As an injured worker in Pennsylvania, workers’ compensation benefits could make a huge difference in your life. You won’t have to pay that big deductible from your medical coverage policy, and you also won’t have constant co-pays every time you see a physical therapist or pick up a prescription.
Pennsylvania workers’ compensation insurance will pay 100% of your related medical expenses, at least until a certain point. However, when the physician managing your care determines that you have reached maximum medical improvement (MMI) for your diagnosis, options for benefits will shift drastically.
Will all of your health coverage cease when a doctor declares you have achieved MMI?
Treatment efforts may end after a patient reaches MMI
It is normal for people to struggle to understand the technical terms that govern workers’ compensation claims and the impact that different changes will have on their benefits. Despite what you may think, a declaration that you have achieved MMI does not immediately end your medical benefits.
Instead, it will end your treatment benefits. If you are unlikely to make significant future improvements, the insurance company may not pay for more therapy or another surgery. However, it will continue to cover the necessary care to manage your symptoms and maintain your health.
MMI could affect your disability benefits, too
Once you have achieved MMI, you may need to re-evaluate your circumstances and communicate with your employer. There could still be limitations on what job functions you can perform, a complication that can quickly frustrate both you and your employer.
You may need to move into a different position or ask for accommodations so that you can keep doing your job. If you can’t reasonably perform the same tasks you once did, you may need to look into a different profession. Reaching MMI might mean that you receive permanent disability benefits if you can’t go back to work at all or need to accept a lower-paying job.
Occasionally, a worker may disagree with the doctor’s decision that they achieved MMI. You may be able to seek a second opinion and potentially ask for ongoing treatment if continued improvement is likely in your case. Know your rights as a worker receiving workers’ compensation benefits.