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What Happens After I Reach MMI Under Texas Law?

May 21, 2020 Workers Compensation

What happens after I reach MMI under Texas Law? That’s a question asked by many people who’ve been hurt on the job and are getting workers’ comp benefits. MMI, or maximum medical improvement, means that a doctor has decided you are as well as you’re going to be from your injury or illness. When the doctor says you’ve reached maximum medical improvement, your company’s workers’ comp insurer may very well try to limit your benefits or stop paying them altogether. Unfortunately, this can happen even if you are not fully recovered and whether or not you are able to return to work. If this happens, you might have to go back to work in spite of your injuries.

Insurance companies are in business to make money. They make more money when they can pay out as little as possible to injured workers. But it’s important to remember that employers are supposed to keep their workers safe. When they fail to do so and a worker is injured or becomes ill while on the job, it is the responsibility of the employers’ workers’ comp insurance company to cover doctor bills and lost wages. Insurance companies should not be turning a profit at the expense of injured workers, but, sadly, they will often try to do so.

What You Can Do After Reaching MMI in Texas

After reaching MMI in Texas, you may very well lose your workers’ comp benefits. MMI happens when your doctor determines you’ve reached it or at approximately 104 weeks from the time you became disabled. When you reach MMI, you will be given an impairment rating (also called an “IR”). This impairment rating involves undergoing a physical exam by a workers’ comp doctor who then assigns a percentage indicating the degree to which you are permanently impaired.

If you don’t have this rating in hand before you reach MMI, your temporary income benefits (TIBs) will end—they cannot be paid beyond MMI—and you will be left without an income. An interruption in income is a frightening possibility to face for many people. Experienced workers’ compensation attorneys know the law and how to take on insurance companies. You should speak with a workers’ comp lawyer as soon as possible after being injured or getting sick on the job. It is especially important if your doctor thinks you are getting close to MMI or if you are reaching the 104-week time limit. A workers’ comp attorney can advise you about next steps to take to help ensure you don’t have a break in benefits.

What Benefits Can You Get After You Reach Maximum Medical Improvement?

After you reach maximum medical improvement and get an IR rating, you may be able to get impairment income benefits (IIBs). These benefits are paid at a lower rate than temporary income benefits. How long you can get them is based on your IR rating. For example, suppose the doctor gives you a 10% impairment rating. You can receive three weeks of benefits for every percentage point you are impaired. So you would receive 30 weeks of benefits. Once the 30 weeks is up, so are your weekly payments.

Of course, the workers’ comp doctor who does your physical exam may decide you are no longer impaired at all. If this happens, you could be forced to return to work in spite of your injury or illness. Or the rating you get might not reflect your true medical condition and you won’t get the amount of benefits that you truly need. When people are facing having their benefits greatly reduced or not having any incomes at all, it is in their interest to have attorneys on their side who understand Texas workers’ comp laws.

Getting Benefits After You Reach MMI and Your Impairment Benefits End

After your impairment income benefits end, you might be able to get supplemental income benefits (SIBs). To get these benefits, you must file an application with the Texas Division of Workers Compensation. These benefits will pay you for an additional time period. However, to get them you must be at least 15% impaired, or you won’t qualify. It isn’t unusual for insurance companies to pressure doctors into rating injured workers just below the 15% minimum to avoid paying additional benefits. Insurance companies want to save themselves money and will try to do it at the expense of injured workers. Workers’ compensation lawyers understand this and will work to stop insurers from getting away with it.

Challenging Impairment Ratings

You can see that the impairment rating you get after MMI has a big impact on benefits. Impairment ratings can be challenged, but it must be done quickly. If not done in a timely way, the rating could become permanent and you will be deprived of the additional income you could have received. You can dispute an impairment rating by filling out the necessary forms and requesting a benefit review conference (BRC). Challenging impairment ratings is a complicated process. If done incorrectly, it will mostly likely be unsuccessful and will further hurt your benefits claim. Texas workers’ compensation attorneys understand the process for challenging impairment ratings and are skilled at taking on workers’ comp doctors and insurance companies.

Our Workers’ Comp Attorneys Can Help You After You Reach MMI

As you can see, the workers’ comp benefits process is highly confusing. Insurance companies want you off their books, so may not always be straightforward in dealing with you. It takes legal understanding of the workers’ comp system to successfully stand up to insurance companies and their teams of lawyers.

When you’ve been injured on the job and are not fully recovered, the last thing you should have to worry about is how you will pay your bills. At Terry Bryant Accident & Injury Law, our lawyers have a clear understanding of how the laws work in Texas. We fight for injured workers and will stand up for your rights. We also handle on-the-job injury cases for workers at Texas companies that don’t carry workers’ comp. Call now to speak with our Houston work injury attorneys at (713) 973-8888 or toll-free 1 (800) 444-5000 – the consultation is free and confidential.

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