post
    Lglegl, they have no work for me if I have any type of restrictions. Sad but true. So I guess I will continue TTD?
    From what Hal says, that seems to be the case, unless I totally miscomprehended that.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: So I Am Reaching MMI

    That is not true in GA. in GA. It has everything to do with entitlement to permanent partial disability benefits (PPD). But you cannot receive PPD and TTD at the same time. If the doctor puts you at MMI it only means you have recovered as much as can be expected.
    If you have been declared stable/MMI has been reached, you'd no longer be Temp Total Disabled, but rated for PPD and those indemnity benefits begin... that may be the same rate as TTD. At MMI the specie of benefits change...from TTD to PPD.
    Maybe it's semantics, but the statement MMI has nothing to do with entitlement to TTD is confusing... if the benefits change to PPD at MMI.
    they have no work for me if I have any type of restrictions. Sad but true. So I guess I will continue TTD?
    No... but your PPD benefits continue. If you are released to return to work, with/without restrictions, you are no longer Temporary Total Disabled.

    If you disagree with that... then do as Hal suggested and request a re evalluation, or change of physisian. There are process for dispute resolution.

  8. #8
    Join Date
    Jan 2010
    Location
    Pennsylvania
    Posts
    609

    Default Re: So I Am Reaching MMI

    It's the same here in PA. the only reason a rating is given is to see if you are 50% or above.....otherwise you receive the same rate of PPD as you have been on TTD...they just call it by a different name. The judge makes the final decision about how many weeks you are entitled to [example...if you are PPD and you are under 50% disabled...you would receive your PPD(same rate as TTD)for say 300 (or 232 or whatever) weeks (if the judge says that's what you are entitled to) ].

  9. #9
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: So I Am Reaching MMI

    Quote Quoting HalWhiteman View Post
    That is not true in GA.
    Ok, Hal, now I AM confused. WHAT is not true in GA ?

    I think BvIA and I both have said simply that once MMI is reached, TTD will likely become PPD (or in some cases PTD) and that settlement may or may not ensue. I just want to be sure that I'm stating that correctly.

    Do you mean that MMI won't necessarily result in a RTW with or without restrictions ?

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