What is Maximum Medical Improvement (MMI)?

Maximum Medical Improvement, or MMI for short, is a simple yet important concept in every personal injury claim. It refers to the point in your medical treatment beyond which you are not expected to get any better from further medical care. This is not to imply that your medical treatment is finished. In many cases, you will still require ongoing treatment (e.g., medications, physical therapy, or assistive devices), but this treatment is intended to maintain your current level of health and functioning. A few examples should make this concept easy to understand.

Examples of MMI

Example 1:Steve is involved in a car accident and suffers a herniated disc in his lower back. This herniation causes not only pain, but also causes Steve’s legs to go numb on occasion. Steve has surgery on his back, which removes the occasional numb feeling, but he still has pain. Six months after Steve’s surgery, Steve’s doctor concludes that another surgery would not relieve Steve’s pain and that Steve is as good as he’s going to get. Steve will require medications for his back pain for the foreseeable future, will have stretching exercises to perform, and is restricted from certain activities which could re-injure or aggravate his back. At this six-months-post-surgery point in time, Steve is at MMI. Steve is not as healthy as he was before the accident and he never will be, but his doctor has concluded that Steve has achieved the maximum level of recovery that medicine can provide.

Example 2:Ann slipped and fell in a grocery store and tore her rotator cuff when she put her arm down to break her fall. Ann had surgery to repair her rotator cuff, but six months after the surgery, Ann still had a great deal of pain in her shoulder and did not have a good range of motion in that arm. Ann underwent physical therapy and takes her medications as directed, but she is still not improving. It turns out that scar tissue formed around her surgery site (a somewhat common complication) and a second surgery to remove the scar tissue is recommended. Ann is not yet at MMI, as her doctor still believes that both her pain level and range of motion will improve from the second surgery (and Ann has no objection to having another surgery).

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Example 3:Joe strained his lower back when he slipped on spilled grease on the floor at a fast food restaurant. His lower back pain improved over eight months of treatment, but did not go away entirely. His doctor does not expect that Joe will ever be pain-free from this injury, and Joe will require over-the-counter pain medication, a heating pad and occasional muscle relaxers to treat his back pain from now on. At the point Joe’s pain level stopped improving and leveled off, Joe was at MMI.

Why does MMI matter?

MMI is important to a personal injury case because it allows the plaintiff’s lawyer to predict your future damages — medical costs, lost wages and pain and suffering. Until you have reached MMI, a fair settlement value or jury verdict will be near-impossible to determine. For example, the woman in “Example 2” may have thought that she would only require one surgery to repair her torn rotator cuff. Had she settled her case before reaching MMI, she would not have accounted for the significant additional medical costs, pain and lost work time from her second surgery.

Often when you reach MMI, your doctor will assign you a “permanent impairment rating,” which is a number, given as a percentage, representing the reduced functioning of your body. There are two types of impairment ratings, one for the injured body part and one for your whole body. For example, you could have a 15% impairment rating as to your right arm, and a 6% whole body impairment. What this means is that your arm is functioning at 15% less than it was prior to the accident, translating into your whole body functioning at 6% less (I just pulled these numbers out of a hat — they are not from the official guidelines, most often the AMA Guides to the Evaluation of Permanent Impairment, your doctor will use). If you have injuries to more than one body part, each will be assigned an impairment rating and the guidelines will show how they are added together to reach a whole body impairment number. A permanent impairment rating allows lawyers and insurers to compare the values between different injuries, but it is not an exact science. An impairment rating will not be assigned until you reach MMI.

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Who Decides When I’ve reached MMI?

Your doctor, not your lawyer, will decide when you’ve reached MMI. Remember, it’s maximum medical improvement, not maximum legal improvement.

Does Being at MMI Mean That My Medical Condition Won’t Worsen?

No. Often people who are at MMI are expected to get worse as time goes on. The most common example is someone developing arthritis in an injured joint. However, being at MMI makes it easier for your doctor to predict how your condition will worsen over time, so that you can recover for this expected downturn in your health.

When will I reach MMI?

Each person’s case is different, but most doctors will not think about placing you at MMI until at least six months after your injury. It could be much longer, sometimes years in cases with multiple complications. This can be a source of frustration with plaintiffs, who obviously would like to be compensated as quickly as possible after an accident. However, your attorney knows that waiting until you are at MMI is the best way to ensure that you are fully compensated for your injuries.

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149 Responses to What is Maximum Medical Improvement (MMI)?

  1. Cee says:

    Can a person receive both social security disability and workers comp
    wage loss money?

    • fl_litig8r says:

      I’m not a workers comp or social security lawyer, but I’m pretty sure SSDI benefits will be reduced if you collect workers’ comp wage loss. If you got a lump sum workers’ comp settlement, the SSDI deduction will likely be calculated by pro-rating the lump sum into monthly payments over your life expectancy.

  2. D26 says:

    I live in Iowa and i injured my elbow at work in june of 09. I had surgery in april of 2011. In janurary of 2012 the work comp doctor told me i was at MMI. I guess it was the PA that told me. I saw the doctor that did my surgery maybe 15 minutes total during this whole thing. It’s been over 2 months and i have not been contacted by the work comp case manager. Should i contact them? I dont have a lawyer yet and I have a lot of questions. Please help.

    • fl_litig8r says:

      Because I’m not a worker’s comp lawyer, much less an Iowa worker’s comp lawyer, the best advice I can give you is to call a local worker’s comp attorney and take advantage of the free consultation. Depending on your injury and how well it’s healed, you may be entitled to a lump sum benefit award equal to a certain number of weeks’ earnings (e.g., 26-weeks for “x” injury, 52 weeks for “y” injury). I think you’ve waited long enough to hear from them. Contacting a lawyer ASAP is the best way to make sure you are not letting any deadlines lapse.

      It may be that you don’t need a lawyer, or that you aren’t entitled to further compensation. The only way to know for sure is to give one a call.

      • D26 says:

        Thanks for the advice I will be contacting a lawyer. I e-mailed the work comp case worker today and asked them about my MMI rating and was shocked when she said that the doctor rated me at 0%. Is this common for them to do this? The doctor even told me i would not be 100% I have issues with my elbow daily and after surgery one year ago I dont have much streingth in my left arm which I’am left handed.

        • fl_litig8r says:

          Unfortunately, this is pretty common. Impairment guides will usually have fixed impairment ratings for certain injuries, like loss of a hand, arm, leg or eye. For other injuries, like shoulder, back and elbow, the guides give the reviewing doctor a certain amount of discretion in assigning a rating. This is when the issue of who paid for the doctor comes into play. Your worker’s comp doctor has likely chosen to assign you a 0% rating to ensure repeat business from your workers’ comp carrier. If he gives out high impairment ratings, he loses business.

          Hopefully, a worker’s comp lawyer can tell you what your chances are at disputing the 0% rating. It will likely require having your own IME (though a treating doctor may suffice).

  3. Marty says:

    Can the surgeon write a MMI statement on your physical therapy an wish that you still see a chiropractor an to get a FCE to give you the percentage?
    I had my surgery over a year ago an with chiropractor an medication along with my home tens unit an medication I have remained the same. Along with no income in over 3 yrs makes getting to the Drs. office 2 to 3 times per week make it near impossible to do so.

    • fl_litig8r says:

      I’m not quite sure I understand your question. If you had surgery and completed your physical therapy, and now require chiropractic treatment, medication and the tens unit to maintain your current level of health, I’d assume that the surgeon could and would place you at MMI. I can’t say whether he’d require you to undergo an FCE to determine your impairment rating. Many doctors are comfortable assigning the rating themselves, but some are not (mostly because they don’t want to get involved in litigation).

  4. Juila says:

    Well I know that she is not claiming depression. So I guess her employer thinks she is lying but I know My sister there are days she cant even get out of bed. I hope this test well show that she is not lying. Thank you ill pass the information to her!!

  5. h. Ann says:

    had disk surgery, spine surgeon told me mmi will be reached @6wks post-op. He is insistent my neck symptoms were not caused by accident that caused lumbar herniations and will order MRI but will not be able to attribute neck problems to this accident because neck symptoms started 2 days after accident. He says they may be a stress reaction, but again he can’t say this accident caused it. I was adamant I had no neck pain b4 accident. Doesn’t this seem odd that he’s so insistent upon this opinion? Isn’t it reasonable to assume that neck injuries have occured from twisting injuries strong enough to cause 2 herniations?(especially since I had no pain b4?) What possible reason could he have for insisting this view-especially after he performed surgery?

    • fl_litig8r says:

      It does sound odd that he seems so convinced that your neck symptoms are unrelated to the accident, especially if you had no prior complaints of neck pain. It would be pretty coincidental for these symptoms to suddenly appear 2 days after your accident if they were caused by something unrelated. I’m not sure your doctor has a good grasp on how causation works in an accident case. He may think that if the neck symptoms weren’t directly caused by trauma from the accident, they are legally unrelated — which is not the case. Even if your neck symptoms were caused by reflexive tightening of your neck muscles due to your lower back pain, they would be “accident-related” (this assumes, of course, that your neck pain wasn’t traumatically induced).

      I can’t say why he would be so quick to rule out an accident-related cause. You may want to get a second opinion on that.

  6. Joan says:

    I was in a car accident five months ago. I didn’t want to hire a lawyer at first. I saw a doctor who took x-rays of my knees and said that the x-rays showed no injury. I knew that the pain in my neck and back and knees should go away in a few weeks. However, the knee pain remained after all of the other pains left. So after a couple of months I saw a lawyer who sent me to a doctor on a letter of protection. After two months, the doctor said he was going to discharge me because he didn’t think that I needed surgery and he was a surgeon. He didn’t give me any prognosis other than my knees would never be the same again. He had told me at the previous visit a month before that if I still had pain at the next visit he would order an MRI. He must have forgotten that he had said this. Was he trying to tell me that I am at MMI? Should I get a second opinion? How will I be compensated for the pain that I will probably have forever, as the doctor did say I would need to do the knee exercises the rest of my life? He acted like it wasn’t a big deal, although the exercises are quite lengthy and not part of any regular exercise routine.

