Which States Allow Telemedicine for MMI Determinations?

                               

Around the States

Since the COVID-19 pandemic, telemedicine has become a regular option for employers, workers, and insurers navigating the contours of a workers' compensation claim, including maximum medical improvement (or other similar state-specific terminology) determinations.

With some help from Simply Research, we took a look at what the states have to say about MMI and telemedicine.

Alabama

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes. Per the State of Alabama telemedicine is covered if approved by the payer.

Alaska

MMI Rule: "Medical stability" means the date after which further objectively measurable improvement from the effects of the compensable injury is not reasonably expected to result from additional medical care or treatment, notwithstanding the possible need for additional medical care or the possibility of improvement or deterioration resulting from the passage of time. Medical stability will be presumed in the absence of objectively measurable improvement for a period of 45 days. This presumption may be rebutted by clear and convincing evidence.

Telemedicine: Yes. Telehealth in Alaska, HB 265, was signed into law on July 13, 2022. This bill allows for telehealth practices by licensed medical practitioners in the state of Alaska. This will include medical practice covered under workers' compensation. A health care provider licensed in this state may provide health care services within the health care provider's authorized scope of practice to a patient in this state through telehealth without first conducting an in person visit.

Arizona

MMI Rule: Arizona refers to Maximum Medical Improvement (MMI) as medically stationary. This means that nothing further can be medically done to improve the employee's condition and their medical condition is not expected to deteriorate.

Telemedicine: Yes. "Telehealth" includes the use of an audio-only telephone encounter between the patient or client and health care provider if an audio-visual telehealth encounter is not reasonably available due to the patient's functional status, the patient's lack of technology, or telecommunications infrastructure limits as determined by the health care provider.

Arkansas

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: No. Arkansas does not permit telemedicine for workers' compensation purposes.

California

MMI Rule: Permanent and stationary" means the point in time when the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment, based on (1) an opinion from a treating physician, AME, or QME; (2) a judicial finding by a Workers' Compensation Administrative Law Judge, the Workers' Compensation Appeals Board, or a court; or (3) a stipulation that is approved by a Workers' Compensation Administrative Law Judge or the Workers' Compensation Appeals Board.

Telemedicine: Yes. Telehealth is covered under the medical fee schedule for services on or after March 1, 2017.

Colorado

MMI Rule: "Maximum medical improvement" means a point in time when any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonably expected to improve the condition. The requirement for future medical maintenance which will not significantly improve the condition or the possibility of improvement
or deterioration resulting from the passage of time will not affect a finding of maximum medical improvement. The possibility of improvement or deterioration resulting from the passage of time alone will not affect a finding of maximum medical improvement.

Telemedicine: Yes. All treatment provided through telemedicine will comply with the applicable requirements found in the Colorado Medical Practice Act and Colorado Mental Health Practice Act, as well as the rules and policies adopted by the Colorado Medical Board and the Colorado Board of Psychologist Examiners, and will follow applicable laws, rules, and regulations for informed consent.

Connecticut

MMI Rule: Maximum medical improvement has been reached when a physician determines that the patient is healed to the fullest extent expected. At this time the physician determines whether there is any permanent impairment to any body part or if there is a loss of use of the injured organ or body part. The physician will then give a permanent rating expressed as a percentage.

Telemedicine: Yes, but limited. Connecticut allows telemedicine/telehealth in cases of mental health treatment, where the injured employee is unable to
leave their house.

Delaware

MMI Rule: Maximum medical improvement has been reached when a physician determines that the patient is healed to the fullest extent expected. At this time the physician determines whether there is any permanent impairment to any body part or if there is a loss of use of the injured organ or body part. The physician will then give a permanent rating expressed as a percentage.

Telemedicine: Yes. Delaware allows for telemedicine in MMI determinations if an in-person visit cannot be conducted.

D.C.

MMI Rule: MMI refers to the point in a worker's recovery when their medical condition has stabilized. At this stage, no significant improvement is expected even with more treatment. It’s important to note that reaching MMI doesn’t mean the worker is fully healed; it simply means they have reached the best
possible health status given their injury.

