When attorneys call us with questions regarding Medicare Set Asides (MSAs) for both workers’ compensation and liability cases they often say, “My client is at MMI so there is no future care required.”
Unfortunately, this is seldom true. The American Medical Association defines Maximum Medical Improvement (MMI) as
“The point at which a condition has stabilized and is unlikely to change (improve or worsen) substantially in the next year, with or without treatment. While symptoms and signs of the condition may wax and wane over time, further overall recovery or deterioration is not anticipated. However, both the name given to and exact definition of this status may vary depending on the jurisdiction.”
Synonyms for MMI are: end of healing, fixed and stable, maximum cure, maximum degree of medical improvement, or medical stability.
Reaching MMI merely means that the injured individual, in the treating provider’s judgment, is unlikely to improve but may continue to receive appropriate medical care such as continued doctor visits, psychiatric treatment, medication, or injections. Consequently, MMI does not mean that no future care is needed, but rather than the individual’s condition is not subject to change.
In the Medicare compliance context, MMI represents the best time for parties to assess the need for and calculate the proper amount of an MSA. If a claimant’s condition has stabilized, that enables parties to more precisely evaluate his or her future injury related care, and then, if needed, allocate part of those expenses into an MSA.
Leave a Comment