Q: How does "statutory MMI" date get determined?
DOI 3/19/18; pt seen x 2 at different UC clinic. Seen at our facility starting 4/24/18. Released RTW on 7/30/18. Letter from ins on 7/31 requests DD to do MMI/IR - all appropriate, I believe. However, form DWC-032 lists statutory MMI date as 3/24/18, 5 days after DOI. I thought it was 104 weeks... We had not even seen pt by that date, and his ins and employer approved the visits. Will this affect our reimbursement/his claim? Form states date for MMI cannot be later than statutory date?
A:
You ask a good question where the answer can be confusing. To understand the answer you need to know the date when income benefits "begin to accrue". The MMI date IS 104 weeks after "income benefits accrue".
The MMI date is the earlier of:
(A) the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated;
(B) the expiration of 104 weeks from the date on which income benefits begin to accrue; or
(C) the date determined as provided by Section 408.104 (relating to extension of the 104 weeks due to spinal surgery). Section 401.011(30); Section 130.1(b)(1).
The accrual date for income benefits is the date the IW is first entitled to receive payment of income benefits.
Income benefits do not begin to accrue until the eighth day of disability. Section 124.7(b) ; APD 032435. [Cross-reference: Existence/Duration of Disability Raised by Other Evidence (I03) ]. For dates of injury occurring before September 1, 2005, if the disability continues for four weeks or longer from the date the disability began, the income benefits shall be computed from the date disability began. For dates of injury occurring on or after September 1, 2005, if the disability continues for two weeks or longer after the date the disability begins, the income benefits shall be computed from the date the disability begins. Section 408.082(c) .
So if the worker does not have disability until 5 days after the DOI the SMMI date is 104 weeks plus 5 days.
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