Policy
Workers reach maximum medical recovery (MMR) when it is not likely that there will be any further significant improvement in their medical condition.
NOTE
For the purpose of this policy, maximum medical recovery is the same as maximum medical rehabilitation.
Guidelines
Monitoring the file
Decision-makers monitor the health care information in workers' claim files to ensure it is sufficient to identify whether MMR has been reached, particularly if the usual healing time has elapsed.
Usual healing times
Decision-makers may use the chart below as a guide to help them determine when MMR should be reached. However, MMR may be reached before the usual healing time elapses. Decision-makers must consider whether MMR has been reached regardless of how long the worker has been impaired.
Identifying MMR
If a worker has a permanent 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, if the probability of improvement is low.
Decision-makers determine when MMR is reached based on the following information
- the opinion of WSIB medical staff, if consulted
- clinical reports from the treating health professional
- specialists' reports, where appropriate
- reports from treating agencies, and
- information from the worker on the medical condition.
Decision-makers consider
- if recent clinical reports indicate any change in the workers medical condition, and
- if the worker is currently receiving any treatment that is likely to improve the worker's condition.
Specialist referrals and other clinical investigations
tf 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 condition is likely to improve.
Even when referring the question to a specialist, or when considering further clinical investigations, the decision-maker may find that MMR has been reached if there is evidence that the worker's condition is unlikely to improve significantly.
Multiple impairments
In claims where there is more than one permanent impairment, a worker reaches MMR only when significant improvement is unlikely in all of the worker's medical conditions.
The WSIB may set more than one MMR date if, after the first date is established and the NEL is determined, the WSIB recognizes additional permanent 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 injury, or its health care treatment (e.g., an emotional reaction to an injury).
Redetermining MMR
MMR dates can be redetermined if new clinical evidence indicates further health care treatment is likely to improve the worker's condition, or if entitlement to additional work-related impairment(s) is recognized before the NEL benefit is determined.
Assessing permanent impairment
After MMR is identified and recorded, if there is a residual impairment, the WSIB arranges a NEL assessment, (see 18-05-03, Assessing Permanent Impairment).
Application date
This policy applies to all decisions made on or after January 1, 1998, for all accidents.
Document history
This document replaces 18-05-02 dated June 15, 1999.
This document was previously published as:
6.1 dated January 1, 1998.
| Soft Tissue Injuries | all soft tissue menisceal damage, knee herniated disc, conservative treatment | 3 months 3 months 3 months |
|---|---|---|
| Fractures | complex facial upper limb hand simple vertebral, body compression all levels spine, fractures or dislocations pelvis, no reduction pelvis, with reduction femur and hip tibia other lower limb and foot complex and/or complicated fractures major joints fractures or dislocations (including wrist and ankle) | 4 - 6 months 3 - 6 months 3 - 6 months 3 - 6 months 6 months 3 months 12 months 6 - 12 months 6 - 9 months 3 - 6 months 6 months
6 months |
| Infections | osteomyelitis | 4 - 8 months |
| Nervous system injuries | peripheral nerve minor head injuries brain, with persisting neurological deficit spinal cord and cauda equina injuries | 3 - 12 months 3 months 1 year 1 year |
| Shoulder | acromioplasty rotator cuff repair | 3 - 6 months 6 months |
| Knee | arthroscopy -diagnostic -operative -arthrotomy ligament repair |
1 week 6 weeks 3 month 3 - 6 months |
| Ankle | ligament repair | 3 - 6 months |
| Spine | herniated disc - operative spinal fusion -single level -multiple level spinal stenosis decompression -single level -multiple level | 3 months
3 months 6 months
3 months 6 months |
| Nervous system | major nerve repair minor nerve repair carpel tunnel or other nerve repair | 6 - 12 months 4 - 5 months 3 months |
| Tendon | flexor tendon repair or tendon transfer extensor tendon repair tendon release |
3 - 6 months 3 months 3 months |
| Amputation Reconstruction | ------------ digital re-implantation | 3 months 6 - 9 months |
References
Legislative authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 47, 102, 103
Minute
Administrative
#6, July 7, 2004, Page 391