    I went to physical therapy for a month and I am not sure if it helped. I continued to have intermittent pain. I am 45. My knees hit the dashboard when I was rear ended and pushed into the car in front of me.

    • fl_litig8r says:

      Your doctor may have been saying that you are at MMI, which unfortunately means that you can expect knee pain for the rest of your life. Surgeons usually don’t shy away from surgery if it’s at all indicated, so it doesn’t sound like he thinks you have a meniscus or ligament tear. Of course, an MRI would probably be wise to confirm this. Before you get a second opinion, find out what your current doctor’s diagnosis is (aside from “knee pain”, which isn’t a real diagnosis), and see if he’ll order the MRI.

      Without an actual diagnosis, it will be harder to explain causation (relation to the accident) and your prognosis for future pain and need for treatment. If you are in a no-fault state, you will likely have to prove that your injury is permanent before you can recover pain and suffering damages. Therefore, I wouldn’t wait too long before trying to get some doctor to give you a diagnosis and opinion on causation.

  7. Cookie says:

    I had a slip and fall as a letter carrier claim was accepted in 1987, I passed a steno test which eliminated a modified position, my claim was then closed? I was also in the military (reserves) and the fall injured my back and neck. I also did an active duty tour and throughout the military was on profile and aggrevated my injury running and doing pt, my knees neck and back have bother me for years now, i am a disabled vet and have never received MMI, I am still employed administratively at the po (i returned after military tour) Im 2010 I went to a DR for MMI, my knees, depression, back are all VA disability as a result of my initial fall and I consistently for 20 years have received chiropractic treatments, therapy, psycotherapy , theraputic massage, for temporary relief, am i elible for mmi

    • fl_litig8r says:

      I’m not really sure what you’re asking. When you ask if you are “eligible for MMI”, it sounds like you think that MMI is some type of monetary benefit — when you say “I went to a DR for MMI”, it sounds like what you really mean in an IME. Whether you are at MMI will depend on whether your doctors think your condition can be improved through further medical care. If it can, you aren’t at MMI. If you won’t improve any further, even if you still need medical care to maintain your current condition, you are at MMI.

      If you’re asking what comp or VA benefits you should get, neither of those are my specialty so I can’t really say.

  8. 572 says:

    Thank you for your site. My MD has indicated I have reached MMI after four surgeries and I received a rating from my doctor, with the understanding I will need an additional surgery in the future. The defendant’s attorney requested an IME, which I had done. My attorney is recommending I have the next surgery soon in order to help with the settlement offers, but wouldn’t I have to wait another 6-12 months after that surgery to reach MMI again?

    • fl_litig8r says:

      If you need another surgery, I question whether you’re really at MMI in the first place. While you could be at MMI if you’re not going to need another surgery for 10-20 years, as in the case with knee replacements and their future revision surgeries, or if you’re being given an MMI rating in the event you choose not to have the future surgery, if you definitely need another surgery and you’re definitely going to have it, in my opinion you’re not at MMI anyway. In that case, you should have the surgery before settling, even if it pushes back your real MMI date. You want the defendant to pay for any unforeseen complications which may arise from the next surgery. Assuming the surgery goes as planned, it may not be 6-12 months before the doctors can evaluate your recovery well enough to put you at MMI — it really depends on the type of surgery and your individual recovery.

      You should discuss the fact that you want to make sure you have no complications from the next surgery before getting into serious settlement negotiations. Don’t let him push you into settling before you’re comfortable that you know the ultimate outcome of your treatment and what your future medical needs will be.

  9. BAG says:

    Howdy. I am about to settle a PI claim that I have been representing myself on. Question: Upon receipt of settlement money and paying off the medial liens to the surbo company (and ultimately Aetna), can I rest assured that if my back injury requires future medical attention, Aetna will continue to cover me as it did pre-injury/pre-claim? Or will I be expected to pay 100% of any medical bills I accrue that may be deemed related to my accident/injury?

    Great site, BTW!

    • fl_litig8r says:

      Normally, insurers are happy getting reimbursed for just the past medical bills and don’t withhold payment of future accident-related care. That’s not to say that, in theory, they couldn’t, just that in my experience they usually pay for future care without any problems.

  10. BAG says:

    Thanks so much! I truly appreciate what you are doing here.

  11. sh says:

    Wow.. thanks for the great blog.
    I had 2 rear end accidents each 2 months apart. I was already going to PT for the first accident when I got hit again!
    How do I determine my MMI from the 1st accident when it was aggravated again by the 2nd? I would claim the 1st set of bills on the first accident but after the 2nd the PT bills become less clear. How best to play this with the insurance companies? These 2 cases are too small $ for any lawyer to pickup (and I’ve tried). I also have video of the 2nd accident (from a $80 car camera I installed after the 1st accident). The video includes GPS and speed data and video out the front and looking back at me the driver (you can see the truck hitting me in the back window).

    • fl_litig8r says:

      You and your doctor are just going to have to give it your best shot as to apportioning the damages between accidents. In Florida, the law is that if a jury cannot determine how to apportion damages between two accidents, they are to fully compensate the plaintiff for all damages from the time of the accident against whichever defendant she chose to sue (you don’t get to recover twice, but you can choose to sue just one defendant if you wanted, and still get fully compensated for both accidents). I’m not sure how other states handle this type of situation, so you should see if your doctor is willing to apportion the treatment between the accidents. If he can’t, then just use your best judgment based on how you felt right before your second accident and then after, also comparing the relative impacts from both accidents. Then let the insurers know how you see apportionment of the damages and see if you can get them to agree to the percentages each should pay. It’s going to be a pain, as you’ll have to try to get them both on the same page as far as the amount and apportionment your damages, but the only other option is to let them keep pointing the finger at each other and just delay the process while you foot the bill.

  12. sh says:

    Thanks- is the best course here to actually tell the 2 insurance companies about the other accident? Right now-they don’t know about each other. I’m still sorting out the car damages with the 2nd one. Any insight on general damages and negotiations in this complex case? I feel like to matter how well I document the direct medical expenses they are still going to point fingers over the general pain and suffering. Otherwise I have to take them each to small claims ($10k limit in CA).

    • fl_litig8r says:

      I can’t imagine either insurer offering anything to settle the BI claim without seeing your medical records, which will reference the other accident. They also have their own claims search abilities which would reveal both accidents. So, there’s not much harm in telling them up front about it. If you try to hide it, there’s a 99% chance they’ll find out anyway and your credibility with them will be shot.

      As far as evaluating your case and negotiating, see this article on how to value your case and this one on settlement demands. If you’ve been paying your medical bills with your health insurance, be sure to read this article on paying back your health insurer. That enough reading for you? If not, you may want to see my site guide page, which organizes all of my articles by topic.

  13. sh says:

    You’ve been great-thanks again. Just for my understanding when we say “medical records” are we talking the bills witch list out a SUMMARY of the prognosis,treatment, meds, and charges or do I actually have to give them all the notes the dr took? Not that there will be too much difference in this case-whiplash,rest, and PT for both. I went right back to the dr after the 2nd accident to confirm the aggravation injury.

    • fl_litig8r says:

      When I say medical records, I mean the full chart, including the doctor’s notes from each visit. That being said, considering that you are representing yourself, it’s likely that the insurers will want you to give them a medical release so they can get the records themselves — they often don’t trust lay people to send them all of their own records. So, before you go to the expense of obtaining all of your medical records, it might be a better idea, given that this is a soft tissue case, to just send summaries and bills for now and give them a release if they ask for it.

  14. Barbara says:

    Wow, you give great advice and do I ever need some. My 55 yo brother-in-law (BIL) was in an accident on 11/8 where a Mercedes SUV cut him off on his scooter. He was airlifted to hospital and had multiple broken bones (hand, femur, shoulder, crushed knee caps requiring removal) and brain injury resulting in left body deficit (doesn’t move). I’ve been appt as his Emergency Temp Guardian by the court. These are the facts so far: Crash report indicates that he was not at fault and driver of Mercedes made improper turn and failed to yield right of way (no tickets issued – no idea why not). Both driver and owner of car are Finnish residents from Tallinn Estonia. By end of Nov., my BIL’s hospital bill was in excess of $450k. Progressive Auto insurance is prepared to tender the $250k policy the owner of the vehicle carried on the car. The owner of the vehicle was Entrepreneur of the Year 2010 in Finland and a main owner of a construction company worth $100M that builds roads and bridges and was recently purchased by Shanska (international $100B company) and he is the Regional Director for Finland. I’ve googled reports that he earned in excess of $6M in 2010. Bottom line: he’s got resources. To my surprise, no umbrella coverage (couldn’t believe it – what is it? $200 a year?). So here we are … my questions are these: 1) my BIL currently has no insurance and they want to process him for Medicaid. Now I know this sounds like crap, but it seems Florida is undecided on the Ahborne which is about to be contested in the Federal Supreme Court and even with the Medicaid negotiated per diem rate, it could eat up the settlement if all we can get is the $250k. There is no question that Medicaid would be able to attach his settlement, but if we don’t apply for Medicaid, can the hospital (private) attach? I thought I read that Florida made changes to the hospital lien laws. I am not talking about leaving them hanging, but if they are unable to attach, it seems there would be an opportunity to negotiate a reduced amount (much like insurance or Medicaid would do) after settlement. I already have a PI attorney and a Guardianship attorney, and I would prefer not having to hire a Medicaid attorney, etc. It seems like the system is set up for everyone except the plaintiff – how can anyone NOT think it’s a good idea to prorate? That’s just insane. My BIL is the one that has no kneecaps. 2) If he doesn’t apply for Medicaid and gets a settlement and applies for Obamacare pre-existing insurance – does he have to worry about the Medicaid waiver limit? I mean, if he can pay for his own insurance, wouldn’t that be sufficient? It seems like if he does that we wouldn’t have to worry about the SNT or the court-appointed guardianship requiring a guardian attorney and we could just go on about our lives. No? It think it’s going to be hard enough to attach people in another country and he’s got the money to fight the thing — and if we go to court, then we’ll have to pay 40% to the lawyers plus additional expenses.
    Trying to act on behalf of my BIL’s best interest isn’t something that I need the court to “oversee”. I would like to know if the doc’s say that my brother in law can grant me or his brother power of attorney and get rid of the Guardian attorney and the expense that goes along with that. We just want things to be simpler. And we want to have something left over for my BIL after the attorneys and the hospital and medical bills. I know that my questions are kinda all over the place, but I think you know what it is that I’m asking.