Telemedicine: Telemedicine services are available under specific conditions for employees with work-related injuries.

Florida

MMI Rule: Maximum Medical Improvement (MMI) is defined by statute Sec. 440.02(12), which states that the "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes, if the carrier okays. Telemedicine services require authorization by the carrier. Telemedicine visits are reimbursed the same as face-to face visit. The exceptions to carrier authorization for telemedicine are: Emergency services and care and initial evaluation, diagnosis, and treatment by a treating provider at the time of an acute injury when initiated by the employer or the employer’s designee to determine appropriate care.

Georgia

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes. Georgia insurers may not require an in-person consultation or contact before a patient may receive telemedicine services from a health care
provider, except for the purposes of initial installation, setup, or delivery of in-home telehealth devices or services, or as otherwise required by state or federal law, rule, or regulation.

Hawaii

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated based upon reasonable medical probability.

Telemedicine: Yes, if the treating physician determines that a physical exam is unnecessary to set MMI.

Idaho

MMI Rule: Idaho uses the term "stable and nonprogressive."

Telemedicine: Yes. To the extent CMS and/or the AMA have coding guidelines addressing telehealth services, Idaho's fee schedule follows suit.

Indiana

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Likely. There appear to be no apparent restrictions on using telemedicine to determine MMI in Indiana.

Illinois

MMI Rule: MMI is the point in a workers' compensation claim when an injured worker’s condition has stabilized, and no further significant improvement is expected from treatment. It signifies the end of temporary benefits and enables doctors to determine permanent impairment ratings for settlements. 

Telemedicine: Illinois permits the use of telemedicine in workers' compensation, including for follow-up care and, under specific circumstances, assessments that may lead to Maximum Medical Improvement (MMI) determinations. While routine, non-exam-dependent check-ins are common, in-person examinations are still generally preferred for definitive MMI determinations, as tele-evaluations can be challenged.

Iowa

MMI rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Likely. There appear to be no apparent restrictions on using telemedicine to determine MMI in Iowa.

Kansas

MMI Rule: In Kansas, MMI is the point where a doctor determines an injured worker’s condition has stabilized and will not improve further with more treatment.

Telemedicine: Per Kansas Division of Workers Compensation, there are no statutory provisions that address telemedicine.

Kentucky

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes. In Kentcuky, an injured worker shall have the right to decline to participate in telehealth and telephysical therapy.

Louisiana

MMI Rule: Maximum medical improvement (MMI) is declared when a patient’s condition has plateaued, and the authorized treating physician believes no further medical intervention is likely to result in improved function. A physician
must describe in detail any applicable post-MMI maintenance care or treatment anticipated when MMI is declared.

Telemedicine: Yes. Since the COVID-19 pandemic, Louisiana has permitted use of telemedicine visits as an alternative to in-person care.

Maine

MMI Rule: "Maximum medical improvement" is statutorily defined as the date after which further recovery and further restoration of function can no longer be reasonably anticipated based upon reasonable medical probability. It marks the end of anticipated healing or recovery from the industrial injury in question.

Telemedicine: Yes. Telemedicine is a recognized and accepted modality of care for workers' compensation injuries or conditions. The Maine Workers' Compensation Board circulated guidance as follows.

There are no “non-covered codes." Health care providers may bill for any goods or services with a valid procedure code. Valid codes for professional services that are not in Appendix II are paid at the provider’s usual and customary charge pursuant to Chapter 5, 1.07 and 3.8. Telemedicine or virtual health services must be reimbursed or paid so long as it has a valid code and is confirmed to have been medically necessary, appropriate, and causally related to the industrial injury.

Massachusetts

MMI Rule: In Massachusetts, MMI is the point when an injured worker’s condition has stabilized, and no further significant functional improvement is expected, even with continued treatment.

