COVID-19 continues to affect workers’ compensation cases worldwide. Hundreds of studies have been published on this disease, but one thing is clear: there’s still a lot we don’t know. This article helps workers’ comp professionals identify when a worker with COVID-19 can realistically be expected to reach maximum medical improvement (MMI).
What Is Maximum Medical Improvement?
Every jurisdiction defines maximum medical improvement differently. The American Medical Association’s Guide to the Evaluation of Permanent Impairment (6th Edition) offers a widely used standard. It defines MMI as the point where a patient has improved as much as medical and surgical treatment can achieve. In short: no further meaningful recovery is expected.
COVID-19 was first identified in December 2019 and became a global pandemic months later. Because the disease is still relatively new, researchers continue to discover new complications linked to it. Even so, several general conclusions can guide MMI decisions — while keeping in mind that every case is unique.
Common COVID-19 Complications to Watch For
Before determining MMI, you need to identify whether a worker’s symptoms are a direct result of COVID-19 infection. Medical literature reports many possible complications, including:
- Pulmonary issues — pneumonia, acute respiratory distress syndrome, pulmonary edema
- Kidney damage — acute kidney injury
- Cardiac problems — heart attack, congestive heart failure, conduction abnormalities, atrial fibrillation
- Neurological effects — stroke, “brain fog” (anoxia), seizure disorders
- Mental health conditions — PTSD, anxiety, depression
- Other possible effects — diabetes, liver injury (hepatic injury)
This list isn’t exhaustive. Research continues to uncover new complications. Before declaring MMI, each diagnosed complication must be clinically evaluated and confirmed as stable.
How to Determine If a Worker Has Reached MMI
Start by identifying the primary complications tied to the worker’s COVID-19 case. Then ask: has the worker’s clinical condition changed in recent progress notes?
If there’s been no meaningful change for 2–3 months, you can reasonably conclude the condition has plateaued. At that point, send a direct inquiry to the treating provider: “Has maximum medical improvement been reached?”
This doesn’t mean every symptom has fully resolved. It means no further significant functional improvement is expected, which is the standard for declaring MMI.
What the Research Says About COVID-19 Recovery Timelines
Much about COVID-19’s long-term effects remains uncertain, and a worker’s condition can still change. That said, current research points to some useful benchmarks:
- Most individuals reach MMI within 21 to 30 days from the onset of infection
- 65% of infected individuals report feeling “better” within 14–21 days of symptom onset
- Some studies report up to 90% of infected individuals recover within two weeks
- Between 18% and 81% of infected individuals remain asymptomatic, depending on the study
For asymptomatic or minimally symptomatic workers, MMI is typically reached by day 30, often sooner. If symptoms do not significantly develop, no further medical evaluation is usually needed, and MMI has already been reached.
Best Practices for Workers’ Comp Professionals
For workers who remain symptomatic, request clinical records after every evaluation. Watch for two signs:
- No substantial worsening of symptoms
- A stable clinical picture over roughly two months
Once both conditions are met, request a formal MMI determination from the treating provider.
A Note on Long COVID
Workers with “long-haulers” syndrome (also called post-COVID syndrome) need more frequent, thorough clinical assessment. Because their recovery timeline is less predictable, identifying the earliest realistic date of MMI requires ongoing evaluation rather than a fixed timeline.