    • fl_litig8r says:

      I don’t want you to think that I’m ignoring your question, but you’ve asked a series of very difficult questions in areas of either obscure or unsettled law. It’s going to take me a little longer than usual to formulate an intelligent response (also, my internet connection has been down and I’m having to access the internet using my cell phone as a wi-fi hotspot, so my research abilities are very limited right now). Check back in a few days and I’ll give you m best answers. Sorry for the delay.

    • fl_litig8r says:

      I’m going to start with the (relatively) easiest question you asked: the state of Florida’s hospital lien laws. The short version is that the Florida Supreme Court issued a ruling last year (pdf warning) that held that special state laws purporting to create hospital liens for what were essentially private contracts between hospitals and patients violated the Florida Constitution. However, county ordinances which did the exact same thing (as long as they were not enacted pursuant to the special state law) are enforceable. So, as I see it, the issue in your case is whether the county in which your hospital resides has enacted an ordinance granting the hospital a lien. This website is an excellent resource for researching county ordinances. If there is no such ordinance, I would assume you are in the clear from a hospital lien (though as you know, this doesn’t mean you don’t have to pay — just that the settlement funds cannot be attached prior to disbursement).

      With respect to Medicaid liens and the Ahlborn decision in Florida, as you’ve already noted, this is still an area of unsettled law. It appears that the 2d and 3d DCAs (District Courts of Appeal) hold that the Florida Medicaid statute’s manner of dividing a settlement still applies, despite Ahlborn. The 4th and 5th DCAs have held that, under Alhborn, a plaintiff should be entitled to present evidence to reduce the Medicaid lien beyond the method contained in the statute. No word from the 1st DCA, yet. So, if you are located in the 2d or 3d DCA, currently Ahlborn won’t be applied in your case. If you’re in the 4th or 5th DCA, you have a much better chance at getting an Ahlborn reduction. The 1st DCA is up for grabs. The Roberts case (pdf warning) from the 4th DCA (October 2012) contains a good discussion of Florida Ahlborn decisions. The Florida Supreme Court will need to resolve the conflict among the DCAs. Until then, the trial courts will follow whichever DCA they fall under (leaving 1st DCA trial courts free to choose between how the other DCAs have ruled for the time being).

      So, whether you should push for Medicaid to pay your brother’s hospital bill is a big mess of an unanswered question which depends in large part on whether there is a local ordinance giving the hospital a lien and what DCA you are located in (to see how Ahlborn may apply). There is also the issue of Medicaid reducing the hospital’s bill prior to payment — a reduction you probably won’t be able to match negotiating on your own if you choose not have Medicaid pay. Would the Medicaid reduction to the hospital bills offset the risk of having to pay the full statutory reimbursement amount to Medicaid should Ahlborn not apply? This isn’t an easy question to answer. You shouldn’t have to hire a special lawyer to deal with this. Hopefully your PI lawyer can provide the necessary guidance.

      Of course, before you start considering these tough choices, your lawyer should explore how difficult it would be to serve the foreign defendant with process according to Finnish law and how difficult it would be to domesticate a U.S. judgment in Finland. I’m far from an international law expert, but I know that generally democratic countries enforce each others judgments under principles of comity. For a judgment to be enforced in a foreign country, the U.S. court must have personal jurisdiction over the defendant (which you will have under Florida’s long-arm statute due to the accident occurring here), you must serve proper notice of the lawsuit to the defendant (which will need to be done under Finnish law unless you can catch him while he’s in the U.S.), the trial must not be fraudulent (shouldn’t be an issue) and the result must not offend the public policy of the foreign country (often punitive damages will run afoul of this).

      So, while it may be a pain in the ass to go after this guy while he’s in Finland, it is probably doable. It may require the hiring of a Finnish lawyer to help with service of process and domestication of judgment issues, but if the defendant is as rich as you say and your bother is as hurt as you say, it may be worth it.

  15. Thomas says:

    I have a few questions. First I injured my shoulder and had a labrum repair and my surgeon gave me a 0% disability rating which I disagree with. 2012 I injured the same shoulder and again needed a labrum repair and repairs from first surgery was ripped and needed repaired. 2nd now I am on light duty and employer is asking me to go to therapy and dr off work. My therapy is 6 hours a week can they make me use my own time? I am in Florida if that matters. Also how do I get the original rating reviewed. I have not received a rating for my new injury yet and just had surgery in dec 2012.

    Sorry my first shoulder injury was in 2011. Less than one year before my 2012 injury.

    • fl_litig8r says:

      I am not a workers’ comp lawyer, so I can really only answer questions about general principles that area. Yours are a bit too specific for my level of knowledge, so unfortunately I’m just going to have to suggest that you get a free consult from a local workers’ comp lawyer. Even if you don’t need a lawyer right now, I’m sure most of them would be willing to answer your questions in case you need a lawyer later or just to create good word of mouth for their firms. Sorry I couldn’t be more helpful, but no answer is better than the wrong answer.

  16. Big K says:

    Hi. First I would to say I know you are not a workers comp attorney no need for the disclaimer. Lol. But if you can help me out that will be greatly appreciated. First I had a accident at my job Feb 4,2012. I re injured my lower back from a car accident back in 2002 that settle out of court in 2006. I also injured my ankle as well in 2012. I was out of work at least 3 weeks not receiving no workers comp check. I did receive some PT for 1 month then I was cut off. Keep in mind I have a very good workers comp lawyer, the same who represented me back in 2006.
    I had some few tests done by my doctors. I also had just had a exam with a IME doctor better known as the their insurance “DOC”. He tried to butter me up by saying I’m here to help you not hurt you. I answer all the questions honestly and to best of my ability, I describe my pain in my back and ankle so forth. But it’s been well over a year I have not receive not one silver nickel. My lawyer said the case is moving because the first step in settlements talks are, being seen by their doctor and receiving a rating which I have yet receive. My questions is when do you think something will transpire if anything will transpire.
    Also the state is NJ

    • fl_litig8r says:

      If you just had your IME, I would expect that the doctor should have his report completed within 30 days of the exam (if not sooner). So, hopefully, you’ll at least know how much of a fight you need to put up within the near future.

  17. Big K says:

    Also I would like to purchase your tip, please explain to me the steps to do so?

    • fl_litig8r says:

      I wouldn’t really recommend it for worker’s compensation cases. There are differences in the way these cases are handled from standard personal injury cases that would seriously impact the tip’s effectiveness. Sorry.

  18. Kwon says:

    Hello, I hurt my back (Hern disc L4-L5) in 2005 and receive a settlement (2006) based on the WC, MMI, etc……… I was able to continue PT for 2007 paying out of pocket from settlement. I was able to return to work back in 2007 and my back wasn’t giving me no real pain. Got into a car accident in 2010 in company vehicle and my back hasn’t been the same since then. I done the PT for almost a year, popping med & the WC doctor suggested a microdisc but I don’t feel to comfortable with him operating on my back due to several people in PT had the same procedure done 2-3 times. So I basically do the PT exercises and pop meds when the pain is killing me. Ok, I started a new job with better growth opportunity so I informed the WC rep and they said it depends on the situation whether or not they will continue with paying for med treatment. They are asking the Dr for an MMI review. what are my opition? because don’t want to get a lawyer involved but not sure how this will play out. also since I got a settlement in 2006 will that affect the claim in 2010? Sorry for the long comment

    • fl_litig8r says:

      It sounds like the 2006 settlement was for an injury that was mostly resolved by 2007, so the new injuries/aggravation from the 2010 should not be affected. Of course, the E/C can always try to claim that there was no aggravation from the 2010 accident and that you are claiming injuries covered by the 2006 settlement — the outcome of such a dispute will probably depend on the treatment you received (if any) between 2007-2010.

      If you’re not willing to have surgery (I’m not in any way saying you should have surgery, just to be clear), then it may not be unreasonable to think that you may now be at MMI — this may be as good as you’re going to get without surgery (not that surgery has any guarantee of making you better, but without it there probably isn’t much else that can be done to improve your condition aside from what you’re already doing). So, having a doctor review your claim to see if you’re at MMI doesn’t sound all that unusual.

      Giving my usual disclaimer that I’m not a worker’s comp lawyer (and likely not even in your state, unless you’re in Florida), I can’t really say what your options are or what to expect. Why are you reluctant to involve a lawyer? It wouldn’t hurt to hit one up for a free consultation to see if he can do anything for you that might make it worth paying his fees. At least you can squeeze some free info from him even if you don’t decide to hire him.

  19. George says:

    Been 5 yrs. had 3 knee surgerys. Still dissabled.6 dr. incuding The WC rating Dr, sai that I needed A total knee. That was a year ago. Called WC spoke to Bryce Johnson and he said That Wc will not give me a new knee because of my age 43. He said because WC would have to do 3 more knees in my life time. So I have another apt. with the same WC rating DR. How can I go after WC for the time and $ I lost from this 5yr. of waitng?I did get rating by my primary Dr. Wc didn’t like the rating so they sent me to their rating Dr. which said that I’m total dissabled and need a new knee a year ago.

    • fl_litig8r says:

      I really think it’s time you talked to a local worker’s comp attorney. In most states, worker’s comp is pretty notorious for not wanting to pay for knee replacements, due to their expense and the need for revision surgeries (new parts to replace the ones which wore out) every 15 years or so. It sounds like you have a pretty strong argument to make them pay for it, but it doesn’t sound like they are going to unless you get a lawyer.