Telemedicine: Yes. All medical care that is “reasonable and necessary” and is directly related to the treatment of a work-related injury shall be paid by the insurer. If a telemedicine session is necessary for a health professional to evaluate or
follow-up with an injured worker, that would likely meet the standard of reasonable and necessary.

Maryland

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Likely. It does not appear that Maryland restricts MMI evaluations to in-person only settings.

Michigan

MMI Rule: Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes. Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine, the health care professional must be able to examine the patient via a real-time, interactive audio and video telecommunications system, and the patient must be able to interact with the off-site health care professional at the time the services are provided.

Minnesota

MMI Rule: Maximum medical improvement (MMI) is defined in Minnesota Statutes 176.011 Subd. 13a. It is the date after which no further significant recovery from or lasting improvement to a personal injury can be reasonably anticipated, based upon reasonable medical probability, irrespective and regardless of subjective complaints of pain.

Telemedicine: Yes. Minnesota workers’ compensation allows telemedicine/health services.

Mississippi

MMI Rule: MMI in Mississippi is the point when a treating physician determines an injured worker's condition has stabilized and will not improve further with additional treatment.

Telemedicine: The practice of Telemedicine is currently covered in the Mississippi Workers’ Compensation Commission but is limited to only physicians holding a valid Mississippi license.

Missouri

MMI Rule: "Maximum medical improvement" means the point at which the injured employee's medical condition has stabilized and can no longer reasonably improve with additional medical care, as determined within a reasonable degree of medical certainty.

Telemedicine: Yes. In Missouri, workers' compensation covers telemedicine if the employer-selected physician or facility offers it, as the employer/insurer controls medical provider choice. Telehealth can be used for consultations and follow-ups, with MO HealthNet covering it for authorized providers. For Maximum Medical Improvement (MMI) assessments, in-person visits are generally preferred due to the need for a physical examination.

Montana

MMI Rule: Medical stability," "maximum medical improvement," "maximum healing," or "maximum medical healing" means a point in the
healing process when further material functional improvement would not be reasonably expected from primary medical services.

Telemedicine: Likely. Although Telemedicine is not addressed in Montana’s Workers’ Compensation statute, Telemedicine consultations from the treating physician for the injured worker are allowed. It is important to note that the treating physician in Montana must be licensed to practice in Montana.

Nebraska

MMI Rule: MMI is the point where no medical professional has any additional treatment plan, therapy, surgery, or diagnostic test that is likely to produce any change in the workers' injury. At that point, the injury has become stable and because there is no additional treatment planned, it is unlikely that it will improve.

Telemedicine: Yes. Any insurer offering the below must provide a description of the telehealth or telemonitoring services covered under the relevant policy, certificate, contract, or plan.

Nevada

MMI Rule: When the treating physician or chiropractor feels the injured worker has reached maximum medical improvement, the term “stable” should be used. If the treating physician or chiropractor deems the injured worker may have suffered a permanent impairment, the term “ratable” should also be used.

Telemedicine: Yes. Telemedicine can be used to determine Maximum Medical Improvement (MMI) in Nevada workers' compensation cases, provided the evaluation is clinically appropriate, complies with state regulations, and is agreed upon by involved parties. While ideal for follow-ups and minor injuries, virtual MMI determinations must meet standards for medical-legal evaluations. Reimbursement for medical facilities billing an originating site fee for telemedicine services will include all general supplies, technical services, professional services and costs for the telemedicine transmission. Diagnostic or other procedures performed in conjunction with a telemedicine visit are separately reimbursable if prior authorized.

New Hampshire

MMI Rule: Maximum medical improvement (MMI) is reached when an injured worker reaches a position after which further recovery from--or lasting improvement to--an industrial injury or illness can no longer be reasonably anticipated based upon reasonable medical probability. This generally marks the end of active medical care or treatment.

Telemedicine: Yes. Telemedicine can be used to determine Maximum Medical Improvement (MMI) in New Hampshire workers' compensation cases, provided the virtual examination allows the physician to adequately assess the patient's condition.

