After five months of being seen for your workers' compensation injury, despite little improvement in your condition, the doctor hands you a sheet of paper telling you that you are now discharged from his care and are at MMI (Maximum Medical Improvement). You are confused, right? So, what does that mean? What's next? And what do you need to watch out for?
This MMI determination by unscrupulous company doctors, in the 4-5 month time period post-work related injury, is much more of a "shell game" than a medical prognosis. This article will help you understand the game being played by your employer, the insurance company and the doctors hired by them; it will also help you understand your rights.
A) What Does It Mean?
Being placed at MMI is not the problem. Once an employee reaches maximum therapeutic benefit from medical care, the doctors are supposed to declare the patient at maximum medical improvement. That's not where employees are being scammed. The scam comes at the coincidental timing of these declarations of MMI.
Colorado law requires that any worker injured and actively treating and symptomatic for a duration of more than 6 months is required to be rated for permanent impairment utilizing the AMA Guide To Impairment, 3rd Ed. In Colorado, this book provides workers' compensation physicians charts that assign a numeric impairment rating utilizing both diagnosis and range of motion determinations. These ratings then convert to money benefits required to be paid to the worker under the law. A rating on simply a strained back, with some limited range of motion can mean upward of $60,000 or more in money paid to a worker (depending on age and pay rate). However, the Guide often requires both active care and ongoing symptoms for a duration of greater than 6 months in order for a rating to be given.
So is it any wonder that patients who remain largely symptomatic find themselves discharged from their doctor's office and ordered to return to work five months post- accident? It is shameful but true.
Doctors whose livelihood depends on keeping employers and insurance companies happy are finding more and more creative ways to justify releasing workers compensation patients back to work just shy of the six month mark in an effort to cheat the employee out of a much deserved and substantial money recovery. A sprained back with limitation in range of motion coupled with a return to work status within 5 1/2 months post-accident is worth nothing. Simply stated, releasing a worker prior to the six month mark means the difference between a worker getting tens of thousands versus the worker getting nothing. If the patient actually requires more medical care, this results in a theft.
B) What's Next?
If you are placed at MMI before the 6 month deadline, the doctor is not required to rate you. Alternatively, more than 6 months out, once the doctor places you at MMI he is required to evaluate you for impairment utilizing the Guides, and for most injuries, impairment is required. This means you will be compensated for the injuries you sustained.
C) What You Need To Do:
This is the part that so few injured employees understand. If the company doctor releases you before 6 months post-accident with a determination of MMI, you have a very short window, about 30 days usually, to take action to preserve your rights and to fight back.
A week or so after being released from the doctor you will receive a pink sheet of paper in the mail entitled Final Admission of Liability. This is the most important piece of paper to an injured worker. The insurance company and your employer hope you ignore this sheet of paper. You must take immediate action.
The Final Admission is designed to close your case and surrender your rights. You have to keep this from happening. You must file an objection to the F.A. and file a timely demand for a Division of Labor Independent Medical Examination by a neutral doctor not otherwise involved in your case. That doctor becomes, for the most part, the definitive word on whether your are or are not at maximum medical improvement and, if so, whether your symptoms have persisted for a duration of greater than 6 months, therefore requiring you to receive a rating and compensation.
These matters can be complicated and require careful navigation of a bunch of administrative rules and often are ultimately resolved only after a formal hearing. Utilizing and seeking guidance through this complicated and very specialized area of the law is highly recommended.
If you have questions about your workers' compensation claim, please call today and speak with one of our attorneys. At Anderson, Hemmat we look forward to helping you navigate your way through this complicated and stressful period. You have rights, and we want to help protect those rights.