Getting Real About Maximum Medical Improvement in California

Maximum Medical Improvement, or MMI, is the day your doctor looks you in the eye and says, “This is as good as it gets.” In California workers’ comp and personal-injury litigation, that moment flips a switch. Temporary benefits taper off, permanent-disability math kicks in, and both sides finally know the size of the pie they are fighting over. Ignore MMI and you will mis-price the case, mismanage expectations, and burn money you will never see again.

How Do You Know You Have Hit the Ceiling?

1. Treatment Has Stalled
   If physical therapy feels like a rerun and medication changes only shuffle side effects, the treating doctor will signal that continued care is “palliative, not curative.” That phrase is medical shorthand for MMI.

2. No More Reasonable Surgeries on the Table
   A credible surgeon willing to cut can delay MMI. Once every realistic procedure is crossed off, the clock stops.

3. Objective Testing Flat-Lines
   MRIs, functional-capacity tests, and nerve studies are the hard evidence. When those numbers stop improving, subjective complaints carry less weight.

Typical timeline: most California workers reach MMI somewhere between month 9 and month 18. Outliers exist, but if you are still on temporary disability at year two, every stakeholder—from claims adjuster to WCAB judge—starts asking why.

Paper Wins Arguments: Document Everything

In the comp system, “If it is not in the chart, it did not happen.” Make sure each visit, restriction, and medication change is logged. When the defense doctor tries to low-ball your impairment score, you need a paper trail thicker than their expert report. Applicants’ attorneys: audit those charts early. Employers and carriers: push for complete records or you will pay for the void later.

The Money Shift: Temporary Stops, Permanent Starts

• Temporary Disability ends at MMI. California caps TD at 104 weeks in most cases, but reaching MMI cuts it off sooner.

• Permanent Disability begins with an impairment rating. Under Labor Code section 4660.1, the rating runs through a grim little formula that decides how many checks get mailed and for how long.

• Expect a fight over Whole Person Impairment. A few percentage points can add or subtract tens of thousands of dollars.

Impairment Ratings: The Numbers That Drive Settlement

Doctors use the AMA Guides Fifth Edition, but let us be honest: two physicians can look at the same knee and assign ratings that differ by ten points. That spread is where negotiations live.

• Higher rating means larger weekly PD payments and bigger present-value settlement leverage.

• Lower rating lets the carrier close the file cheaply.

• Psych add-ons are mostly gone post-SB-863 unless the injury is catastrophic or the applicant proves a compensable consequence.

If you are an employer, get a quality QME or AME early. A sloppy panel choice can haunt you for the life of the claim.

MMI and Case Valuation: Why Lawyers Suddenly Return Your Calls

Once MMI lands, plaintiff counsel finally sees the finish line. Defense counsel finally has something concrete to offer. Judges at the WCAB push harder for resolution because there is little left to discover. Settlements tend to cluster in the 60 to 90-day window after the first solid MMI report.

Remember: settlement value in California is not just lost wages and future care. Think attorney-fee multipliers, life-pension add-ons, and the very real cost of future liens. Factor those in or expect last-minute sticker shock.

When the Doctors Disagree: Welcome to the QME Cage Match

• Panel QME vs. Treating Physician: expect divergent ratings.

• Defense-Requested IME: usually lower impairment and earlier MMI.

• Applicant’s Secondary Opinion: often higher impairment and delayed MMI.

Strategies:

1. Get an Agreed Medical Examiner if possible. One credible middle voice saves months of litigation.

2. Depose the doctor. A twenty-minute deposition can squeeze out clarifications that swing ratings by several points.

3. Do not wing it. Use a vocational expert if diminished-future-earning-capacity is on the table.

Vocational Rehab: Can You Actually Return to Work?

California offers Supplemental Job Displacement Benefits, but the voucher rarely covers real retraining. Employers: consider modified duties or ergonomic tweaks; they can cut PD exposure dramatically. Injured workers: document every failed job search. Those records backstop a future demand for additional benefits or a higher Compromise and Release.

The Psychological Plateau

MMI is not just a medical plateau; it is an emotional one. Realizing the injury is permanent can trigger depression or anger that tanks settlement talks. Smart parties loop in mental-health support and consider a psych component under Labor Code section 3208.3 if the facts allow.

Practical Checklist

For Injured Workers

1. Nail down a copy of every medical report.

2. Ask bluntly: “Doctor, are we at MMI yet?”

3. Consider a second opinion before your impairment rating gets locked.

For Employers and Carriers

1. Audit medical billing for anything post-MMI. Palliative care is not an open checkbook.

2. Secure a credible QME quickly.

3. Budget realistically. A rushed lowball offer only drags the case out.

Bottom Line

Maximum Medical Improvement is the pivot point where medical speculation ends and financial reality begins. Treat it like the milestone it is. Get the records straight, lock down the rating, and run the numbers with clear eyes. Whether you are paying the claim or living with the injury, misjudging MMI will cost you.