New Jersey

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes, but N.J. law requires physicians to meet the standard of care, which may necessitate in-person exams to establish permanent disability.

New Mexico

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from or lasting improvement to an injury can no longer be reasonably anticipated based upon reasonable medical probability as determined by a health care provider.

Telemedicine: Yes. Telemedicine can be used to determine Maximum Medical Improvement (MMI) in New Mexico workers' compensation cases, provided the evaluation is consistent with ethical medical practice and, if required, agreed upon by stakeholders. Virtual, real-time audio/visual, and secure, interactive systems are required for such evaluations in New Mexico.

New York

MMI Rule: Maximum medical improvement (MMI) means a medical judgment that --

(1) a claimant has recovered from the work injury to the greatest extent that is expected and

(2) no further improvement in his or her condition is reasonably expected.
The need for palliative or symptomatic treatment does not preclude a finding of MMI.

In cases that do not involve surgery or fractures, MMI cannot be determined prior to six months from the date of injury or disablement, unless agreed to by the parties.

A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant.

Telemedicine: Yes. Telehealth will mean treatment by physicians, podiatrists, psychologists, nurse practitioners, physician assistants, and licensed clinical social workers authorized by the Chair to provide treatment and care under the Workers’ Compensation Law (hereinafter “Authorized Medical Provider”) using two-way audio and visual electronic communication, or audio only.

(1) When rendering medical treatment or care via telehealth, an Authorized Medical Provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the Authorized Medical Provider must be able to meet the claimant at the Authorized Medical Provider’s office within a reasonable travel time and distance from the claimant’s residence.

(2) Telehealth must be used in accordance with any applicable New York State Medical Treatment Guideline. Treatment by Board-authorized physicians, podiatrists, nurse practitioners, and physician assistants under the Official New York Workers’ Compensation Medical Fee Schedule or the Official New
York Workers’ Compensation Podiatry Fee Schedule may be rendered by telehealth following an initial in-person clinical encounter when medically appropriate and subject to the following restrictions:

(i) Acute and Subacute phases of injury or illness. Within the first three months following the date of injury or illness, use of telehealth shall be at the clinical discretion of the treating physician, podiatrist, nurse practitioner, or physician assistant except that at least every third clinical encounter must be an in-person assessment by the treating physician, podiatrist, nurse practitioner, or physician assistant.

(ii) Chronic phase of injury or illness. When more than three months has passed from the date of injury or illness, use of telehealth shall be at the clinical discretion of the treating physician, podiatrist, nurse practitioner, or physician assistant, except that there must be an in-person assessment by the treating physician, podiatrist, nurse practitioner, or physician assistant, no less than every three months unless or until such provider has determined the patient has reached Maximum Medical Improvement (MMI) and has stated that the impairment or disability status is permanent and unlikely to change.

(iii) Injury or illness at MMI. When the claimant is in the chronic phase of injury or illness as defined in subparagraph (ii) of this paragraph and the treating physician, podiatrist, nurse practitioner, or physician assistant’s opinion is that the claimant has reached MMI and the patient’s impairment or disability status is permanent and unlikely to change, use of telehealth shall be at the discretion of the treating physician, podiatrist, nurse practitioner, or physician assistant, except that there must be an in-person assessment by such provider at least annually.

North Carolina

MMI Rule: The injured worker has reached the end of their healing period and no further significant physical improvement is expected. At this point, temporary benefits often stop, and a permanent disability rating may be assessed, triggering potential settlement discussions or a return to work.

Telemedicine: No rules prevent the use of telehealth related to workers' compensation. valuation and management visits conducted via telehealth can be billed using the same Evaluation & Management codes that are used for an in-person office visit, except that “02” should be used as the “Place of
Service” code. For any services with CPT codes that do not have a specific fee schedule amount, the charges would be paid per agreement between the carrier and medical provider. If a carrier or third party administrator refuse to authorize a telehealth visit, the injured employee may file a medical motion with the Commission asking the Commission to order the carrier or third party administrator to authorize and pay for the telehealth visit.