  20. steve schober says:

    I was attacked at job by another worker. my right eye socket was fractured and bone behind ear was fractured. had to have plates put in. I was almost killed. what could i expect back in compensation??

    • fl_litig8r says:

      Well, the first thing you need to determine is whether this incident is covered under worker’s compensation law, which will vary from state to state. In many cases, coverage will be determined by whether the attack was motivated by a work-related dispute (like an argument over job duties) or whether it was a personal dispute that just happened to take place at work (like a man attacking a co-worker for sleeping with his wife). If this incident is not covered under your state’s worker’s comp law, you may not be able to make any recovery against the employer or its insurer unless you can show that the co-worker was negligently hired or retained — this would often require proving that the employer had notice of the co-worker’s violent propensities before this attack. If you can’t recover against the employer under any theory, you’d be stuck trying to recover directly against the co-worker, which in most cases won’t be worth the effort due to the co-worker not having sufficient funds to pay any judgment you might get.

      If you haven’t already, I’d suggest consulting with a worker’s comp lawyer to see if the facts of your case make it eligible for worker’s comp in your state.

  21. Kwon says:

    thanks for the feedback, just heard back from my worker’s comp and their requested doctor gave me a rating of 5% in the amount of 7,500. Now I was under the impression that any MMI settlement would cover future procedures down the line (incase I can’t deal with the pain or my back gets worse). Now, she said I can contact the doctor and dispute his rating but that’s about it. Now, if I was 100% before the 2010 injury (and had no treatment from 2007-2010) and the 5% to me means the Dr is saying I’m 95% better or back at the stage I was before the injury! but I have 2 herniated disks, still leaning, still got numbness in my left leg, and taking pain medicine everyday just to numb the pain. Should I just get a lawyer or continue to be generous by not speaking with a lawyer?
    Thanks ( 5% at 500 for 15 weeks ) = 7,500 something not adding up.

    • fl_litig8r says:

      Whenever you have doubts as serious as yours, you should at least consult a lawyer. Most will give you a free consultation, so you really don’t have anything to lose. You’d hate to find out months down the road that you should have pursued the matter more aggressively.

  22. Keri says:

    My husband fell from a ladder at work approximately 14 months ago fracturing his tibia, fibula and powdering his ankle. He received 3 surgeries. He was receiving wage benefits until he reached MMI and was given an impairment rating of a 4. He was able to work a little after that but the pain has continued to get worse to the point that he can not be on his feet more than an hr or two a day and when he is then he is in severe pain for several days. It has been 5 months since his impairment rating was given. He went back to the orthopedic Dr. today and was told that his ankle joint is basically disintigrating and caving in. We are looking at him having to have additional surgery to either fuse the ankle or have a total ankle replacement if that is even an option. My question is: Can a person’s impairment rating change and is it possible to receive wage benefits again now that he won’t be able to work for some time.

    • fl_litig8r says:

      First, my standard disclaimer that I am not a workers comp lawyer, and that these laws can vary from state to state. That being said, it should be possible to re-open a workers comp case based on a change in condition, as long as it is traceable back to the original injury.

  23. Stephanie says:

    My husband was pulled off a power pole on March 18th and ultimately ended up breaking his knee. We have been told of a “lump sum compensation” check coming our way, but we have yet to understand what this check is for. He was released to work last Friday and had his MMI exam at that point. Where can we find the information as to what this check is about and is there a way to find out how his MMI percentage is determined?

    • fl_litig8r says:

      It sounds like a lump sum workers compensation award, which is often calculated based on the body part injured and his weekly pay. Usually these are determined by assigning a certain number of weeks worth of pay to an injury based on body part, and multiplying that by his weekly benefit (usually 2/3 of his average weekly wage). I’d suggest searching one of the no doubt many web sites which discuss workers comp awards in your particular state, and see if there is a standard award for a knee injury. Of course, there are more complicated aspects to this, such as whether this injury is considered temporary or permanent and whether it is considered a partial or total disability.

      If you can’t find sufficient information on the web to satisfy you that the award is fair, you should at least consult a local workers’ comp lawyer before signing any agreement or release of the claim.

  24. Sherry says:

    My husband injured his shoulder and has received and MMI of 80% from his doctor and 60% from insurance company doctor. his doc said he would probably need surgery again in the future or his shoulder will become useless. If we settle with worker’s comp will they still cover future med bills?

    • fl_litig8r says:

      It depends upon the nature of the settlement. As I say in the article, being at MMI doesn’t mean that no further treatment is needed — it just means that the condition is not expected to improve. Further treatment may be needed to maintain the current level of functionality. Additionally, certain treatments, like hip or knee replacements, inherently will require further surgery to replace the artificial parts that wear out (say, every 15 years). Obviously, it sounds like your husband is going to need future surgery just to maintain his current level of functionality.

      Depending on the state, some will allow the future medical treatment part of the claim to remain open, even if all other aspects are settled. More commonly, the insurer will try to buy out the whole claim, assigning a lump sum for future medical care (this will also involve something called a Medicare set-aside, to be sure that Medicare doesn’t pay for treatment which should rightly be paid by workers comp). If you are unsure as to whether your husband is being offered a fair deal, he needs to consult a lawyer before agreeing to any settlement.

      • Lisa Howard says:

        My husband fell and hurt is shoulder and had operation no other treatment other then using a rope at home. now his went for a impairment rating with no treating dr. every since then he has been in lot of pain and have no treating dr. for pain. What do we do.

        • fl_litig8r says:

          I’m assuming that this is a workers compensation claim (even if it isn’t, the answer will be the same). Call a local lawyer to see what his options are at this point. While workers comp doesn’t pay “pain and suffering” damages, it does pay for medical care to relieve pain and suffering from a workplace injury. If they aren’t providing the medical care he deserves, you need to call a lawyer.

  25. Mike R says:

    Retired military and Government worker. Fell and fractured my lunate bone in wrist at work Nov 2011. First surgery June 2012 inserted a screw; second in Nov 2012 removed screw, then MRI noted a crack; third surgery in June 2012, wrist was fused. Should I ask VA doctor/treating physician for maximal medical improvement (MMI) to submit to OWCP? Is there a format? Not asking for settlement. Not sure if I can afford or need a lawyer. Hoping process with OWCP works.

    • fl_litig8r says:

      I assume that you mean the third surgery was June 2013. If that is the case, it may be a bit premature to say that you’re at MMI, as it often takes months after a surgery to determine that the condition has sufficient stabilized. You could certainly discuss this with your doctor to get a timeframe on when he expects you to be at MMI, which may prompt him to say that you’re there now and file his report (there are specific federal forms for your doctor to file). You can get more information about MMI and scheduled awards for FECA claims here (See #3 – Determining Scheduled Awards). That link will take you to the Procedure Manual for the Division of Federal Employees’ Compensation, which has a lot of useful information about the processing of FECA claims. This manual also has links for many forms, including attending physician reports.

      • Mike R says:

        Thank you very much Sir! I will prompt my doctor and post my response here with hopes that my findings can help someone as you have helped me. Mike R

  26. Robert B says:

    August 2012 I sustained a compensable work injury to my right knee (fracture, [subsequently healed] minor ligament damage, and, according to two doctors [first was original orthopod, second was IME upon appeal] and the MRI report, a “degenerative signal change” in my meniscus, “no surface tear.” Fast forward to today; I recently had another MRI because–and here is my issue–I had claimed since original injury that I had a sharp pain in my right knee–especially when trying to bend down–and this was essentially dismissed. The most recent MRI revealed a grade 3 tear in my meniscus. The sports medicine doc who is currently treating me (who was actually a treating physician for the United States Track and Field Olympic team in Athens in ’04) showed me the two separate MRI’s (2012/2013), side-by-side, exact same image location of knee. in his office. They both revealed the tear. He basically told me that “sometimes doctors get tunnel vision” and focus on one injury–in this case my fracture and slightly strained MCL–and neglected the meniscus evidence/injury. He said “probable arthroscopy” and is referring me off to another orthopod. WC, upon reaching MMI (no impairment rating, ftr) sent me paperwork to sign off on claim. I did no such thing because I knew there was something wrong with my knee as I was still in pain. Now, I have contacted work comp about the most recent MRI findings, and the doctor’s prognosis/plan, and suspect they will deny based on the employer’s history and contempt for injured workers. My question is really straight-forward but I at least wanted to give you a general background: based on the above info would it be prudent to retain the services of an attorney now? I can foresee issues with residual pain and complications going forward (grade 3 chrondomalacia already present, osteoarthritis [44 yr old male], in addition to what might be a subrogation claim at some point. The way I see it, even if WC agrees to cover, I still have issues now with a probable impairment rating, future costs, etc.

    Thank you for your hard work.

    • fl_litig8r says:

      You describe your issue very thoroughly and succinctly (thanks). I would absolutely consult a worker’s comp lawyer now. At least take advantage of a free consultation to let him sell you on why you should hire him now, as opposed to waiting to see how they react to the new interpretation of the MRI.

      • Robert B says:

        This is what I figured. Admittedly I was leaning this way ( a benefit and tribute to your tips, and other people’s experiences and pitfalls ). At worst my own insurance picks it up, and an attorney can help me navigate waters that an insurance company would love me to swim alone in.

  27. gabbs says:

    Question I was injured by door device in landlord building resulting in lumbar and cervical radiculopathy with compressed herniated bulging dics in 2010 out of work ever since and on ssd.My lawyer’s expert dr only reviewed my lumbar mri and not the cervical mri both on same disc because of a 5 month difference time period. Can that be? Should I go to a neurologist of my own for a second opinion?

    • fl_litig8r says:

      I don’t know what you mean by “My lawyer’s expert dr only reviewed my lumbar mri and not the cervical mri both on same disc because of a 5 month difference time period”. Obviously, by disc you can’t mean the same disc in your back, given that one is lumbar and one is cervical. I also don’t know what you mean by a 5 month time difference — difference in what?

