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.
Category: Workers’ Compensation
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.
There is no hard and fast rule as to how the doctor gives you restrictions. Some doctors will order a Functional Capacities Evaluation. They will review the recommendations from the FCE and either adopt those as your permanent restrictions or modify them.
Other doctors will use their personal judgment regarding what you can do. Many of these doctors scoff at the increased use of FCEs and are confident they can accurately assess safe levels of physical activity.
A third group of doctors are inclined to give you no set restrictions at all but encourage you to watch yourself or “find another line of work.” These doctors are undoubtedly well intentioned but often create real problems in workers’ compensation claims. As we’ve heard, this set of doctors explain they are concerned that giving you written restrictions will handcuff you indefinitely, especially if you are looking for work with a new company. On the other hand, we think it is a little naïve to expect an employer to accommodate a worker’s request for job modifications when the doctor hasn’t specifically said the injured worker needs it.
An example of where this third group can inadvertently create problems occurred for us when a doctor released our client without any restriction in writing. Our client insisted that the doctor had told him to find a different line of work. Based on this, the client did not return to work the next day. Not showing up for work he was summarily terminated. The insurance adjuster then moved the Industrial Commission to cut off his weekly checks on the basis that he had no documented disability.
We took the doctor’s deposition and he seemed astonished. “But, I told the rehabilitation nurse that he could not return to his old job. I just didn’t want to limit him in terms of his future options.” When asked why this didn’t appear anywhere in her report the nurse simply replied that she’d asked advice from the adjuster. The adjuster told the nurse to leave it out of the report, as she wanted to terminate the injured worker’s checks. The rehabilitation nurse went along with the adjuster’s request.