In our 2023 Auto Accidents Statistics resource, compiled using official crash data from the Texas Department of Transport, we revealed an individual is injured in a Texas auto accident every two minutes and four seconds. Many of these injuries were severe — with 18,728 people suffering suspected serious injuries in crashes.
The Federal Highway Administration (FHWA) defines a suspected serious injury — otherwise known as an incapacitating injury — in Texas as any severe injury that prevents the “continuation of normal activities.” Examples include distorted limbs, internal damage, and a crushed chest.
These injuries and others like them often require a lengthy recovery — if a recovery is even possible.
Of course, many Texans sustain similar injuries in accidents of all kinds, whether at work, from a slip and fall, or because of a product defect.
If you’ve sustained a severe injury that may take months or years to heal or will affect you for the rest of your life, you might be entitled to substantial compensation from the person or party responsible.
But when determining how much compensation you’re entitled to or negotiating a settlement, one factor can make a massive difference: maximum medical improvement (MMI).
In this blog, McAllen and San Antonio personal injury lawyer Dr. Louis Patino explains what maximum medical improvement in Texas means, what happens after you’ve reached MMI, how it can impact your personal injury claim, and why you should avoid agreeing to a settlement before you’ve reached maximum medical improvement.
What Is MMI? The Definition of Maximum Medical Improvement in Texas
Maximum medical improvement is when an injured person’s condition will not improve further, even with additional treatment.
This term is typically used in Texas workers’ compensation claims to determine when an injured worker no longer qualifies for Temporary Income Benefits (TIBs). However, the concept can be helpful in assessing your overall health and long-term prognosis when pursuing compensation in a personal injury claim.
Does Reaching MMI in Texas Mean a Person Is Fully Healed?
Reaching MMI can mean a person is fully healed or cured, but it doesn’t always.
Take this example:
A person sustains a spinal cord injury and is partially paralyzed. After extensive treatment and rehabilitation, they recover some mobility — but not to the extent they enjoyed before their accident.
When additional treatment is unlikely to provide any further benefit, they will have reached maximum medical improvement, even if they never fully recover their range of motion.
However, a person can reach MMI in Texas, but still need ongoing treatment. For example, an injured person may require medication for the rest of their life or ongoing rehabilitation for a traumatic brain injury to maintain their condition. In these scenarios, reaching maximum medical improvement simply means that continued treatment will prevent their conditions from worsening, but they will not get better.
MMI and Workers’ Compensation Claims
Maximum medical improvement is a vital component of Texas workers’ compensation claims.
When a worker is injured on the job in Texas, they have several options for recovering compensation for their lost wages and medical bills.
- If their employer has workers’ compensation insurance, they can file a workers’ comp claim with their employer to recover the cost of their treatment and a portion of their lost wages.
- If their employer does not have workers’ comp insurance and their employer’s negligence caused the accident, they can pursue a traditional personal injury claim.
- If a third party is liable for the employee’s injuries — such as the manufacturer of defective equipment — they can sue the third party, even if they’ve received workers’ compensation benefits via their employer.
Temporary Income Benefits in Texas
Employees who cannot work due to an injury, receive Temporary Income Benefits.
To qualify for income replacement, workers must earn less after their injury than before for at least seven days. On the eighth day, they become eligible for weekly checks.
TIBs are calculated by taking your gross earnings for the 13 weeks before your injury and dividing the total by 13. This sum is your Average Weekly Wage (AWW). Your TIBs check will be for 70% of your AWW, called your Comp Rate. Temporary Income Benefits are not taxed, so most workers find their income replacement benefits are similar to their usual take-home pay after deductions.
As the name suggests, these benefits are short-term and end when the worker reaches maximum medical improvement.
Maximum medical insurance in Texas, then, is critical in determining when an employee is no longer eligible to receive TIBs.
In workers’ compensation claims, an employee is considered to have reached MMI when 104 weeks (two years) have passed since they became eligible for Temporary Income Benefits, even if their condition might still improve.
After a worker has reached maximum medical improvement or their temporary income benefits have ceased because two years have passed, their only option for ongoing financial support is to receive an impairment rating from a treating physician, a referral doctor, or a doctor hired by the workers’ compensation insurance provider to perform a medical examination.
This rating determines how long an employee will receive impairment income benefits, with each percentage point equaling three weeks of benefits.
| Here’s an example:
An employee breaks their wrist at work. They recover most function and mobility after physical therapy, but they have permanent weakness, and further treatment is unlikely to help. Because of their injury, they can only return to work on reduced duties, affecting their income. Their doctor determines they have reached MMI and uses the Guides to the Evaluation of Permanent Impairment to determine an impairment rating of 10%, entitling them to benefits for 30 weeks. |
Patino Law Firm does not handle workers’ comp cases or impairment rating disputes. However, we can help you with a personal injury claim if an employer or third party is liable for an injury.
But MMI doesn’t just relate to workers’ comp — it’s a crucial consideration in all injury claims to recover maximum compensation after a Texas accident.
How Does Maximum Medical Improvement Affect Your Personal Injury Claim?
We’ve already touched on the potential long-term consequences of an injury:
- Memory loss, difficulty concentrating, mood swings, chronic headaches, or dysarthria (slurred speech) after a traumatic brain injury;
- Loss of sensation, bladder dysfunction, chronic pain, or muscle spasms after a spinal cord injury;
- Flashbacks, nightmares, depression, poor sleep, or hypervigilance from post-traumatic stress disorder after a car accident;
- Limited mobility, permanent weakness, arthritis, or joint stiffness after an orthopedic injury;
- Scarring and disfigurement (and the associated emotional trauma) and sensory loss after a burn injury;
- Prosthetic issues and lack of mobility after an accident requiring limb amputation;
- Digestive problems, impaired mobility, and increased risk of infection after sustaining an internal injury.
