The goal of physical therapy, or PT, is to improve your movement, improve your physical functioning, and reduce pain. It is not a stall that a doctor necessarily insists on prior to a surgery – although it may seem like it some times.
Why is that? A lot of injuries can be repaired with physical therapy. It’s non-invasive, and although it can cause some temporary pain and swelling, and is effective in some situations. Many people are cured with physical therapy and are quite happy. Some injuries, though, require much more. It’s pretty common, however, that your doctor will order PT prior to recommending surgery. If you’re one of the lucky ones whose problems are solved with PT then you’re good with this. If you’re one of the ones who requires surgery… well PT can be frustrating because you feel like it’s a waste of time. In most situations there isn’t any harm in trying the conservative approach first but it can be frustrating.
Following a surgery PT is often necessary to help rebuild your strength and prepare you for a return to work. And while PT often hurts during and afterwards you’ll likely hear your therapist explain that there is a difference between “hurt” and “harm.” As irritating as that is when you hurt… it’s true.
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.
Permanent Partial Impairment ratings are given by the doctor at maximum medical improvement. These are intended to document the loss of use you have to your injured body part.
The legislature has assigned a value, expressed in weeks, to your body:
Back 300 weeks
Arm 240 weeks
Hand 200 weeks
Thumb 75 weeks
First finger 45 weeks
Second finger40 weeks
Third finger 25 weeks
Pinkie finger 20 weeks
Big toe 35 weeks
Other toes 10 weeks
Foot 144 weeks
Leg 200 weeks
Eye 120 weeks
A “week” is one week of your compensation rate – the amount you were paid each week while out of work.
There are a few things to keep in mind about ratings. First, ratings are the primary means of compensating or settling with an injured worker who can return to his or her old job or make just as much money as before. If you aren’t able to return to your old wage-earning levels don’t worry about your rating.
Second, if the adjuster doesn’t like the rating that her hand-picked doctor gave you then she can send you for a second opinion on the rating. On the other hand if we don’t like the rating we can get a second opinion with a doctor of our choosing and the adjuster has to pay for it.
Third, the rating is usually paid out week by week, not in a lump sum. The adjuster may do it in a single payment but it’s likely she won’t and she’s not require to do so.
Fourth, as with the rest of the money you receive from workers’ compensation this is tax-free money.
