Workers' Compensation

What happens with my medical treatment at maximum medical improvement?

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.

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