• I want to consult about a traffic accident in the Yaizu, Yoshida, Makinohara, Fujieda, and Omaezaki area
• The insurance company told me it is "about time for MMI" and I am not sure what to do
• I want to know what happens to medical expenses and solatium once MMI is declared
• I want to know what to do if pain remains after MMI
• I want to consult a lawyer about whether to apply for a residual disability rating

Are you troubled by issues like these in Yaizu, Makinohara, Omaezaki, Fujieda, Shimada, Yoshida Town, or surrounding areas?
Yaizu Sogo Law Office offers a free initial legal consultation regarding traffic accident concerns. There is no obligation to retain our services after the initial consultation. We are also available on weekday evenings and Saturdays. Please feel free to contact us by phone or email.

What Is Maximum Medical Improvement (MMI)?

If you are injured in a traffic accident, you will first receive treatment at a hospital or orthopedic clinic.

Treatment often improves symptoms such as pain and numbness, but in some cases symptoms remain even after a certain period of treatment.

The condition in which no significant further improvement can be expected despite generally accepted medical treatment is called "Maximum Medical Improvement" (MMI).

In simple terms, MMI does not mean that the injury has completely healed.

It means "a condition in which significant further improvement is unlikely even with continued treatment."

Therefore, pain and numbness may still be present at the time of MMI.

Rather, the question becomes whether the symptoms remaining after MMI will be evaluated as a residual disability.

Who Determines MMI?

Regarding the determination of MMI, the insurance company may tell you, "It is about time for MMI" or "We will end payment of medical expenses at the end of this month."

However, MMI is inherently a determination that involves medical judgment.

Therefore, the most important factor in determining the timing of MMI is the opinion of the attending physician.

Just because the insurance company says it will end medical expense coverage does not automatically mean that the date becomes the MMI date.

Of course, if the matter ultimately goes to court, the court will determine the timing of MMI.

However, even in that case, the physician's medical certificates, medical records, treatment history, and test results serve as important evidence.

Therefore, even if the insurance company requests MMI, it is important to first confirm your current symptoms and future treatment prospects with your attending physician.

What Changes Once MMI Is Declared?

MMI is a very important milestone in traffic accident damage compensation.

This is because the types of damages that can be claimed differ before and after MMI.

Before MMI, the following types of damages are typically at issue:

• Medical expenses
• Transportation costs for hospital visits
• Lost income
• Solatium for hospitalization and outpatient treatment

On the other hand, if symptoms remain after MMI, the following damages related to residual disability become relevant:

• Solatium for residual disability
• Lost future earnings due to residual disability

In other words, MMI marks "the point at which the treatment phase transitions to the phase of assessing the presence of residual disability."

What Happens to Medical Expenses After MMI?

After MMI, it generally becomes difficult to claim medical expenses from the at-fault party.

This is because treatment after MMI is often regarded not as treatment aimed at improving symptoms, but as treatment aimed at maintaining or alleviating symptoms.

Therefore, outpatient expenses and medical expenses after MMI are less likely to be recognized as damages caused by the traffic accident.

In practice, medical expenses after MMI are prone to disputes, so the timing of MMI must be carefully determined.

Insurance Company's Termination of Medical Expense Coverage and MMI Are Not the Same

A common consultation regarding traffic accidents is: "The insurance company told me they will cut off my medical expenses. Does that mean I have reached MMI?"

What should be noted here is that the insurance company's termination of lump-sum medical expense coverage and medical MMI are not the same thing.

Insurance companies may attempt to end medical expense payments after a certain period has passed since the accident. In particular, for whiplash injuries, the topic of cutting off medical expenses may arise around 3 or 6 months after the accident.

However, just because the insurance company has cut off medical expenses does not necessarily mean that there is no longer a need for treatment. If pain still remains and the attending physician determines that continued treatment is necessary, it is possible to continue outpatient treatment using public health insurance and later claim the necessary and reasonable medical expenses.

If the insurance company tells you it will cut off medical expenses, rather than simply stopping your outpatient visits, it is important to consult with your attending physician and a lawyer to consider your future course of action.

Reasons You Should Not Settle Before MMI

In traffic accidents, the insurance company may request a settlement while treatment is still ongoing. However, settling before MMI is generally not recommended.

Before MMI, the treatment course has not yet been finalized.

Therefore,

• The final treatment period
• Outpatient treatment solatium
• Lost income
• Whether a residual disability will remain
• Whether a residual disability grade will be certified

have not yet been determined.

If you settle at this stage, even if pain or numbness remains later, it may become difficult to make additional claims for residual disability solatium or lost future earnings.

