When estimating future medical cost for an injured worker who has reached maximum medical improvement, the estimate should be based on what?

• A. The most recent six months of medical costs
• B. Average cost over the past three years since MMI date
• C. A fixed percentage increase from the current costs
• D. The predicted costs for the next year

Answer: (B)

After maximum medical improvement, future medical costs are best estimated by looking at the typical ongoing care the injury requires, as reflected in a stable pattern over time. Using the average of medical costs from the three years prior to reaching MMI provides a smoothed, realistic baseline that captures the regular level of treatment the worker needs going forward, while avoiding distortions from short-term spikes or recent changes.

This approach is more reliable than relying on only the most recent six months, which can be volatile; more arbitrary than applying a fixed percentage increase; and more grounded than guessing next year’s costs without anchoring to actual historical data. The three-year average prior to MMI aligns with the way ongoing, reasonable, and necessary medical care is projected after the injury has stabilized.