In workers’ compensation law, the concept of maximum medical improvement can be an especially thorny one. That’s because this determination spurs important questions about the continuation and amount of benefits.
Maximum medical improvement is considered the point at which a worker’s medical condition has stabilized to the point that any further improvement isn’t likely, even in spite of ongoing treatment or rehabilitation. Essentially, it’s a plateau, meaning the worker is “as good as he/she is going to get.”
This can indicate full recovery, but it also can simply mean the patient is not going to get any better. It is from this point a determination can be made regarding permanent partial impairment.
Based on this finding, the worker may need to decide with a qualified workers’ compensation lawyer whether to settle with the employer/insurer for a final amount, releasing them of further liability, or to press for the continuation of benefits for medical care and other expenses.
It’s worth noting only a doctor can determine whether a person has reached maximum medical improvement, and it’s usually the treating physician. In some cases, the insurance carrier will request an independent medical examination by a similarly qualified doctor to examine the patient, review the records and make a determination. In these cases, the treating physician would receive this report and, upon review, decide whether to concur or disagree with it. A concurrence would result in a termination of temporary total disability benefits and a figuring of permanent partial disability (if any). In the event the treating physician disputes the finding, the case would be forwarded to the state industrial commission for review.
In the recent case of State ex rel McCormick v. McDonald’s, which was weighed by the Ohio Supreme Court, a worker injured in a fall eight years earlier disputed the findings of an independent medical examination that determined she had reached maximum medical improvement.
According to court records, claimant slipped and fell while working at a fast food restaurant. Her workers’ compensation claim covered for the following conditions:
- Bruising scalp
- Neck sprain
- Bulging disc
- Aggravation of pre-existing degenerative disc disease
- Bilateral stenosis
The independent medical examiner concluded claimant had reached a treatment plateau and could return to her former job absent any restrictions. Physician indicated no further treatment was necessary for the reported conditions.
Two weeks later, claimant’s treating physician ordered a series of steroid injections – which were later approved by the workers’ compensation insurer. Three days after that, claimant’s chiropractor determined she would reach maximum medical improvement within three months.
On request of insurer, based on the findings of the independent medical examiner, the state commission terminated claimant’s compensation for temporary total disability.
On appeal, claimant argued the finding was not supported by the evidence, specifically pointing to her ongoing steroid injections.
The court ruled a doctor’s opinion on maximum medical improvement is not automatically rendered premature just because there is a subsequent request/approval for follow-up treatment. Courts have broad discretion with which to determine the appropriateness of the physician’s findings, based on the individual facts laid forth in the case.
The outcome here underscores the importance of having a skilled attorney at your side, presenting ample evidence and arguing for the position that is of greatest benefit to you.
For information on Atlanta work injury compensation, contact J. Franklin Burns, P.C., at 1-404-303-7770.
State ex rel McCormick v. McDonald’s, Jan. 20, 2015, Ohio Supreme Court
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US Bank Home Mortgage v. Schrecker – Afternoon Break Street Crossing Injury Not Compensable, Jan. 12, 2015, Atlanta Workers’ Compensation Lawyer Blog