      • gabbs says:

        excuse me for the misunderstanding the expert dr. meaning the one who may or may not testify on behalf of my case and he only reviewed my lumbar mri’s and not the cervical mri’s on disk because he said that the lumbar was initial and approximately five months later the cervical mri’s were done revealing more of the severity.From get go my back and neck were disclosed to be injured and was told they focus on one body part at a time at the hospital at time of injury although both would be taken into consideration.all medicals records show no prior injury and in good health and I want to know can this help or hurt my case if the cervical mri’s are to be excluded?should I get a second dr. opinion?

        • fl_litig8r says:

          If there is documentation in the medical records supporting your complaints of both lumbar and cervical pain from the outset of treatment after your injury, the doctor should consider both. I don’t know why both your lumbar and cervical spine would not have been MRI’d at the same time to see which condition was more severe. It seems pretty crazy for a hospital to assume that the lumbar spine should receive priority without having even done an MRI of the neck, given that you complained about both — but there’s no fixing that now.

          It really sounds like the reviewing doctor questions the causation of the cervical injury, so it would behoove you to meet with your lawyer and make sure that he gets the expert on the same page as you. If you have medical records from the hospital documenting your neck pain from the outset, I don’t see causation being an issue, regardless of the fact that the cervical MRI wasn’t done until 5 months later. Now, if the hospital didn’t record your initial complaints of neck pain, that could be problematic when trying to prove that it’s related to the door device injury.

  28. Anneliese says:

    I hope u can provide me with an advice. I had felt at work 3 yrs ago hurt my shoulder, neck and leg. I went to the 1st doctor the insurance assigned me. Dr.#1 took many many x-rays I mentioned everything that was hurting (the leg was not hurting at the moment because I was not walking regularly). The doctor sent me to PT and that is when I told my leg was hurting and reported it immediately to the doctor. After two months I was not improving I requested a referral to an orthopedist. (dr. #2). When I went to Dr. #2 he received papers to treat only for the shoulder and neck. Dr. #2 did an MRI I have a bulging disk and he gave an MMI for degenerative disease. (I NEVER had a neck problem in my life ) The shoulder was not treated and the leg Dr#2 did some tests after I called WC office and they spoke with the insurer. They did different exams EXCEPT an MRI to see the damage cause in my lower leg. Dr #2 gave me an MMI and told me “You well get better soon”. Practically he kicked me out of his office. All that took place from Sep. 2010 to Feb. 2011. I didn’t know what to do so I went to an attorney and took my case. We did the one time change doctor (dr.#3). I went to dr. #3 the first thing he said he won’t do surgery … I was surprised by the comment but I ignored it. Dr.#3 prognosis .. I had a sprain ankle and sent me to PT. After 3 weeks of PT, the physical therapist told me I will need to do the exercises at home. After 4 months I got better and dr#3 provided a 3% MMI for my leg. Again I reached out to my attorney a deposition was done I was sent to dr #3 AND he was not happy. He refused to do anything to my leg, he took an x-ray of my shoulder he found a bone spur and injected my shoulder with some medicine and the pain went away. Then he couldn’t treat my neck because he is not a neck doctor. Dr.#3 referred me to a Pain Management doctor (dr. #4). To me a pain management doctor is a drug supplier. I am in worst pain from the day I felt. DR#4 prescribed very strong medications; I was falling asleep at work, I was unable to concentrate and I was in Mars. When I found out that I can get in trouble if I get in a car accident I stop taking them. Took me a week to get back to normal. The answer to any request is NO, no pt, no MRI of the leg just mild medications that get me a good night sleep (sometimes). I am not pleased with the treatment but my attorney says that is all that can be done because they are teh doctors (even thou I am the one in pain). I need PT on my neck NO, I want a high back chair at work NO. My attorney implied I am lying about my symptoms and Dr #4 implied if I complain to much my employer could fire me for any reason here in Florida. In a nutshell that is my case. Currently the neck injury is affecting all the upper body; headaches and muscle spasms.The leg is getting worst by the day when I walk I am in pain and after one minute standing I am in pain. The doctor that performed one of the tests said something is wrong with my leg but more test an an MRI is needed Dr. (4) refused to do the MRI. My question to you … what else can be done? I believed MMI was reached without exhausting all that can be done medically. Waiting for your response 🙂

    • fl_litig8r says:

      First, know that I’m not a workers’ comp lawyer. Seeing that you already used your option to change doctors and didn’t wind up with a better one, I don’t know if there’s anything else to do. I am a bit confused about your leg. You said in one part that Dr. #3 diagnosed a sprained ankle and sent you to PT, after which you got better and were assigned a 3% permanent impairment rating for the leg. Then, without saying what happened, you go back to having complaints about your leg.

      As far as neck surgery goes, I can’t really find fault with the doctors not wanting to do surgery. Unless you have radiculopathy (usually hand weakness or sporadic loss of control when a cervical injury is involved), which you don’t mention, I don’t know that surgery on your disc will do you much good. I’ve seen many cases where people who had disc surgery when their only complaint was pain come away with no relief — in fact, some have worse pain afterward, or have radiculopathy afterward when they previously had none. Your complaint of spasms sounds more like a soft tissue injury to me, which can take a very long time to resolve. I’m not aware of any treatment options available to speed the healing process of a soft tissue injury — often pain management of one form or another is the only way to obtain relief while your body heals. While pain management doctors have a bad reputation, especially in Florida, for pushing pills, they do provide other non-narcotic treatments such as trigger point injections which may be worth trying.

      As far as you being placed at MMI without exhausting “all that can be done medically”, that’s really not the standard applied in workers comp cases. You are only entitled to receive treatment which is “medically necessary”, based on current prevailing medical standards. While I’m confused about what’s going on with your leg currently, I haven’t heard anything so outrageous about the suggested course of treatment for your neck to think that the doctors are departing from the generally accepted standard of care. Surgery may not be indicated or helpful for your condition, and if you won’t accept pain management, I don’t know that there’s anything else that can be done. That’s really more of a medical question than a legal question, but just based on my own experience representing people with these kinds of injuries, the doctors may be doing all they can for you.

      • Anneliese says:

        Hi fl_litig8r,

        Thanks for your response. I know you are not a lawyer but you know more than anyone I know. I am doing a lot of research and your answers are correct. You are not a lawyer but you are a person with extensive knowledge of how things works with WC, so I gave it a try. Thank you so much for the time you dedicate to respond to my question as well as your dedication to the website.

        My reply to you:
        In relation to my neck I don’t want surgery but they do not allow Physical Therapy either. The PT referred by Dr #1, was done to help with the upper back pain caused by inflammation and muscle spasms, DID NOT treat my neck. Dr. #2 sent me to PT for my neck but the treatment was not long enough. The physical therapist tried to do the cervical traction but I was in awful pain she stopped. They wanted to gradually move me to do the cervical traction. It was going to be a painful and a long treatment. But when the two weeks passed Dr# 2 denied to extend PT instead I got the MMI. Why? How do they know if cervical traction it was going to work or not? Currently the middle, the sides and the center (back) of my neck are in pain. The pain extends to my shoulders and the upper back, it causes muscle spasms and headaches. I still do the stretching exercises I learned three years ago. I need professional help that WC doctors is not willing to provide.

        My Leg:
        Few days after I felt I told Dr#1 about the leg pain I pointed to the tibialis anterior (I didn’t know the name back then) he just said to continue to wear my tennis shoes. That is why I was surprised when there was not mention of it on the referral to Dr #2 . Dr# 2 requested a Bone Scan and X-ray his findings: no fracture and no nerve damage instead and MMI. Then we go to Dr.#3 that said the leg pain was caused by an untreated sprain ankle and as soon as the ankle gets better the pain will be gone. The ankle got better but the tibialis anterior pain not. After three years I decided to go to MY orthopedist and he believes is my meniscus (two doctors already think that). Previously I asked Dr#3 to do an MRI of the lower part of my leg to see the entire leg he said no ALL tests (not MRI) were done and they are negative. They looked at the nerves, Bone Scan, Nerve Conduct test, MRI of my lower back NOT the leg, x-rays tons of them. Each time I perform a test I asked the doctor if they can see if they can see any damage in the tibialis anterior they all said no you CAN NOT see muscles with this test. In asked the question to the last doctor that perform the nerve conduct test and he said: ” by the way you stand, walk and position your foot it could be the meniscus or arthritis but further tests are necessary”.
        What I am looking for is a way to have them look at my lower limb perform the MRI so we can move on. My current WC doctor,Dr #4, refuses to do anything except prescribe medications. My attorney is useless I believed he thinks I am lying no one will speak with me because I have an attorney. The only option is pay $1,000.00 to an independent doctor (he knows one) that will perform an exam do the MRI and write a letter. Oh and it will be discounted to $500.00 because is his friend. This issue concerns me because sometimes my leg blocks, and I trip with my own feet. I am afraid to fall and hurt worst. That is why I would like to know if I can dispute the treatment done. They have not exhausted all they can do. I am not a doctor but I am not idiot either. I don’t understand, doctors suppose to find the cause and treat you regardless of the insurance you carry.

        Thanks 🙂

        • fl_litig8r says:

          When I said I wasn’t a workers compensation lawyer, I think you misunderstood. I am a lawyer. I just don’t practice workers compensation law, so my knowledge in that area is limited.

          I can’t say why the doctor ended your physical therapy for your neck when it seems that the physical therapist wasn’t done with you. Sometimes doctors will rigidly believe that “x” amount of treatments are all that is reasonable for a certain type of injury, regardless of how the patient is responding. This would be something worth disputing through your lawyer.

          As to the leg, the only option I see for you at this point is to have the doctor recommended by your lawyer perform your own IME, so that you establish grounds for contesting the E/C’s doctor placing you at MMI. $500.00 for an IME sounds pretty cheap. Without a medical opinion to back up your claim, I doubt that your lawyer will be able to contest the workers compensation doctor’s opinion and get you the additional treatment you need. While this $500.00 exam by a doctor friend of your lawyer sounds shady to a lay person, sometimes this is the kind of thing you need to do in order to get a fair result. Doctors who accept workers compensation patients know that if they don’t play ball with the E/Cs and keep their costs down, they won’t get referrals from those E/Cs down the road. It sounds like you need your own hired gun to compete with their biased opinions.

