Understanding Maximum Medical Improvement and Fitness for Duty

The maritime industry is crucial to global commerce and tourism, employing thousands of crew members on cruise and cargo ships. Among the many challenges faced by these crew members, health-related issues, including injuries and illnesses, are prominent. In managing these health concerns, two critical terms are often used: Maximum Medical Improvement (MMI) and Fitness for Duty (FFD). Both concepts play significant roles in the treatment, recovery, and employment status of ill and injured crew members, yet they serve different purposes and must be determined with care. Moreover, laws like the Jones Act underpin the rights of maritime workers, further complicating the landscape.

Defining Maximum Medical Improvement (MMI) and Fitness for Duty (FFD)

Maximum Medical Improvement (MMI)* is a medical determination that indicates a patient has reached a state where no significant functional improvement is expected with further medical treatment. It does not mean that the individual is fully recovered but rather that their condition is stabilized and unlikely to change substantially with continued treatment. This concept is particularly pertinent in the maritime industry as it can influence decisions regarding permanent disability or the need for ongoing medical accommodations.

Fitness for Duty (FFD)*, on the other hand, assesses whether an individual is physically and mentally capable of performing their job duties. In the context of maritime employment, FFD evaluates a crew member's ability to safely and effectively fulfill their responsibilities aboard a vessel, ensuring both their own safety and that of their colleagues and the ship. FFD assessments must consider the specific requirements of the position, whether it involves heavy lifting, prolonged standing, or operating complex machinery.

Key Differences Between MMI and FFD

While MMI and FFD are interconnected, they serve distinct roles. MMI is a clinical determination focused on the medical status of an individual, whereas FFD is an occupational assessment concentrating on the person’s capability to perform their job functions.

An employee can reach MMI without being fit for duty. For instance, a crew member with a spinal injury may be deemed to have reached MMI if further medical treatment is unlikely to yield significant improvements. However, that same individual might not be fit for duty if they require substantial physical strength to perform their job, and the injury left them with permanent restrictions.

Reciprocally, a crew member may be FFD but not MMI.  A crew member may be able to perform their job but with modifications that are acceptable to their company but still need continuing or future medical care.  This requires close coordination between the medical providers, the case managers and the employer, including an understanding of the crewmember's job description by the medical providers.

Differences in MMI and FFD for Injured vs. Ill Crew Members

The path to determining MMI and FFD differs significantly between injured and ill crew members. Injuries tend to have more predictable recovery trajectories and can often be assessed with a higher degree of certainty. For example, a broken bone typically has a set healing time, after which point MMI can be reasonably determined.

Illnesses, particularly chronic or severe conditions, may present more variability. A crew member with a chronic illness like diabetes or heart disease might face an unpredictable course of treatment and symptoms. In such cases, determining MMI can be complex, as new treatments and interventions may continually emerge. Similarly, FFD assessments for ill crew members must account for the possibility of episodic flare-ups or the need for ongoing treatment that could affect job performance.  Another example of a patient who might be FFD but not MMI is a cancer patient who needs long term chemotherapy to control their cancer but can easily perform the duties of their job.

It is critical to work with providers, provider networks and case managers who have a comprehensive understanding of MMI and FFD.

Providers should be reminded on a regular basis to reassess their patients (crew) for status as to both and asked to estimate the time frame to achieve goals and account for variances.  Providers should always be provided with the job description for their patients.

AP Companies provides constant support and care, ensuring shipowners are fully informed about the state of the patient, the timeframes for MMI, and the likelihood of reaching FFD. Our clients benefit from our Home Country Case Management, which offers a clear picture of costs and timelines at any given moment.

The Jones Act: Protecting Maritime Workers

The Jones Act (Merchant Marine Act of 1920) is a federal statute that provides protection and rights to seamen who are injured or fall ill while in service to a vessel. Under the Jones Act, maritime employers owe a duty to provide a reasonably safe working environment and can be held liable for injuries resulting from negligence.

The act allows seamen to pursue compensation for medical expenses, lost wages, and pain and suffering resulting from their injury to seek redress and care. However, the Jones Act also adds layers of complexity to the determination of MMI and FFD, as these designations can influence the entitlement and extent of compensation claims.

There is a lot of confusion around this act, and on many occasions, shipowners end up paying for medical conditions that did not result from an injury on board. In such cases, AP Companies provides crucial support and guidance to its clients, helping them understand how to contain costs, what needs to be covered, and what falls outside their obligations. This ensures that shipowners are well-informed and can make decisions that are both legally compliant and cost-effective.

Conclusion: Navigating MMI and FFD in the Maritime Industry

The journey from injury or illness to recovery and return to work is a complex process for maritime crew members. Understanding the distinctions between MMI and FFD is crucial for all stakeholders, including crew members, healthcare providers, and employers. Recognizing that MMI is a medical endpoint and FFD is an occupational readiness measure helps ensure that crew members are provided with appropriate care and are safely integrated back into their roles.

AP Companies offers comprehensive reports that address both MMI and FFD, enabling shipowners to manage expectations and make informed decisions. These detailed reports provide relevant information that ensures shipowners are fully aware of their crew members' medical status and readiness to return to duty.

Incorporating the provisions of the Jones Act, particularly for injured and ill crew members, adds an essential layer of legal protection and support during this process. However, chronic conditions like back pain exemplify the inherent challenges in these determinations, requiring nuanced and individualized approaches.

The ultimate goal is to safeguard the health and rights of maritime workers while maintaining the safety and efficiency of maritime operations. Only through meticulous assessment and collaboration can we, at AP Companies, achieve these dual objectives, ensuring that ill and injured crew members are treated fairly and are truly fit for the demanding roles they undertake at sea.

In my next article, I will discuss the specific challenges of managing crew members with acute and chronic back pain and the difficulties that may occur with determining FFD and MMI in these individuals.

Dr. Arthur L. Diskin is a graduate of the University of Miami School of Medicine with specialty training in Emergency Medicine and an interest in critical care. He is certified by the American Board of Emergency Medicine and is a Fellow of the American College of Emergency Physicians. He has held leadership roles such as the Past President of the Florida College of Emergency Physicians and is the former Chief of the Department of Emergency Medicine at Jackson Memorial Hospital in Miami, Florida, and Mount Sinai Medical Center in Miami Beach, Florida. Dr. Diskin has also as an examiner for the American Board of Emergency Medicine as an examiner and is a past Chair of the Section on Cruise Ship and Maritime Medicine within the American College of Emergency Physicians.