If your doctor says you have reached maximum medical improvement, you may wonder whether workers' compensation will stop paying for treatment. In Virginia, reaching MMI alone does not end your medical benefits.
If your claim has been approved, your employer remains responsible for necessary treatment related to your work injury, generally through its workers' compensation insurance carrier.
What Does Maximum Medical Improvement Mean?
Maximum medical improvement, or MMI, means your doctor does not expect your condition to improve significantly. It does not mean that your injury has disappeared or that you will never need another appointment.
For example, someone with a permanent back injury may reach MMI but still need medication, follow-up visits, or treatment to manage pain. Virginia law requires the employer to provide necessary medical care for a compensable injury for as long as that care is needed. There is no automatic cutoff when you reach MMI.
What if My Condition Changes After MMI?
MMI reflects your condition when your doctor makes that assessment. If your symptoms worsen or a new treatment becomes appropriate, tell your authorized treating physician and ask them to document what has changed. They can assess whether you need additional care for your work injury.
What if the Insurance Carrier Refuses to Pay?
The carrier may claim that treatment recommended after MMI is unnecessary, unrelated to your work injury, or outside the care covered by your award. Ask for the reason for the denial in writing. Keep your doctor's treatment recommendation, along with any medical records explaining why you still need care.
The firm of Ackerman & Falcon can review your workers' compensation award and the carrier's explanation, then work with your authorized treating physician to obtain evidence addressing the denial. If the carrier still refuses to pay, the firm can bring the dispute before the Virginia Workers' Compensation Commission and seek an order requiring payment for the treatment. A denial from the carrier is not the Commission's final decision on your benefits.
Get Help with Your Medical Benefits
You should not have to guess who will pay for the medical care your work injury still requires. The firm of Ackerman & Falcon can review your claim, your medical records, and the carrier's reason for denying treatment. Call 703-288-1400 or use our online form to schedule your free consultation.