  29. Margo says:

    I had several surgeries for a knee injury in 2010 to 2011 I was released and received my MMI. I went back to work and about a year later I fell again at work and hurt the same knee. My question is am I going to be eligiable for another MMI payment or will the insurance company take it due to be having been paid one on the knee before.

    • fl_litig8r says:

      You are allowed to recover for an aggravation of a pre-existing condition. If you had previously been assigned a permanent impairment rating for the knee, you can only recover for the amount of additional impairment above that (and related medical bills) that you now have due to the new accident.

  30. Pamela says:

    I had a work injury where my right finger wascut almost off and crushed now I have nerve damage and is limited to light duty no physical work.it has been 2 years and I have not received compensation I have a lawyer but they are not working for me .what can I do?

    • fl_litig8r says:

      If you reached MMI, which after two years I would expect that you did, I have no idea why your case hasn’t been resolved. The injury, while bad, is fairly straightforward. It’s not like a back injury where one would expect some dispute as to its severity.

      The first thing I would do is set up a face-to-face meeting with your lawyer to see why this hasn’t been resolved. If you’re having trouble getting hold of him, see this article. If you are not satisfied after that meeting, I would ask him to voluntarily withdraw from representing you so that you can obtain other counsel without having to worry about still owing him a fee.

  31. harold decker says:

    hi my name is Harold. i was stabbed with a knife in my left wrist at work by a co employee.
    on 6-27-2011 I had surgery on it and I still have no feeling in my left hand on the medial nerve side and zapping, with pain from fingers to shoulders. on 12-12-2012 went to my doctor office with my wife and a nurse case manager that was assigned to me by work comp. my dr said to me and my wife that my nurse case manager is a liar as she was pushing for me to get a mmi done so I could have some money for Christmas. my dr was mad at her and let her and us no that I was not ready for a mmi due to I needed more treatment. Almost one year later that same dr sent a mmi rating on my left hand dated on 12-12-2012 to work comp. i was in my dr office for 3 min max when he was calling case manager a liar for 2 min of that time and the last min of our visit was him telling me that I need more care and referred to another specialist …..so my question is can a dr give a mmi on a patient without even touching me on that day in his office or testing of any kind?

    • fl_litig8r says:

      Without knowing everything this doctor had to review with respect to your case, I can’t say whether his opinion that you were at MMI is questionable. I am a bit confused as to your timeline (you talk about one year later, but both dates you give are from December 2012 — I assume the second should be 2013?). Did this doctor treat you for a year and send you to the specialist as discussed? Or did he only examine you once, give you the speech about the manager being a liar and say you needed more care only to turn around and put you at MMI that same day? This is where my confusion about the dates you provide causes problems.

  32. harold decker says:

    I have report from surgeon dated on 12-12-12 stating he refers me to nerve specialist in St. Louis, MO. And told us I wasn’t ready for MMI. But when mediation with work comp came, THEY have a MMI report from same surgeon that I didn’t received dated 12-12-12, but noticed on bottom of that report, it was faxed to work comp almost one year later. so what I’m saying there is two papers from same surgeon dated same day but stating different.

  33. harold decker says:

    I talk to you last week on my surgeon gave me a mmi.i have the proof I need can I bring dr or his company up on any charges

    • fl_litig8r says:

      If you’re talking about criminal charges, I doubt that anyone would be interested. It might be worth bring to the attention of your state worker’s compensation board, but keep in mind that it’s going to be your and your wife’s word against the doctor’s, if he chooses to deny that he told you you weren’t at MMI. If you have a lawyer handling your case already, I wouldn’t do anything without his knowledge and consent.

      • Harold Decker says:

        I talked to you last week and since then, I have an app on my phone that allows me to record any call outgoing or incoming. I talked to me Surgeons receptionist regarding getting appointment through nurse case manager and she stated she entered a file of conflict about scheduling appointments which cause 8 months of delayed time. She stated work comp and office manager removed the file in front of her and she almost lost her job for writing her conflict. Removing something from my records breach the hepa law in any way?

        • fl_litig8r says:

          HIPAA really only governs the privacy of patient records, so that likely wouldn’t apply. It doesn’t sound like what the case manager filed was a medical record anyway. That’s not to say that this information wouldn’t be useful in your workers compensation claim — to show the bias and dishonesty of the doctor and carrier — just that I doubt that it would provide grounds for any independent claim. Have you brought this information to your lawyer’s attention?

  34. D Ward says:

    I got hit by a truck that didn’t see me in time to brake while I was crossing an intersection. I have no car, no insurance and live in the state of Florida. I was taken by ambulance to the hospital immediately and have been in the hospital once since with migraine, vomiting, and speech problems. I am seeing a chiropractor 3 times a week and looking for a gp and a nuerologist as instructed by the hospital. I am, in my opinion, severely injured. Both of my hips, my spine crooked from tailbone to base of head, one knee, my shoulder, limited range of motion, only able to walk short distances with a cane, and as I mentioned severe migraines and nuerological problems. I have a good lawyer, the driver of the truck that hit me is not denying negligence, and his insurance is State Farm. I’m a self employed housekeeper and unable to work. I’m wondering what your opinion would be on how long this could take because I can’t pay my bills right now….

    • fl_litig8r says:

      Obviously, there are many factors which play into how long a claim/lawsuit can take. Two of the most important are the policy limits of the at-fault driver and how long it takes you to reach MMI. If the driver has clearly inadequate policy limits, given your degree of injury, your claim could be resolved rather quickly as the insurer will tender those limits. Obviously, this is not what you want, because it means you’re getting (perhaps a lot) less than your claim is worth.

      How long it takes to reach MMI depends on your injuries and how well you respond to treatment. It doesn’t really sound as though your injuries have been adequately assessed at this point, seeing that you’re still looking for a neurologist. Usually, it will take at least 6 months (and often longer) of treatment to reach MMI from a serious injury. If you require surgery, you need to add the amount of time it takes to obtain the surgery and see how well you respond to it on top of that.

      Even after you’ve reached MMI and you’re ready to settle, there are plenty of factors which could delay or prevent your claim from settling. Even though the defendant has admitted fault in your case, it can still challenge other elements of your case, such as causation (did the accident cause all the injuries you claim), the extent of your injuries and the appropriateness of the care provided. I discuss why “admitted fault” cases can still be difficult to resolve in this article.

      I would expect there to be some contention over any wage loss claim you make due to the fact that you’re self-employed. Because you can’t simply point to a paycheck and how much time you missed from work to establish your earnings, proving lost wages for the self-employed is often much harder to do. Differences between how much you gross versus how much you net, market conditions which could cause ups and downs in your business that could also explain lower wages, and issues such as whether you could have hired someone to fill in for you during your disability come into play. This is aside from the fact that many self-employed individuals’ tax returns won’t withstand any level of scrutiny. Claims made to make your income appear lower for tax purposes come back to bite you in personal injury cases.

      That’s a long way of saying that I really have no idea how long your case will take to resolve. There are too many variables in play to even ballpark such a thing.

  35. mike says:

    what criteria is used as a bases to determine your MMI rating. Is it weakness, range of motion I can not find an answer to this question could you help me.

    • fl_litig8r says:

      Many states use the AMA Guides to the Evaluation of Permanent Impairment, which contains guidelines for doctors to evaluate numerous different impairments to different parts of the body (and how to merge them to reach a whole body impairment rating). The tests and criteria will vary depending on the nature of the injury and the body part involved. The reason you can’t find these criteria online is because the AMA charges $194.00 for this book (though Amazon sells it for $140.65 as of the time this comment is made), and it is copyrighted.

  36. joe says:

    I was injured on the job in august of 2013, seen company doctor for 4 months before getting a different doctor, after a couple months of tests & bad weather finally had surgery on my right shoulder (dominant arm) in mid febuary, it’s now coming on june & had 4 wks therapy, then 3 wks of work hardening, now half way through another 4 wks therapy/work hardening, my shoulder still has allotta pain under strain & popping & clicking. I had a labral tear, debridement from 8 Oclock, to 1 Oclock, & synovitis, how much more therapy or whatever before i’m at MMI

    • fl_litig8r says:

      This is really a medical question, not a legal one. Your treating doctors are the ones who put you at MMI, and that depends on how well you respond to the treatment prescribed. I hope for your sake that you’re not at or near MMI if you’re still having such problems — because if you are, that means they’re likely permanent.

  37. joe says:

    How much therapy (is normal) when they decide MMI is there a normal guide line as far as length of time most doctors use? I’ve personally never been so sick of therapy, the more they have me do the worse it hurts & more swolen it get I was previously at 4hrs a day, in those few hrs I found massage & stretching would help relieve the pain, I think it had alot to do with the initial (my arm was at rest) cause as soon as i’d go back to my normal therapy the pain & swelling would be right back. I was told by 2 other people I should request another Artheogram MRI to see if something was left behind? Trying to get another opinion? It literally &or physically hurts with any movement the more the worse & even worse yet under heavy strain. At Physical Therapy I cant push a sled w/50 lbs in it & sled probly weighs 25 lbs, can’t lift 20 lbs out to a 90 degree infront or out to the side of me. Picking weight up of the floor 35 lbs feels like it’s pulling my shoulder apart it gets worse if I try more weight

    • fl_litig8r says:

      I’m sorry, but your questions are really medical ones that I can’t answer. I haven’t handled so many shoulder injury cases that I can say what’s typical and what’s not. I would imagine most doctors have a timeline in mind which is subject to change based on how the patient responds, but I can’t say what that is.

  38. Gorillamom says:

    I’m 43 federal employment, I have a ca2 for my lumbar herniated disks, I had 2 surgeries, now the doctor want to do a double fusion; I been in physical therapy for 2 months only after 3 months of the second surgery, but my problem is the doctor want me to decide by next week…. if I’m going to do the double fusion now, and look like he have ready my “MMI” if a said NO, because the secretary told me I have your disabilities paperwork ready, I Also request a second opinion with WC with another surgeon, next week. I didn’t want to get a lawyer but I feel scared that the doctor just want to free. What I need to do? Sorry english is not my first language.