Once you sign a settlement agreement, it generally cannot be redone. Therefore, a traffic accident settlement should, in principle, be made after treatment ends or after MMI.

If symptoms remain, it is important to consider whether a residual disability application is necessary before proceeding to settlement negotiations.

Considering a Residual Disability Application After MMI

If pain, numbness, restricted range of motion, deformity, or neurological symptoms remain at the time of MMI, you should consider applying for a residual disability grade certification.

If a residual disability grade is certified,

• Solatium for residual disability
• Lost future earnings due to residual disability

may be claimed.

For example, if Grade 14-9 is certified for whiplash, the residual disability solatium is approximately 1.1 million yen under the attorney standard.

If Grade 12-13 is certified, the residual disability solatium is approximately 2.9 million yen.

As such, the final compensation amount varies significantly depending on whether a residual disability grade is certified. You should avoid settling without applying for a residual disability rating when symptoms remain after MMI.

The Residual Disability Medical Certificate Is Important

When applying for a residual disability rating, you will have your attending physician prepare a Residual Disability Medical Certificate.

The Residual Disability Medical Certificate is an extremely important document in the residual disability grade certification process.

The medical certificate includes:

• Name of injury/illness
• Subjective symptoms
• Objective findings
• Test results
• Range of motion restrictions
• Neurological findings
• Future prognosis

and other information.

Even if symptoms actually remain, if the Residual Disability Medical Certificate is insufficiently documented, the appropriate grade may not be certified.

Therefore, when having the Residual Disability Medical Certificate prepared, it is important to accurately communicate your remaining symptoms to the physician.

Additionally, it may be necessary to review test results such as MRI, CT, and neurological examinations as needed.

Premature MMI Can Be Disadvantageous

If MMI is declared too early, it can be disadvantageous to the victim.

After MMI, the period for calculating medical expenses and outpatient treatment solatium generally ends.

Therefore, if MMI is declared too early when treatment should have continued,

• Medical expenses may not be fully covered
• Outpatient treatment solatium may be reduced
• It may be disadvantageous in residual disability certification

such problems may arise.

In particular, for neurological symptoms such as whiplash, the treatment period and consistency of symptoms are important in residual disability certification.

If symptoms are still severe and there is room for improvement through treatment, MMI should not be declared hastily.

If the insurance company requests early MMI, it is recommended that you confirm your attending physician's opinion and consult a lawyer as needed.

Problems When MMI Is Delayed Too Long

On the other hand, it is not the case that delaying MMI beyond what is necessary is always better.

If you continue outpatient visits aimlessly despite there being little need for treatment, the insurance company may argue that "medical expenses after that point are unrelated to the accident" or "those visits do not qualify for outpatient treatment solatium."

Additionally, if the case goes to court, the MMI date may be determined to be later than the date claimed by the insurance company or earlier than the date claimed by the victim, based on the actual treatment course and the physician's judgment.

Whether MMI is too early or too late, problems can arise.

What is important is to consider a timing that is reasonable both medically and legally, taking into account the course of symptoms, treatment details, and the physician's opinion.

If Pain Persists After MMI

If pain or numbness persists after MMI, there are broadly two courses of action to consider:

The first is to apply for residual disability grade certification.

If there is a possibility that the symptoms may be evaluated as a residual disability, you should have a Residual Disability Medical Certificate prepared and apply to the compulsory automobile liability insurance (CALI).

The second is to continue treatment at your own expense or using public health insurance as needed.

Even after MMI, some people continue outpatient visits to alleviate pain or maintain their daily life.

However, whether such medical expenses can be claimed from the at-fault party is a separate issue.

When applying for a residual disability rating, the outpatient situation and changes in symptoms after MMI may also be relevant, so it is important to respond in consultation with your physician.

What to Check When Told You Have Reached MMI

If the insurance company or your physician raises the topic of MMI, you should check the following points:

• Whether pain, numbness, or other symptoms still remain
• Whether symptoms are still improving with treatment
• Whether the attending physician has determined that MMI has been reached
• Whether further treatment is still necessary
• Whether necessary tests such as MRI and CT have been conducted
• Whether a Residual Disability Medical Certificate needs to be prepared
• Whether a residual disability application should be filed
• Whether it is the right stage to begin settlement negotiations

MMI is an important turning point in traffic accident compensation procedures.

If you follow the insurance company's explanation without fully understanding, you may end up settling without claiming the damages you are entitled to.

Summary

Maximum Medical Improvement (MMI) refers to a condition in which no significant further improvement can be expected even with continued treatment.

MMI does not mean that the injury has completely healed. Whether the symptoms remaining after MMI will be evaluated as a residual disability is the key issue.

