What is Maximum Medical Improvement (MMI)?

In workers' compensation cases, Maximum Medical Improvement (MMI) is the point in your recovery where your treating doctor determines that your injury or illness is “stable and stationary.” In other words, further medical treatment is unlikely to result in significant improvement. Your injuries are not getting any better and not getting any worse. 

This doesn't imply that you've fully healed but that your condition has plateaued. Your future loss of earnings and return to full work capacity is difficult to assess accurately before this point.

MMI and Whole Person Impairment (WPI) in Queensland

WorkCover Statutory Claims 

For a WorkCover claim, once your injuries are stable and stationary (have reached maximum medical improvement), WorkCover QLD will arrange a Permanent Impairment Assessment appointment with a specially qualified doctor. The doctor will assess your injuries and prepare a report that states your degree of permanent impairment (DPI %) for each of your injuries. This is a percentage representing the permanent impact of your work-related injury on your overall health and functional capacity. 

Following this assessment, generally, you will be made a lump sum offer by Workcover which correlates to the % DPI. It is a very small sum compared with what could be awarded via a common law claim for damages.

There are specific implications of accepting the Workcover lump sum offer. In general, if you accept the lump sum offer and wish to make a common law claim for damages, the lump sum payment (as well as all payments made to you by Workcover throughout your statutory claim) must be repaid to Workcover at the end of a common law claim. This is general advice only and can vary from claim to claim, so it is very important to consult with a lawyer first before accepting any lump sum offer from WorkCover. 

If you are assessed as having a DPI higher than 20%, then you can keep the lump sum payment, and also claim common law damages (without having to refund this amount to Workcover). If you are assessed at over 30% (only very severe injuries would be over 30%), you will be entitled to additional lump sum compensation.

• Impact on Benefits: In some cases, reaching MMI might signal a change in your WorkCover benefits, and usually is the trigger for WorkCover to cease your weekly wage replacement payments and in certain cases offer you a lump-sum payment.

• Legal Guidance: Navigating the DPI assessment process and understanding its implications for your entitlements can be complex. Seeking the advice of a personal injury lawyer specialising in WorkCover claims is often beneficial. Smith’s Lawyers offer free initial advice and risk-free claims with no upfront costs.

Common Law Claims for Damages 

In Queensland, unlike some other states, you no longer have to reach a certain threshold (% degree of whole person impairment) to make a common law claim for damages for a work injury, motor vehicle accident or any other type of injury. 

If you decide to make a common law claim for damages, your injuries may also be assessed to determine your degree of “Whole Person Impairment” as part of this process. Once your injuries have reached Maximum Medical Improvement, your lawyers may organise an Independent Medico-Legal Examination for you to attend. In these appointments, the doctor will assess your injuries and write a report which will include a WPI %. The doctor will also make comments as to your predicted future medical expenses, rehabilitation, care and assistance you will require and your future loss of earning capacity. 

Every claim is different, and your lawyers will provide more detailed advice on the medico-legal examination process based on your specific injuries and situation. 

How is WPI Calculated?

In Queensland, WorkCover uses the Work Capacity Decision Guide, which aligns with the American Medical Association Guides (AMA Guides), to determine WPI. The Doctor or Approved Medical Specialists will perform a detailed examination and analyses to evaluate the severity of your permanent impairments and limitations. Factors considered include:

• The nature and extent of your physical or psychological condition
• Your loss of function
• Any pain or suffering experienced
• Your ability to undertake everyday activities

Where to Find More Information

• WorkCover Queensland: For detailed information on impairment assessments and compensation procedures: https://www.worksafe.qld.gov.au/
• Office of Industrial Relations (Queensland): Provides guides, forms, and resources related to Queensland's workers' compensation system (https://www.oir.qld.gov.au/)

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