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Compensation Claims: Maximum Medical Improvement

Compensation Claims: Maximum Medical Improvement

Article by Personal Injury Lawyer, Tyla Leo.

July, 2023

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Tyla Leo is a Litigation Lawyer and Senior Associate at O’SheaDyer Solicitors Townsville. Tyla practices exclusively in Injury Claims, acting for Plaintiffs.

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I have a Compensation Claim, and my lawyer is talking about Maximum Medical Improvement. What does this mean?

If you have a Compensation Claim, it is necessary for your injuries to stabilise in order for your claim to be quantified. When your injuries are stable, your lawyer can then work out what your damages/compensation should be.

All injuries are different and unique. Some injuries will resolve in a matter of days or weeks. Some will resolve in a couple of months and others can lead to long-term or permanent issues.

When you make a Compensation (Personal Injuries) claim, you may hear the term Maximum Medical Improvement. The term is quite confusing and takes a bit of explanation.

First things first – Maximum Medical Improvement does NOT mean that your injuries have resolved or that you are no longer experiencing symptoms.


What does Maximum Medical Improvement mean?

In simple terms, Maximum Medical Improvement is the point at which your injuries have stabilised and are as good as they will ever be, based on the medical evidence. For some people, this will mean that they have made a full recovery. For others, this may mean they have a more permanent and ongoing disability.

When your injuries have reached Maximum Medical Improvement, your treating doctors expect your condition is not likely to improve further. It will in some cases be the point at which your treating medical team will advise you that no further treatment will result in your medical symptoms improving.

At this point, your injuries are classified as being ‘stable and stationary,' which is another, similar term we often hear during the claim process.


Why is Maximum Medical Improvement Important to a Compensation Claim?

Medicolegal evidence is an essential element of a personal injuries/compensation claim.

It is important to wait until your injuries reach maximum medical improvement before having them assessed by a specialist for a medicolegal report.

We do not want to waste time or money having to send you back to the specialist because your injuries are not stable and stationary.

If your injuries are assessed too soon after an accident, it is likely that you and your treating doctors (or team of medical professionals) will not know the full extent of the injuries and how they may impact you in the future.


How long does it usually take for injuries to reach Maximum Medical Improvement?

As a general rule, your injuries will take around 9-12 months following an accident to reach Maximum Medical Improvement. During this time, you will have been receiving treatment and taking medication, and some clients may have even attempted to return to work. Sometimes you may also require additional surgery and it may take 2-3 months to recover from this surgery.

The medical expert examining your injuries must take into account the impact your injuries will have on you in the future. If you are assessed too soon following an accident, it may give a false reading on how your injuries will impact you in the long term. You may also be denying yourself the opportunity to access all available treatment prior to your injuries being assessed.

Once your injury is determined to be at Maximum Medical Improvement by a medical expert, you will be assessed for a percentage impairment in accordance with the AMA (American Medical Association) Guides/Tables. 


How long will my Claim take? How will Maximum Medical Improvement affect the length of my Claim?

This is a simple question but there is no simple answer to this.

What I can say is, you need to have a lawyer who plans ahead and continues to place pressure on the insurer to progress your claim. Once your injuries have stabilised and you have reached Maximum Medical Improvement, reports need to be obtained immediately so that your claim can be progressed to a Compulsory Conference.

Insurance companies, particularly in relation to motor vehicle claims, are in no hurry to finalise claims. Your lawyer needs to pressure them into also obtaining their own reports and if necessary, should be taking Applications in the Court to force the timely progress of your claim.

Relevant legislation requires claims to be progressed as quickly as possible to Compulsory Settlement Conferences.

If your claim cannot be resolved at a Compulsory Conference, it can then be commenced in the Court. Court rules require the matter to be progressed quickly, with a further conference (usually a Mediation Conference) scheduled prior to a Court Hearing.

Once your injuries have stabilised after an accident or after surgery, if your lawyers have been proactive, a Compulsory Conference should take place within 2-3 months. If your claim does not settle at or soon after this conference, it can be filed in the Court. The Court rules will then apply and your claim should proceed to a Mediation Conference, and if necessary, a Court Hearing within a further 6-9 months.

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O'Shea Dyer Compensation Team

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