Workers’ Compensation Benefits After Maximum Medical Improvement Finding

In South Carolina workers’ compensation claims, temporary total disability benefits are generally payable until such time that a physician deems the injured employee to have reached a point called “maximum medical improvement.”
The phrase maximum medical improvement has both medical and legal significance. Medically, it means that curative medical treatment has ceased, and the injured party is essentially as good as he or she is going to get.

A determination from one physician could be disputed by another, though. For example, an orthopedic doctor could release a patient from care, but the neurologist may still be continuing treatment. There could also be disputes between an authorized treating physician (chosen by the patient) and an independent medical evaluation.

From a legal standpoint, Rock Hill workers’ compensation claims will be heavily determinant on the date of maximum medical improvement, but there are also be considerations regarding the person’s work history, skill sets and the employment market. There may also be consideration for whether there is permanent partial disability. In other words, the state will consider whether there are lifelong effects from the injury.

These cases are often complex, as the recent case of Harman-Bergstedt, Inc. v. Loofbourrow, illustrates. Here, the Colorado Supreme Court determined that temporary total disability benefits are not barred by a failure to seek a division-sponsored independent medical examination.

According to court records, the plaintiff first injured her back in late 2008, while lifting and cooking chicken at the fast food restaurant where she worked. This injury was reported to her employer, and therefore its insurance company, and she immediately sought medical care.

Her employer referred her to an authorized treating physician (a doctor designated by the employer to treat an employee for a work-related injury). She received medical treatment from this doctor, and during this time continued to work, though she labored under a few work restrictions that her employer was able to accommodate.

These accommodations didn’t result in wage losses, so the company never reported the injury to the division of workers’ compensation and didn’t deny or admit liability.

After a month of treatment, the doctor determined she had reached maximum medical improvement. This documentation was included in the doctor’s bill.

Several months after, the worker began to again experience back pain. In August of 2009, she sought treatment from her private doctor. He recommended various work restrictions. Her employer was unable to accommodate these restrictions. As such, she sought temporary total disability and other workers’ compensation benefits, dating to August 2009, when she received those work restrictions.

At an administrative hearing, the judge concluded that her injury was compensable dating back to the 2008 injury. She was awarded temporary total benefits dating back to that time.

Her employer’s insurance firm appealed this because of the earlier finding of medical maximum improvement and the fact that the worker had never disputed this claim or sought an independent medical examination to refute it between December 2008 and August 2009.

The state’s Industrial Claim Appeals Office reversed the ALJ’s findings, indicating that temporary disability benefits had to cease when a claimant reaches maximum medical improvement, absent an independent medical examination that shows otherwise.

On appeal, the appellate court remanded the case with directions to reinstate the ALJ’s award for temporary total disability benefits. The court clarified that the worker was arguing a worsening condition since December 2008, not contesting the maximum medical improvement finding reached at that time.

The state supreme court affirmed this decision, saying the worker was under no obligation to seek an independent medical examination between December 2008 and August 2009.

If you have been injured at work in Rock Hill, contact the Lee Law Offices at 800-887-1965.

Additional Resources:
Harman-Bergstedt, Inc. v. Loofbourrow, Jan. 27, 2014, Colorado Suprem Court

More Blog Entries
Total Incapacity Status After a North Carolina Work Injury, Jan. 31, 2014, Rock Hill Workers’ Compensation Lawyer Blog

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