If you suffer these complications after an accident caused by someone else’s negligence, you can recover compensation for them in a personal injury claim.
Recovering compensation for a personal injury begins with negotiating a settlement with the insurance company of the person or party responsible.
If you’re injured in a car accident caused by a negligent driver, you’d negotiate a settlement with the driver’s insurer to recover compensation for your medical expenses, lost wages, pain and suffering, emotional distress, and other losses.
But if you haven’t yet reached maximum medical improvement, you risk settling for less than you deserve, especially if an insurance adjuster tempts you into accepting an early offer.
Should You Accept a Settlement Offer before Reaching Maximum Medical Improvement?
After your accident, the insurance adjuster assigned to your claim will assess your accident to determine their client’s liability and how much your claim is worth. Then, they’ll make an offer to settle your claim, preventing you from pursuing legal action and taking your case to trial.
It can be tempting to accept the first offer from an insurance company, especially if you have bills to pay and cannot work. The insurer might persuade you that accepting a settlement allows you to begin to move forward and put your accident behind you or try to scare you with stories about claims dragging on for months and a costly, time-consuming lawsuit with no guarantee of a win.
But the primary issue with accepting the first offer from an insurer is that you may not yet know the full extent of your injuries. You might sustain an injury and expect to make a full recovery, only to suffer chronic pain or need surgery, costing even more money and requiring additional time off work.
Injuries aren’t just physical, though. You might develop post-traumatic stress disorder that makes you withdrawn, impacts your relationships, and affects your overall quality of life — possibly for months or years after your accident.
Injury complications aren’t always possible to predict, but you’ll have a more accurate idea of where you stand if you wait until you reach maximum medical improvement before negotiating and accepting a settlement. If you accept an offer before you understand the potential long-term consequences of your injuries and your condition later worsens, you cannot pursue additional compensation. As a result, you risk not being able to afford the extra treatment you need.
One of the benefits of reaching MMI is that it establishes how your injuries could impact you in the future. MMI might represent a total recovery, meaning you can confidently negotiate a fair settlement based on your past losses.
If you have permanent or long-term damage, reaching MMI will provide an understanding of what life will look like now that your condition is unlikely to improve further. If you have chronic pain, you’ll know how much pain you suffer on an average day. If you suffer muscle weakness or limited mobility, you’ll know what activities it prevents you from doing. If you have dysarthria after a brain injury, you’ll understand the emotional impact of struggling to communicate as effectively as you could before your accident.
Of course, waiting until you reach maximum medical improvement is not foolproof. Your injuries might still get worse, but understanding these factors gives you a more accurate starting point for negotiations. The benefit of waiting for maximum medical improvement is that you’ll have evidence of the losses you’ve incurred until now. If you had settled early, the portion of your compensation relating to future losses would have been an estimate — if your settlement was even enough to cover your losses.
Why Should You Hire a Personal Injury Lawyer before Reaching Maximum Medical Improvement?
Hiring a personal injury attorney when you’ve been injured in an accident caused by someone else’s negligence offers multiple benefits. Here’s how our personal injury lawyer can help you as you move toward reaching maximum medical improvement.
Negotiating a Settlement
Your personal injury lawyer understands the tactics insurance adjusters use to dispute your entitlement to compensation or reduce the amount they offer. We can handle all communications with insurance companies, so you don’t have to worry about your statements being used against you. We’ll also calculate all your losses and negotiate the best possible settlement to ensure you receive fair compensation for your medical bills, lost wages, property damage, pain and suffering, and more.
Helping You Get Medical Care
It’s vital to seek medical attention as soon as possible after your accident to begin treatment and document your injuries so that the insurance company cannot argue you did not sustain them in your accident. However, you’ll likely need ongoing medical treatment, especially if you’ve yet to reach MMI. We can help you get the medical care you need and arrange payment plans or defer payment until your claim is resolved so you can get the treatment you need without worrying about the cost.
Filing a Lawsuit within the Statute of Limitations
You have just two years to file legal action for a personal injury, and the clock starts ticking as soon as you’re injured. Most personal injury claims settle, but if your losses exceed the liable party’s insurance coverage or the insurer refuses to make a fair offer, you might choose to sue and take your case to trial. You must do this within the two-year statute of limitations, but this can pose challenges if you’re holding off on negotiations until you achieve maximum medical improvement — or are close to reaching MMI. We can explain your options for recovering compensation, including your chance of success at trial and what to do if you’ve yet to reach MMI and do not know how long it might take for your condition to improve.
Securing Expert Witnesses
Expert witnesses can provide valuable testimony and reports to support your personal injury claim. Witnesses can include medical professionals who specialize in your specific injury and economic experts who can calculate your future losses, ensuring your compensation is enough to cover your long-term expenses. In the context of maximum medical improvement, a doctor can testify to how your injury will never fully heal and explain how it will continue to impact you physically, emotionally, and financially for the rest of your life. As a result, their professional opinion can massively influence the compensation you’re entitled to and give you an advantage as your attorney negotiates a settlement or pleads your case to a jury.
As your Texas personal injury lawyer, we can tap into our network of expert witnesses — who are among the best in their respective fields — to secure the most effective evidence to build your case and secure maximum compensation.
See if you have a claim by contacting our personal injury lawyer in McAllen and San Antonio. We represent clients injured in all types of accidents across the Rio Grande Valley and San Antonio Metropolitan area, from Edinburg to Schertz. We offer a free, no-obligation case review so you can learn where you stand and determine if we’re the right firm for you. Se habla Español, and you don’t pay legal fees until we win. Call 855-LAW-NINJA or submit a contact form to speak to a leading personal injury lawyer today.
