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Workers’ Compensation Maximum Medical Improvement Errors

work injuryMaximum Medical Improvement (MMI) occurs when an injured employee reaches a state where his or her condition cannot be improved any further or when a treatment plateau in an injured workers’ healing process is reached.

However, many patients are placed at MMI ahead of when they should be and as a result the amount of treatment they receive is limited by this decisions. Many their treating doctors later realize the diagnosis is incorrect but they Workers’ Compensation process do not know the well enough to correct the previous decision.

How do treating doctors make this mistake?

Workers’ compensation guidelines are complicated for most, and many treating physicians do not know the process of how to progress a patient through care. Workers’ compensation rules are much different that rules for regular private insurance and many physicians office do not deal with enough injured workers to fully understand the workers’ compensation process. Additionally, workers’ compensation guidelines change frequently and physicians don’t have the patient volume to justify staying up to speed with the new regulations. For this reason many physicians don’t treat work injuries and often instead choose to pass patients to clinics such as ourselves at San Antonio Pain and Injury Workers' Compensation Doctors who specialize in treating injured workers.

What is the impact of Workers’ Compensation Maximum Medical Improvement Errors?

Workers’ Compensation cases are time sensitive. If a treating physician can’t get a patient into the proper program to fit the injured patient’s injury, insurance companies can deny any request for therapy.

Often the patient loses a much of their treatment time because they don’t realize the worker’s compensation forms were incorrectly completed. The treating physician and patient must wait for the denial to be received and then figure out what they did wrong to resubmit for care. This creates a gap in care. Gaps in care are detrimental to a workers’ compensation case. Insurance companies and independent medical examiners use this gap in care to convince Texas Division of Workers' Compensation into thinking that the patient no longer needs therapy or help. If the gap is significant or long enough, the patient runs the risk of missing their window for help through the Workers Compensation system.

When a designated doctor sees this gap in care and there are no more requests from the treating physician for care, the designated doctor sees this as a patient being well enough to return to work or determines that too much time has passed for a patient to benefit from any care at that point and the patient may be placed at maximum medical improvement incorrectly.

When this happens, inexperienced treating physicians accept the decision and the patient is either forced to return to work with their injuries or the patient is unable to return to work within a timely fashion and loses their job. This is unacceptable.

Correcting Workers’ Compensation Maximum Medical Improvement Mistakes

Luckily for those patients, our physicians at San Antonio Pain and Injury Workers' Compensation Doctors won’t accept an inappropriate MMI decision. We have the experience and the success of fighting claims that have been inaccurately determined to be at MMI. Many patients come to us for workers’ compensation second opinions and many times we have helped them receive the care they need.

If you feel that your claim was inappropriately placed at Maximum Medical Improvement, please contact us today at San Antonio Pain and Injury Workers' Compensation Doctors 210-446-5115 to help get your case back on track and receive the help you need.

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