Policy
Workers reach maximum medical recovery (MMR) when they have reached a plateau in their recovery and it is not likely that there will be any further significant improvement in their medical impairment.
NOTE
For the purpose of this policy, the concept of maximum medical recovery is the same as maximum medical rehabilitation. The term "maximum medical rehabilitation" applies to claims with accident dates prior to January 2, 1990.
Guidelines
Definition
Significant improvement refers to a marked degree of medical improvement in the work-related impairment that is demonstrated by a measurable change in objective clinical findings.
Impairment means a physical or functional abnormality or loss (including disfigurement) which results from an injury and any psychological damage arising from the abnormality or loss.
Permanent impairment means impairment that continues to exist after the worker reaches maximum medical recovery.
NOTE
For the purpose of this policy, impairment plus a loss of earning capacity refers to disability in pre-1990 claims.
Monitoring the file
Decision-makers monitor, assess and weigh the health care information in workers' claim files to ensure it is sufficient to identify whether MMR has been reached, particularly if the usual recovery time has elapsed. However, MMR may be reached before the usual recovery time elapses. Decision-makers must consider whether MMR has been reached regardless of how long the worker has been impaired. If required, an opinion from WSIB clinical staff can be obtained to assist in determining MMR and the usual recovery time.
Identifying MMR
If a worker has a permanent disability/impairment, decision-makers identify when MMR is reached and record the date. A worker may have reached MMR and still be receiving treatment, such as physiotherapy or drugs where a significant improvement is unlikely.
Decision-makers determine when MMR is reached based on the following information which includes but is not limited to
- clinical reports from the treating health professional{s)
- specialists' report(s), where appropriate
- reports from agency(ies) providing treatment and/or evaluation, (e.g., Regional Evaluation Centres)
- information from the worker on his/her medical impairment
- external, evidence-based medical/scientific guidelines on disease and injury-specific impairment and treatment, and
- the opinion of WSIB clinical staff, if obtained.
Decision-makers consider
- if recent clinical reports indicate any change in the worker's medical impairment, and
- if the worker is currently receiving or will receive treatment that is likely to improve the worker's medical impairment.
Specialist referrals and other clinical investigations
If the clinical progress reports do not reveal any significant change over time, the decision-maker may request a specialist's opinion regarding whether the worker's medical impairment is likely to improve.
Even when referring this question to a specialist, or when considering further clinical investigations, the decision-maker may still find that MMR has been reached if there is evidence that the worker's condition is unlikely to improve significantly.
Identifying MMR In occupational disease claims
MMR for occupational disease claims is generally determined using the same criteria listed above under the heading, "Identifying MMR". In some cases, due to the nature of the illness or disease, a significant improvement in the worker's recovery may not be expected, and the day following the date of accident may be considered as the date of MMR.
Multiple disabilities/impairments
In claims where there is more than one permanent disability/impairment, a worker reaches MMR only when significant improvement is unlikely in all of the worker's permanent disabilities/impairments.
The decision-maker may set more than one MMR date if, after the first date is established and the permanent disability/NEL benefit is determined, the decision-maker recognizes additional permanent disability(ies)/impairment(s)
- for which entitlement was initially denied
- resulting from a new accident caused by the original injury, (e.g., because of an injured leg, a worker falls and sustains a back injury}, see 15-05-01, Resulting from Work-Related Disability, or
- arising out of the sequela of the original impairment, or its health care treatment, (e.g., an emotional reaction to an impairment).
Redetermining MMR
MMR dates can be redetermined
- if new clinical evidence indicates further health care treatment is likely to improve the worker's medical impairment, or
- if entitlement to additional work-related impairment(s) is recognized before the permanent disability/NEL benefit is determined.
Assessing permanent disability/impairment
After MMR is identified and recorded, if there is a permanent disability/impairment, the WSIB arranges a permanent disability evaluation/NEL assessment.
For more information on permanent disabilities for accidents prior to January 2, 1990, see 18-07-01, Determining the Degree of Disability.
For more information on permanent impairments for accidents on or after January 2, 1990, see 18-05-03, Assessing Permanent Impairment.
Application date
This policy applies to all decisions made on or after June 1, 2006, for all accidents.
Document history
This document replaces 11-01-05 dated October 12, 2004.
This document was previously published as:
18-05-02* dated June15, 1999
6.1 dated January 1, 1998
05-03-11* dated February 20, 1991.
*05-03-11 and 18-05-02 combined to become 11-01-05 dated October 12, 2004.
References
Legislative authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 47, 102, 103
Workers' Compensation Act, 1990, as amended
Sections 1(1), 42
Workers' Compensation Act, 1980, as amended
Sections 45(1), 132
Minute
Administrative
#1, May 2, 2006, Page 423