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If you’re in the middle of a long-term disability (LTD) claim, you may come across the term MMI, or Maximum Medical Improvement. It’s a medical milestone, but it can also have major implications for your benefits. While that may sound like closure, in the world of disability insurance, it often marks a shift in how your claim is evaluated.
What Is Maximum Medical Improvement?
Maximum Medical Improvement is the point where your doctors determine you’ve recovered as much as you’re likely to, even with continued care. It means your condition is considered “medically stable.” But this doesn’t mean you’re symptom-free or able to return to work. Many people reach MMI while still dealing with pain, fatigue, or permanent limitations.
MMI helps clarify your long-term medical outlook. It gives insurers and doctors a better idea of how your condition will affect you over time. It also signals to the insurance company that your treatment phase is mostly complete.
Why Ongoing Treatment Is So Important—Even Before MMI
Before you reach MMI, it’s important to stay engaged in active medical treatment. Consistent care does two things:
- Supports your recovery.
- Builds a strong medical record to support your disability claim.
Disability insurers want to see that you’re doing everything you can to get better. If you stop treatment too early or skip appointments, they might use that as a reason to question your claim—or even deny benefits altogether.
Regular treatment helps document your symptoms, limitations, and response to care over time. This information shows that your disability is real, ongoing, and supported by medical evidence.
How MMI Affects an LTD Claim
Once you’ve reached MMI, the insurance company may shift how they evaluate your claim. Here’s how:
1. It Defines Your Long-Term Limitations
After MMI, your doctor can more accurately outline your permanent restrictions. This includes your ability to sit, stand, lift, or concentrate. These limitations help the insurance company decide whether you’re still eligible for benefits under your policy’s definition of disability.
2. It May Trigger a Closer Review
Many LTD policies change after 24 months. Initially, you may only need to prove you can’t do your own occupation. But after two years, you often have to show you can’t perform any occupation.
If you’ve recently reached MMI, insurers may take that as a cue to reassess your case. They might conduct a vocational review or arrange an independent medical exam (IME) to determine whether you could work in a different capacity.
RELATED POST: Own Occupation vs. Any Occupation
3. It Can Affect the Future of Your Claim
MMI doesn’t automatically mean your benefits will stop—but it often leads to increased scrutiny. The insurance company may decide that you’re no longer “actively” treating your condition, even if you still need ongoing maintenance care, medications, or specialist follow-ups.
That’s why it’s important to continue appropriate treatment, even after MMI. It shows that your condition still requires medical attention and reinforces the legitimacy of your ongoing disability.
What If You Haven’t Reached MMI Yet?
If you’re still undergoing treatment, that’s not a bad thing—in fact, it can help strengthen your LTD claim. You’re showing that you’re doing everything possible to improve your condition and return to work, if feasible.
During this time, it’s especially important to:
- Attend all scheduled appointments
- Follow your doctor’s recommendations
- Keep detailed records of your symptoms and limitations
Your medical records during the active treatment phase carry significant weight in LTD evaluations.
Protecting Your Claim as You Approach MMI
- Ask your doctor to clearly document your functional limitations, especially if they’re likely to be permanent.
- Continue receiving appropriate, ongoing care, even if it’s only for symptom management.
- Monitor how the insurance company communicates with you around the time of MMI—this is often when reviews or denials occur.
- Don’t ignore red flags like requests for an independent medical exam or vocational assessment.
Need Help Appealing Your LTD Claim Denial?
Reaching MMI can be a pivotal moment in a long-term disability case—but it doesn’t mean your need for support is over. If your insurance company cuts off your benefits, the Ortiz Law Firm can help.
We represent claimants nationwide and will fight to recover the benefits they deserve. Call (888) 321-8131 for a free case evaluation to review your situation and discuss your options.
