Maximum Medical Improvement

All conscientious employers take as many steps as they can to reduce the likelihood their employees will sustain work-related injuries.  Even if all the right measures are taken, an employee may still sustain a work-related injury.  The workers’ compensation system will provide the employee with medical treatment costs and temporary disability benefits.  In some cases, the employee’s work-related injury may be so severe that it will never completely heal.  In such a case, the worker will be deemed to be permanently disabled.  Whether an injury is still healing or is determined by a medical professional to be one that will never heal is essential to the type and duration of benefits provided through workers’ compensation.  Maximum medical improvement is the term used in workers’ compensation cases for when an injured worker’s condition will not improve.

When an employee sustains a work-related injury, hopefully the employee is able to receive treatment and recover fully.  However, when an employee has received treatment and a medical professional has determined the employee’s condition is unlikely to improve, then the employee will be said to have reached maximum medical improvement.  Under California law, maximum medical improvement is defined as the time when the medical condition “is well stabilized, and unlikely to change substantially in the next year with or without medical treatment.”

A medical professional is the only one who can make the determination that an employee has reached maximum medical improvement.  The medical professional will write a report setting out the fact the employee has reached maximum medical improvement.  The report will also include an impairment rating.  The impairment rating will determine the amount of permanent disability benefits the employee will receive, as the employee’s disability rating directly impacts the amount of benefits.

Employers need to remember that the insurance company or the injured worker can both elect to dispute the medical professional’s assessment.  If this happens, then the disputing party is entitled to get a second opinion from another physician.  The physician will be chosen from a list of Qualified Medical Evaluators that is maintained by the Division of Workers’ Compensation.

If you have questions about workers’ compensation or disability ratings, contact us today.  We can talk with you about workers’ compensation and your business.

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