    • fl_litig8r says:

      It wouldn’t hurt to at least talk with an attorney. Be sure to find one that specializes in Federal Workers Compensation, as it is quite different than state workers comp, and not many lawyers handle federal. If you’re a “non-appropriated funds” federal employee, you might even have to find a lawyer who handles Longshore Act claims, as non-appropriated funds employees fall under the Non-Appropriated Fund Instrumentalities Act (NAFIA), an extension of the Longshore and Harbor Workers’ Compensation Act — it’s complicated.

  39. InjuredWorker says:

    Hi, I was recently declared P&S or MMI about a week and half ago, and its been 15 months since my date of injury. My adjuster says we need to wait for the doctor’s report to determine PPD if any, and she will give him til October to fill it out. My question is, how long does it usually take a doctor to fill out his report and give me my rating? Can I apply for SSI Disability while I wait? I’m not sure when I will receive any sort of income.

    • fl_litig8r says:

      In my experience, doctors can usually provide an MMI report within 30 days of one being requested. Of course, that’s purely anecdotal and it really depends on the doctor (how busy he is) and how complicated the determination is. You can apply for SSDI while you wait, though the fact that it is expected that you will only be found to be partially disabled doesn’t bode well for your chances, as SSDI requires a finding that you be disabled from performing any job in the economy. There are other factors which may work in your favor, such as age (the older you are, the easier it is to be approved) and transferable skills (the fewer you have, the easier it is to be approved), so I’m not discouraging you from applying by any means. I see no reason to wait if you want to apply.

  40. JB says:

    Hi I am 53 yr old female, I suffered a 5c disc injury 10yrs a go, I did have surgery but now I’m having complication again, can I reclaim a old injury for medical expensive.

    • fl_litig8r says:

      Was this a workers compensation case or a personal injury case (I’m assuming you made a claim of some sort when the injury originally occurred)? If this was a personal injury case, then I’d say you would most likely be barred from any present-day recovery due to either a settlement and release signed back when the original claim was made and/or the statute of limitations. If this was a workers compensation claim, how was your original claim resolved? What did your settlement provide regarding future medical treatment? Also, it would probably help to know what state you’re in.

  41. tony [last name removed by admin] says:

    I got hurt on the job 2010/ received 4months w.m. comp than 8 months disability , filed ssd 2013, I do not have a income. have been in the union for 13yrs carpenters, before my injury. Doc say’s I need a trail stimulater . It has been to long for me to wait .I do see the doc once a month , for meds. That’s all he wants to give me. I want to settle .I do have a lawyer .WM.comp won’t pay me but pays my doc’s appt. How can I tell my lawyer I’m done with all this bullshit.I do hurt . just had another epidural .. I feel depressed ,My wife has two jobs and we have a 13yrold daughter,that I am sure of is depressed, seeing me like this too. Can you advise me what I can do to settle this big problem

    • fl_litig8r says:

      It sounds like you have no more wage loss benefits owed under workers comp, but they’re still paying your medicals, so I don’t know what you want to settle. It may be possible to do a wash-out settlement for your future medicals, but I don’t know that that’s such a great idea, especially if you plan to spend the money on other things, leaving you with an inadequate amount to cover your medical needs. It would also depend on whether the employer/carrier would also be interested in a wash-out — if they’re not, I don’t see that you have any recourse. A wash-out may also require a medicare set-aside (an amount put aside to pay for accident-related medical bills that medicare would otherwise pay, assuming you’re eventually approved for SSDI and medicare), so that may further reduce the amount of money available to you in a lump sum.

      I’m sorry, but you and your lawyer may be doing all you can already. You just need to hold out and hope your SSDI is ultimately approved. If you try to go back to work now, against your doctor’s advice, you could hurt not only yourself physically but also your SSDI claim. You’re not alone in suffering while waiting for SSDI approval — many people experience extreme hardship during this time. Unfortunately, the only thing you can do is bear with it until your SSDI comes in.

  42. nene says:

    i had a deep cut in the right thight went into surgery did physical therapy afterwards was on restrited duty at work got cleared from the doctor from that already but never heard about impairment until someone told me about it so i called the adjuster and he told me the doctor said i had no impairment and now is been two months but i still don”t feel 100 % when i walk i could still feel it bothers me from time to time .. how can i get impairment for that ?? when the doctor already told the workers comp adjuster that i wasn’t gonna have no impairment ??? what should i do ??

    • fl_litig8r says:

      You should really consult with a local workers compensation lawyer about this. If this is your treating doctor who said you have no impairment (as opposed to an IME doctor), it’s going to be tough to overcome. Pain is a factor that doctors consider when assigning an impairment rating, but I can’t say whether yours is sufficient to warrant one.

  43. Janice Hutchinson says:

    I a two level fusion, 360 (front and back cut). I stayed at work 8 months before I stopped working and another year after that I finally had surgery.
    I was given a 10% IR and then my MMI was back dated 8months. My employer now wants $16,971.00 refunded for overpayment of TIBS. Of course I’m appealing and talking to an ombudsman, but has anyone experienced a back dated MMI especially one of 8 months….??

    • fl_litig8r says:

      As far as I know (I’m not a comp lawyer), back dating your MMI date is technically allowed (though the practice is controversial and worth challenging). If I were you I’d consult with a workers comp lawyer ASAP about disputing this. There are often very short time frames for disputing MMI reports (though it seems you are already familiar with the process).

  44. flyhigh2fly says:

    Suffered wc injury in Aug 2003, initially diagnosed as sprain/strain and later diagnosed with cervical bulging discs with bone spur. I constantly complained of symptoms primarily to my right shoulder blade and back, though bulging disks are on the left. During the numerous MRIs to the neck over the years I requested doctor to order MRI of my right shoulder, he refused and insisted symptoms were related to the neck injury.

    After years of injections, medications, PT, etc., I was pressured into settling claim in Oct 2009, included future medical and a reconsideration clause. I continued to treat with the same ortho as symptoms continued and progressed, especially in my right shoulder. In April 2012 after the most recent epidural block did not work, I offered to pay for MRI of my right shoulder. Ortho ordered the MRI that showed multiple tears; rotator cuff repair was performed including bone graft and placement of screw to hold tendon in place. My neck injury has progressed and will likely require surgery but my doctor still pursues the conservative treatment route. It appears he is trying to save face after failure to diagnose my shoulder injury in timely manner.

    Regarding my shoulder surgery, is there any recourse since the rotator cuff tear was not part of the settlement? My right shoulder is very weak with ongoing pain. Thanks so much for any input you provide.

    • fl_litig8r says:

      Even assuming that the shoulder injury isn’t barred by your settlement, I wouldn’t be too optimistic about proving that an injury first diagnosed in 2012 was caused by an incident in 2003. I understand that you complained all along, but whether you would have any chance of proving your case would really depend on whether your doctor documented those complaints. I think it’s worth consulting with a worker’s comp attorney about, but I wouldn’t get my hopes up.

      • flyhigh2fly says:

        I failed to note WC did not deny the 2012 claim, considered it part of initial injury as symptoms are clearly documented over the years. Ortho insisted they were related to the neck injury even though he was perplexed symptoms were primarily on the right but bulging disks on the left. All the more reason to MRI the right shoulder…duh.

        In 2009 I received an MMI perm impairment rating of 15% to the body as a whole. That rating was based on my neck. Since WC also covered the shoulder injury in should there be another rating after rotator cuff surgery? I am in TN.

        Family and friends have strongly encouraged me to sue the ortho for untimely diagnosis that resulted in further damage to my shoulder. I do not want to pursue this avenue but I want to do what is right for me. Prior to the injury in 2003 I was in almost excellent health at age of 42. Now my body functions as someone much older, even elderly. I plan to consult with a WC lawyer but am hesitant since still employed with the same company. I fear it will appear I am after money, which seems to be how WC claims are viewed. Thank you sir for responding.

        • fl_litig8r says:

          I really can’t give you any advice about the likelihood of you being able to recover additional benefits for the shoulder from worker’s comp at this point. I really don’t do any comp work, and I’m not even in your state. Those types of questions are best asked of a local comp lawyer, so you’ll have to wait until you talk to them to get your answer.

          As far as you being afraid of the perception that you’re just after the money, well — you are. That’s what comp is for. No need to be ashamed of it. Retaliation from an employer is a legitimate concern, though. While there are laws prohibiting retaliation for pursuing a worker’s comp claim, as long as the employer waits a sufficient amount of time between the claim and whatever retaliation they plan, there’s a good chance that they can get away with it. That’s something to consider and weigh against the potential benefits of pursuing the claim.

  45. nikki says:

    First off I’d like to thank you for such an informative and open website.

    I’ve been recovering from a car accident and have been waiting to achieve MMI prior to submitting my demand letter to the other party’s insurance and I think I am finally as well as I will get. As I understand it the statute of limitations in California is 2 years which is coming up in a few months. I was wondering how much time I realistically need to have a settlement agreed upon (my insurance and the other party’s insurance have already agreed to the liability being 50/50). Also, at what stage in this process will my job be done in terms of the statute of limitations? For example, by sending the demand letter prior to the 2 years will I be protected in the event that they drag the settlement on and on with negotiations, or what should I be worried about at this point in time?

    I appreciate any guidance you can provide as I handle this case myself.


    • fl_litig8r says:

      To be protected from the statute of limitations running, you’d need to actually reach a settlement agreement before it runs (preferably in writing). It’s not enough to just send a demand and start negotiations before the statute runs. You need to actually settle. In theory, you could have them agree in writing to the statute of limitations being tolled while you negotiate, but the safest route is to either settle or file suit before the statute runs. If I were you, I’d start the negotiations ASAP to allow you time to reach an agreement before the SOL runs, and if you haven’t reached an agreement by the time that there’s a month left (preferably a little longer), hire a lawyer to file suit. It’s likely that you’ll still be able to settle after the suit is filed, so don’t think that filing suit cuts off negotiations. It doesn’t. It just keeps your claim alive while you try to resolve it through further negotiations.