Additionally, once MMI is declared, the period for calculating medical expenses and outpatient treatment solatium generally ends, and the matter shifts to issues of residual disability solatium and lost future earnings.

Even if the insurance company requests termination of medical expense coverage or declares MMI, you should not immediately stop outpatient visits or settle.

It is important to confirm the opinion of your attending physician and, if symptoms remain, consider applying for a residual disability rating.

If you have concerns about MMI or termination of medical expense coverage after a traffic accident, we recommend consulting a lawyer before settling.

Frequently Asked Questions

The Initial Legal Consultation for Traffic Accidents at Yaizu Sogo Law Office Is Free of Charge

Yaizu Sogo Law Office provides a free initial legal consultation regarding traffic accidents.

We handle all traffic accident-related legal matters, regardless of severity or whether they involve property damage or personal injury. If you are feeling stressed by dealings with insurance companies, or if you want to know whether the amount offered by your insurance company is fair, please do not hesitate to consult with us.

Yaizu Sogo Law Office is available not only during regular weekday hours but also on weekday evenings and Saturdays. Please contact us by phone or email to schedule a legal consultation.

Are You Troubled by a Traffic Accident?

• Settlement Offers from Insurance Companies Are Almost Always Low
• The Insurance Company Said They Would Cut Off My Medical Expenses
• Dissatisfied with the Fault Ratio
• When and How to Consult a Lawyer About a Traffic Accident
• What Claims Can Be Made in a Personal Injury Accident?
• What Claims Can Be Made in a Property Damage Accident?
• What You Need to Know About Whiplash
• Traffic Accidents and Health Insurance
• Procedures and Steps to Follow After a Traffic Accident
• Fault Proportions Between a Through-Going Vehicle and a Right-Turning Vehicle at an Intersection
• Diminished Value (Loss of Market Value)
• Amount Claimable from the Other Party When Personal Injury Protection Insurance Was Used Prior to the Claim for Damages Against the Other Party
• Free legal consultation is available for traffic accidents
• Filing a Victim's Claim with Compulsory Automobile Liability Insurance (CALI)
• Lost Wages for Salaried Employees (Wage Earners) in Traffic Accidents
• Understanding a Company's Losses When Employees Are Killed or Injured in a Traffic Accident
• Finding the Court with Jurisdiction over Traffic Accident Lawsuits
• Want to Know Whether You Can Offset the Other Party's Damages Against Your Own in the Same Traffic Accident
• The at-fault party refuses to use their voluntary automobile insurance. What should I do?
• I was seriously injured in a traffic accident in June 2017, before the enforcement of the amended Civil Code (April 1, 2020). Three years have passed (but less than five years) since I completed my treatment. Is the statute of limitations still valid?
• How to Identify a Hit-and-Run Driver from a Vehicle License Plate Number
• Methods of Dispute Resolution in Traffic Accidents
• What You Need to Know About Medical Commuting Transportation Expenses
• How to Find the Insurance Company of the At-Fault Driver in a Traffic Accident
• Understanding Workers' Compensation Insurance in Traffic Accidents (Leave Compensation)
• How Much Is the Standard Compensation for a Traffic Accident?
• What Is Residual Disability Grade Certification in Traffic Accidents?
• How Much Compensation Can You Get for Whiplash from a Traffic Accident?
• Benefits of Hiring a Lawyer for Traffic Accidents
• Key Points When Dealing with Insurance Companies After a Traffic Accident
• How to Calculate Lost Income from a Traffic Accident
• The Relationship Between Number of Hospital Visits and Compensation for Pain and Suffering in Traffic Accidents (Key Considerations When Visit Frequency Is Low)
• What Is Maximum Medical Improvement (MMI) After a Traffic Accident?
• How to Use Lawyer Fee Special Coverage for Traffic Accidents?
• How to Handle a Traffic Accident When the At-Fault Driver Has No Insurance
• Damages in Bicycle Accidents
• Claiming Compensation When a Passenger Is Injured in a Traffic Accident
• Do You Have to Pay a Traffic Fine for a Burned-Out Brake Light?
• "I Said I Would Pay the Full Repair Cost" in a Bicycle Accident
• If Repair Costs Exceed Your Car's Market Value After a Traffic Accident, Can You Still Recover the Full Amount?
• Can a Car Proceed if a Pedestrian Yields at a Crosswalk?
• What Are "Replacement Incidental Costs" When a Vehicle Is Totaled in a Traffic Accident?
• What Damages Can Be Claimed When a Family Member Dies in a Traffic Accident?

See all articles on traffic accidents