North Dakota

"Maximum medical improvement" means the injured employee's recovery has progressed to the point where substantial further improvement is unlikely, based on reasonable medical probability and clinical findings indicate the medical condition is stable. "Date of maximum medical improvement" or "date of maximum medical recovery" means the date after which further recovery
from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated based upon reasonable medical probability.

Telemedicine: Yes. The organization may pay for audio and video telecommunications instead of a face-to-face "hands on" appointment for the
following appointments: office or other outpatient visits; new and established evaluation and management visits; individual psychotherapy visits; and pharmacologic management visits. As a condition of payment, the patient must be present and participating in the telemedicine appointment. The professional fee payable is equal to the fee schedule amount for the service provided.

Ohio

MMI Rule: "Maximum medical improvement" is a treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures. An injured worker may need supportive treatment to maintain this level of function.

Telemedicine: Yes. Ohio BWC allows for telemedicine. Telemedicine services are reimbursable pursuant to the Professional Provider Fee Schedule OAC 4123-6-08 in effect on the date of service.

Oklahoma

MMI Rule: "Maximum medical improvement" means that no further material improvement would reasonably be expected from medical treatment or the passage of time.

Telemedicine: Yes, but all services must be appropriate, and the form of communication must be appropriate for the service provided.

Oregon

MMI Rule: Maximum medical improvement is the point where an injured worker's condition is unlikely to improve further, either with or
without additional medical treatment, and is determined by a doctor.

Telemedicine: Yes. Oregon allows the use of telemedicine for medical evaluations, including Maximum Medical Improvement (MMI) determinations in workers' compensation, provided the service is medically appropriate, utilizes interactive audio/video, and adheres to the same standards of care as in-person visits. Key requirements include consent from involved parties and ensuring the technology allows for an adequate assessment.

Pennsylvania

MMI Rule: "Maximum medical improvement" means a point in time when any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonably expected to improve the condition.

Telemedicine: Pennsylvania allows the use of telemedicine for workers' compensation, including potential medical evaluations for maximum medical improvement (MMI), provided the services meet the accepted standard of care and involve appropriate, licensed providers. While telehealth is increasingly used to reduce barriers to care, it is generally not used for comprehensive physical exams required for MMI determinations.

Rhode Island

MMI Rule: Maximum medical improvement (MMI) means a point in time when any physical or mental impairment due to a work-related injury becomes stable and when no further treatment is reasonably expected to improve the
condition.

In general, it is the worker's authorized treating physician would makes such a determination. In some cases a consulting independent medical examination (IME) provider or the court may need to make this final designation. A finding of MMI by the workers' compensation court may be reviewed only where it is
established that an employee's condition has substantially deteriorated or improved.

Telemedicine: Rhode Island allows telemedicine for worker's compensation, including for evaluations and management services, provided they are medically necessary, clinically appropriate, and equivalent to in-person care. The state has expanded access to telehealth for injured workers, allowing for remote, real-time, two-way audio-visual communication. 

South Carolina

MMI Rule: "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury
or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Telemedicine: Yes. Under South Carolina's 2024 Telehealth and Telemedicine Modernization Act, licensed providers can perform virtual assessments to evaluate, diagnose, and treat patients, including for MMI, as long as the evaluation is consistent with appropriate medical practices.

South Dakota

MMI Rule: “Maximum medical improvement” means the point at which a person has reached a substantial plateau in the medical recovery process, such that significant further improvement is not expected, regardless of treatment.

"Ascertainable loss," is a loss becomes ascertainable when it becomes apparent that permanent disability and the extent thereof has resulted from an injury and that the injured area will get no better or no worse because of the injury.

Telemedicine: Yes. South Dakota generally allows the use of telemedicine for medical evaluations in workers' compensation cases, provided the services are medically necessary, compliant with HIPAA, and use real-time audio/visual technology. 

