The insurance company can assign a “nurse case manager” or a “rehabilitation nurse” to be a go-between with you, the doctor, and the adjuster. In theory this is fine. However, many, if not most, of these nurses work almost exclusively for the insurance companies. In fact some of them work in cubicles right next to the adjuster. In that kind of situation it’s hard not to believe that the nurse is going to put your interests ahead of those of her employer. We aren’t saying all nurses are bad people – they aren’t. But human nature is… well, human nature. We’ve seen documented cases of nurses altering Functional Capacities results, turning a blind eye to known inaccuracies in job descriptions, even coordinating schedules with private investigators.
Maximum Medical Improvement, or MMI, is the point where a doctor says you are as good as you’re going to get. In all honesty you’ll probably get a bit better over time, and there’s always a chance you’ll decline some, but it’s when the doctor thinks he’s done what he can do and it’s time to cut you loose. At that point, you are eligible to a permanent award based on either loss of earnings or permanent injury to you. In an accepted claim this is the point where an adjuster will want to close her file. Even if you’ve not had an attorney up to that point it’s an excellent time to give us a call and get us to walk you through your options. If there’s a single point in your case where the adjuster has no obligation to explain all of your legal options to you this is it. What she’ll propose is quite likely just a fraction of what you could receive. Every case is different but yours is certainly worth a thirty-minute phone call. We don’t charge for this and you’ll have a far better idea of what your claim is actually worth.
You are still entitled to medical treatment if your doctor says you will continue to need this. While “maximum medical improvement” is supposed to mean what it says – the end of the healing period, or when you are as good as you’re going to get, it often really means the treating physician doesn’t have anything more to offer.
This doesn’t mean that you’ll never see a doctor again – as much as the adjuster might hope that’s what it means. If you need to see a doctor quarterly or yearly your doctor should say so. If you are going to continue on medication your doctor should say so. And if you are going to require ongoing therapy of some type your doctor should say so. Your adjuster is responsible for all of this.
Many times, adjusters have told injured workers that workers’ compensation didn’t have to provide for medical treatment or prescriptions as of the date of maximum medical improvement. This is inaccurate. It’s possible that the adjuster really believes this or it’s possible that the adjuster believes this is what the law should be. But it’s not what the law is. If necessary, you are entitled to medical treatment for this condition indefinitely – even if that’s for life.
What you need to look for when the doctor is declaring you to be at maximum medical improvement is (a) what additional treatment, evaluation, or medicine do you need and (b) who does your doctor think should provide it. We see a lot of instances where the doctor intends there to be a continuing source of prescriptions but doesn’t make a specific referral to your family doctor or another physician to be writing those prescriptions. Without that referral don’t be surprised if the adjuster refuses to pay for prescriptions written by your family doctor – even if they are identical to what her hand-picked doctor had written for you just the month before.
