Maximum Medical Improvement and Coordinated Claim Management

By Gary Anderberg, PhD

SVP Claim Analytics
Gallagher Bassett

The onset of an episode of disability, work-related or not, is usually pretty clear. Determining when an episode ends — and its impact on return-to-work (RTW) expectations — can be much more complex.

A great deal can hinge on the determination of “maximum medical improvement” (MMI). Have your MMI processes for non-occupational disability and workers’ compensation (WC) been reconciled across the board to ensure that all comply with the interactive process mandated under the Americans with Disabilities Act (ADA)?

It’s an important question; to explain why, let’s start with the basics. MMI can be difficult to define with some claims in which a degree of residual disability remains after the person has recovered. That’s the point of an MMI determination; this person has healed and recovered function to the extent possible following the treatments and therapies applied after the accident or the onset of the illness. We prefer, of course, to think of people returning to 100% of pre-incident/illness function, but that doesn’t always happen. Residual disability is the situation we focus on here.

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