Tennessee

MMI Rule: In all workers’ compensation claims, statements of causation, date of maximum medical improvement, permanent restrictions, and permanent impairment rating(s) must be provided by a medical doctor, doctor of osteopathy, or doctor of chiropractic in accordance with the workers’ compensation law.

An employee claiming an injury as defined in 50-6-102, when the date of injury is on or after July 1, 2014, shall be conclusively presumed to be at maximum medical improvement when the treating physician ends all active medical treatment and the only care provided is for the treatment of pain or for a mental injury that arose primarily out of a compensable physical injury. The employer shall be given credit against an award of permanent disability for any amount of temporary total disability benefits paid to the employee after the date that the employee attains maximum medical improvement as determined by a workers'
compensation judge.

An employee claiming a mental injury, as defined by 50-6-102, occurring on or after July 1, 2009, shall be conclusively presumed to be at maximum medical improvement upon the earliest occurrence of the following:

At the time the treating psychiatrist concludes the employee has reached maximum medical improvement; or

One hundred four (104) weeks after the date of injury in the case of mental injuries where there is no underlying physical injury.

Telemedicine: Telehealth for workers’ compensation is an available option for medically appropriate healthcare services to be provided with the
voluntary consent and agreement of the injured worker and the willingness of the healthcare services provider as provided in these rules.

Telehealth services are subject to any and all appropriate utilization review protocols or other protocols for healthcare treatment adopted by the bureau, shall be based on evidence-based guidelines, and shall be in accordance with the Tennessee standards of medical practice.

The provision of medical services via telehealth does not change or in any way affect the requirements for causation, date of maximum medical improvement, or permanent impairment ratings required of an authorized treating physician pursuant to the workers’ compensation law. In all workers’ compensation claims, statements of causation, date of maximum medical improvement, permanent restrictions, and permanent impairment rating(s) must be provided by a medical doctor, doctor of osteopathy, or doctor of chiropractic in accordance with the workers’ compensation law.

Texas

MMI Rule: Maximum medical improvement means the earlier of the following:

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;

The expiration of 104 weeks from the date on which income benefits begin to accrue;

The date determined as provided by 408.104.

This statute applies to MMI following a spinal surgery. The 104 week period above may be extended in these cases. The employee must first request an extension within 12 weeks before the expiration of the 104 week period. If an order is issued granting the extension, the order will extend the statutory period to a new end date based on the medical evidence presented to the Commissioner. Only an authorized doctor may certify MMI, determine permanent impairment, and assign an impairment rating. These designations or ratings from unauthorized providers are considered invalid.

Telemedicine: Yes. Texas allows and permits the use of certain telemedicine and telehealth services for workers' compensation claims. Accordingly, the rendering medical providers are allowed to bill and seek reimbursement for these telemedicine services. Injured employees may receive these services regardless of their geographic location. Telemedicine services are those provided by a physician licensed in Texas. Telehealth services are those provided by health care professionals other than physicians.

Telemedicine and telehealth services may include or extend to include exams by the established authorized treating doctor to certify maximum medical improvement (MMI) and the evaluation of permanent impairment when:

The injured employee has been examined by the treating doctor for the condition in question at least once before the examination to certify MMI;

The injured employee has consented to the examination to certify MMI by telemedicine or telehealth; and

The condition in question qualifies as a minor injury requires no additional treatment and has resulted in no impairment.

Utah

MMI Rule: “Maximum medical improvement” means the point at which a person has reached a substantial plateau in the medical recovery process, such that significant further improvement is not expected, regardless of treatment.

Telemedicine: Yes. Utah allows medically necessary, non-experimental, and cost-effective services provided via telehealth.

Vermont

MMI Rule: End medical result, medical end result, or maximum medical improvement (MMI) mean the point at which an injured employee has reached a substantial plateau in the medical recovery process such that significant further improvement is not expected, regardless of treatment. This generally represents an informal end of a worker's active care under their workers' compensation claim.