      • nikki says:

        I am very appreciate of your prompt response as time is of the essence for my case.

        What is the typical time frame from the submittal of the demand letter to getting a response from them? It is going to be a fairly straight forward demand letter and at this point I’m fine with 50% fault as I just want it to be over with. I’m assuming the only issue will be recovering the part of the settlement for pain and suffering (cervical strain) as well as potentially requiring future treatment down the road. Are insurance companies known for dragging on these kinds of things in hopes that it will be past the statute of limitations?

        Another question I have is the typical “how much is my case worth”…basically 10k total medical costs (amount was given to me by my insurance company) plus various other amounts for missed work, rental car, etc. which total an additional 2k or so.

        When I make up my demand letter I’m not quite sure how much I want to ask for since I don’t want to low ball it and shoot myself in the foot in the event I need a lawyer and that won’t give him or her that much room to work. I also don’t want to ask for a ridiculous amount and not be taken seriously by the insurance company. Is 2x or 3x of actual costs a reasonable starting point with negotiations for this kind of case?

        Thank you again for taking the time to answer the questions here I know we are all very appreciative.

        • fl_litig8r says:

          Most initial settlement demands from plaintiffs give the insurer a 30-day response deadline, mainly for purposes of preserving a potential bad faith case, and because that’s a reasonable amount of time for an insurer to review the case, assuming you’ve sent it adequate materials in your demand from which it can do so. After that initial demand, how long it takes to settle varies widely from case to case. I can’t say how long it will take for you and the insurer to agree on a settlement figure even if you concede their position that liability is 50/50. Liability is just one of many issues that goes into valuing a case.

          The insurer may or may not drag its heels due to the impending statute of limitations. It’s best that you let it know in your initial demand that you are aware of the upcoming deadline, and that you hope to resolve the claim quickly to avoid having to hire a lawyer and litigate the matter. This way, they know they won’t be able to lull you into sleeping through the statute with delay tactics, and they also know that if they don’t wrap things up quickly they’ll have to pay their own lawyer to litigate the claim you’ll be forced to bring.

          I’ll refer you to my How Much Is My Lawsuit Worth article for general advice on valuing a claim for settlement purposes. I will say that with only $12,000 in economic losses (medical and wage loss) and comparative fault of 50%, you’re obviously not looking at a lot of money. Asking for twice the $12,000 in your initial demand, using the threat of possible future medical costs and your pain and suffering, past and future, to justify the high number, wouldn’t be unreasonable. I think asking for 3x that would be a stretch, especially if you’re trying to get to realistic numbers quickly so you can settle.

          • nikki says:

            Thank you once again for such a thorough response.

            I was leaning towards coming up with a number up to 2x the damages as my initial demand so I’m glad, given the basic details you’ve been provided, that that amount is fairly reasonable. I’m obviously not trying to profit or get rich off of this by any means, and only want to recoup what is rightfully mine and help cover any additional medical expenses I may have down the road as I still am experiencing pain but nothing that will require surgery or anything expensive other than more physical therapy.

            I received all my medical costs from the legal representation of my medical insurance and they also provided me with a lien that they want me to sign and return to them. I noticed in their cover letter they stated that if they are to receive less than the full amount of the lien, they need to agree to the settlement amount prior to me agreeing to it.

            I was initially under the impression that I’d come to an agreement with the insured’s insurance, then negotiate with my medical insurance the amount they are to receive as a result. At any point in the negotiations is it unrealistic to have the legal representation of my medical insurance to deal directly with that of the insured if a settlement cannot be agreed upon?

            I’m just concerned that since now I apparently have to worry about coming to an agreement with both the insured’s insurance and my medical insurance’s legal representation prior to agreeing upon a settlement, which will cause further delays and will make it even more difficult to finalize prior to the statute of limitations running out. I know I’m doing them a big favor by recovering anything for them so hopefully they are fairly easy to deal with but I’ve never gone through any of this before so I have no idea what to expect.

            Also, going through the documents provided by my medical insurance’s legal representation I don’t think they accounted for the prescription costs. Is it best to not worry about that at this point in time (there were only a couple prescriptions for the accident) or should I try to obtain the costs of those as well, if only to prove that I was taking them as a result of the accident?

            Thanks again

          • fl_litig8r says:

            It’s kind of unusual for a health insurer to want to negotiate its lien prior to you actually agreeing to a settlement, but apparently that’s what they want to do (maybe because you’re pro se?). I would actually prefer to negotiate the medical lien before the settlement is made because knowing what kind of reduction you will get really helps you make an educated decision about the settlement — but most health insurers don’t want to commit to a reduction before a settlement is finalized, probably because they fear that a plaintiff will reach a larger settlement than they had been originally told.

            I wouldn’t expect the health insurer to get involved in the settlement negotiations with the liability insurer — nor would I want them to. You’re the only one who can agree to settle the liability case, and only you know what amount will in theory make you whole. The liability insurer likely wouldn’t be interested in negotiating separately with you and the health insurer, anyway.

            Despite the health insurer’s representation that they won’t accept less than the full amount of the lien if you don’t get their prior approval for a settlement, whether they have to accept less than the full amount isn’t entirely up to them. In a case such as yours, where the plaintiff and defendant legitimately agree to 50/50 liability, I doubt that any court would enforce the full amount of the health insurance lien against you. At most, the health insurer should be able to recover 50% of its lien. That being said, to avoid an unnecessary fight it would be best to try to get them to agree to their reduction before you finalize a settlement with the defendant. If they drag their feet in getting back to you, such that it puts you in a position where the statute of limitations is running out while a good offer is on the table, I’d take the offer and then fight the health insurer, if necessary. Don’t just roll over and accept that they won’t reduce at all if you reach a settlement without their prior approval.

  46. nikki says:

    Thank you for taking the time to clarify these things in such a timely manner. I’ll definitely be referring back to your responses as well as rereading your informative articles as I proceed with my demand letter. If I come up with more questions I’ll definitely post them here so everyone else going through something similar can also learn from this experience. Thanks again

  47. kwon says:


    I posted my situation late last year and now that I got a lawyer involved my old employer want to settle for 10k only because the workers comp DR I was seeing changed his mind about a microdiscectomy procedure since getting a lawyer. I was told I have 2 things working against me, i’m still able to work regardless if I’m working in pain everyday and fact that I left last job for a better less stressful position and they will shift the burden to mu current job Now……………I know with the healthcare law have to treat pre-existing injury but what is the estimate cost for this microdiscectomy.

    Thank you

  48. Nurse says:

    Hi I have some questions. I had a decompression with synovialectomy shoulder surgery on my right arm (dominant) in mid June 2014. I am still having pain 4-5/10 during the day and 8/10 at night. I am still unable to drive. My nurse case manager called and informed me she will be at my next Dr appt to discuss decreasing my pain medication as well as my work restrictions. 2-3 weeks ago I recived a call from my Wc case manager stating they cannot continue transportation because I need a Dr note stating I cannot drive. As a nurse I’m worried about returning to work while in pain meds as well as driving. I still don’t have full range of motion either. Can I be sent back to work in this condition? My appt is next week and I go to PT 2-3 times a week. Thanks in advance.

    • fl_litig8r says:

      Whether you will be returned to work really depends on the restrictions placed by your doctor, and whether you can perform your job given those restrictions. Modified (light or sedentary) duty might be available as a temporary solution if your restrictions allow it. Clearly, the issue of the side effects from narcotic pain medication should be considered, especially in a position that especially requires clarity — so that really depends on what kind of nurse you are. I can’t say there are any hard and fast rules regarding this, though. How pain medications affect people’s ability to work really depends on dosage, how the person tolerates the medication and how often they have to take it. This is something that needs to be evaluated on a case-by-case basis. The only thing you can do at this point is express your concerns to your treating doctor and be sure he knows what your actual job duties entail. If he returns you to work and you don’t think you’re capable of it, consult a local worker’s comp lawyer as soon as possible.

  49. Nurse says:

    Thanks for yor help! One more thing what about the driving situation. WC stopped providing it because “I need a Dr note stating I can’t drive”. I’m going to ask my Dr to provide the nurse case manager with one since she will be present. I’m not sure how they except me to get 30 miles to work and I can hardly manage getting 5 miles to PT. Thanks again!

    • fl_litig8r says:

      As you probably already guessed, a lot of this comes down to your doctor and how supportive he is of your claim. When it comes to subjective symptoms, such as how loopy pain meds make you, your carrier will practically always assume that you’re exaggerating your impairment, so having a doctor who believes you and is willing to back you up is key.

  50. Nikki says:

    I’m getting ready to submit my demand letter to the insurance adjuster. What is the best way to have it sent to them so there isn’t any doubt that they received it? Is direct signature or registered mail sufficient?
    I’m a little bit nervous on what my expectations should be once it is in their hands. Is there any possibility of them simply rejecting the demand without offering a counter offer or will they at least offer something?

    • fl_litig8r says:

      When lawyers want confirmation that a letter is received we use “certified, return receipt requested” (the one with the little green postcard that gets attached to the envelope and sent back to you when the letter is delivered).

      There is always the possibility of the insurer completely ignoring your demand, which is what I would consider a worst case scenario for you. If they respond at all, I would expect them to make some kind of offer. There’s only one way to find out — so send that letter out as soon as you can.

      • alen says:

        after i recieved my settlement check payment for Workers’ Compensation and my case closed and my condition it was MMI can i apply for job and go back to work again

        • fl_litig8r says:

          If your disability in the worker’s comp claim was either partial or temporary, and you find work within your restrictions or after the “temporary” disability ends, then there clearly is no reason why you couldn’t take that job. It becomes a bit murkier if you were deemed permanently and totally disabled in the comp case. Factors such as how you settled the case, whether any specific stipulations were made about you not returning to work, what state you’re in and how long it has been since the settlement would affect the risks you face in resuming work. I’m not a worker’s comp attorney, and this is something you would really need to have answered by a comp lawyer in your state.

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