Telemedicine: Yes. Vermont law requires workers' compensation insurance carriers to cover health care services delivered through telemedicine to the same extent as in-person visits, provided the care is clinically appropriate. This includes consultations and evaluations, allowing for remote MMI determinations if a physical examination is not strictly required

Virginia

MMI Rule: An injury that is well stabilized and unlikely to change substantially, with or without medical treatment. Once an injured worker reaches MMI, a physician can assess how much, if any, permanent partial disability resulted from the work injury.

Telemedicine: Virginia law permits the use of telemedicine for many medical services in workers' compensation cases, including potential Maximum Medical Improvement (MMI) evaluations, provided the technology allows for a secure, synchronous (real-time) audio-video interaction that is equivalent to an in-person visit. However, QME evaluations often require a physical exam, making in-person visits generally preferred for final impairment ratings. 

Washington

Washington considers "MMI” and “fixed and stable” to be synonymous. 296-20-01002 gives a definition of MMI as follows: Maximum medical improvement occurs when no fundamental or marked change in an accepted condition can be expected, with or without treatment. Maximum medical improvement may be present though there may be fluctuations in levels of pain and function. A worker's condition may have reached maximum medical improvement though it might be expected to improve or deteriorate with the passage of time. Once a worker's condition has reached maximum medical improvement, treatment that results only in temporary or transient changes is not proper and necessary.

An accepted condition has reached maximum medical improvement (that is, fixed and stable) when it is reasonably certain that further medical treatment will not improve the illness or medical condition. “Fixed” does not necessarily mean “healed” or “static.” Rather, it means the worker has reached a stable plateau from which further recovery is not expected, although the passage of time may produce some benefit.

Telemedicine: Whenever the department or the self-insurer deems it necessary in order to (i) make a decision regarding claim allowance or reopening, (ii) resolve a new medical issue, an appeal, or case progress, or (iii) evaluate the worker's permanent disability or work restriction, a worker shall submit to examination by a physician or physicians selected by the department, with the rendition of a
report to the person ordering the examination, the attending physician, and the injured worker.

The examination must be at a place reasonably convenient to the injured worker or use telemedicine if the department determines telemedicine is appropriate for the examination.

West Virginia

MMI Rule: "Maximum medical improvement" means a condition that has become static or stabilized during a period of time sufficient to
allow optimal recovery, and one that is unlikely to change in spite of further medical or surgical therapy.

Telemedicine: Yes, with a caveat. Yes, West Virginia allows for telehealth services in workers' compensation cases, provided the technology used, such as video, meets the appropriate standard of care. While not explicitly prohibiting Maximum Medical Improvement (MMI) determinations via telemedicine, such evaluations must adhere to West Virginia Code §33-57-1 and §30-3-13A, requiring that services provided via telehealth are covered, and reimbursed at the same rate as, in-person consultations. 

Wisconsin

MMI Rule: Wisconsin refers to Maximum Medical Improvement (MMI) as end of the healing period. The WKC16 medical report should be requested from the treating physician, when an end of healing has occurred and when permanent partial disability has been assessed.

Telemedicine: Wisconsin generally allows telemedicine for medical evaluations in workers' compensation cases, including potential Maximum Medical Improvement (MMI) determinations, provided the technology meets standards equivalent to in-person care. Physicians must use professional judgment to ensure the virtual visit is safe, appropriate, and complies with Wisconsin Administrative Code Med 24. 

Wyoming

MMI Rule: Maximum Medical Improvement (MMI) Chapter 1 (dd) 27-14-102(a)(ii). Maximum Medical Improvement (MMI) is a medical condition or state that is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Over time, there may be some change; however, further recovery or deterioration is not anticipated. This term may be used interchangeably with the term "ascertainable loss."

“Ascertainable loss” means that point in time in which it is apparent that permanent physical impairment has resulted from a compensable injury, the extent of the physical impairment due to the injury can be determined and the physical impairment will not substantially improve or deteriorate because of the injury.

Telemedicine: Yes. Telehealth visits are considered the same as in-person visits and are reimbursed the same as regular, in-person visits.