Can You Dispute Your Workers Comp Doctor’s Finding of MMI?

In North Carolina, the expectation is that you will return to your job after recovering from a workplace injury. Once a workers comp doctor determines that you have reached maximum medical improvement (MMI), no more medical treatment will be covered under your claim.

If you are unable to fulfill the duties of your previous role, you can file for permanent disability benefits. But you might not agree that you’ve reached a point where further treatment isn’t needed. How can your Charlotte workers compensation lawyer challenge the doctor’s determination that you have reached MMI?

What Role Does a Workers Compensation Doctor Play in Your Claim?

You must receive treatment from an approved workers compensation doctor. Seeing another doctor for your workplace injury could jeopardize your benefits. Any specialists you are required to see will receive a referral from the workers compensation doctor – not from your primary care physician.

In addition to the medical aspect, the doctor you are assigned will also be the one who determines when you return to work or whether you have reached a point where you no longer benefit from treatment. The amount of time you are off work could range from a short period of time, like weeks, all the way up to permanent disability due to an inability to work.

What is MMI and How Does Your Doctor Determine When You’ve Reached This Point?

Maximum medical improvement, or MMI, is the term used when an employee has reached the point where further treatment would be futile. Once an injured worker reaches MMI, they are no longer eligible for workers compensation benefits.

There are two main ways your workers compensation doctor will determine whether you’ve reached MMI.

  • Detailed review of your medical records: The doctor will look for evidence of healing and improvement over time. They will also consider whether you’ve reached a plateau in your recovery. Once you’ve stopped showing improvement, your benefits will end.
  • Physical examination: The doctor will assess your range of motion, strength, and flexibility. They will also look for any signs of pain or discomfort. If they find that you’ve reached a point where you’re not showing any further improvement, they will likely conclude that you have reached MMI.

the workers comp doctor is not always fair in assessments

Why Would Your Workers Compensation Lawyer Dispute MMI Findings?

There are several reasons why you may want to dispute your doctor’s finding that you’ve reached maximum medical improvement:

  • You may feel that you are not yet ready to return to work.
  • You may also disagree with the doctor’s assessment of your condition and feel that you could still improve with additional treatment.
  • The MMI finding may negatively impact your benefits, so it is important to make sure that the determination is accurate.

If you have valid reasons for contesting the MMI finding, you should reach out to your workers comp attorney to discuss your options. They can help you gather evidence to support your case and represent you in negotiations with the insurance company.

Evidence Needed When Filing an MMI Dispute

If you disagree with your workers compensation doctor’s MMI findings, you have the right to dispute the decision.

Before you do anything, you should talk to your workers comp doctor and let them know your thoughts. If you’re able to convince them that you need further treatment, there will be no need for formal action. If not, make sure you ask for a copy of your medical records so your workers compensation attorney in Charlotte can review them.

If your doctor won’t consider changing their decision, you can request a hearing with the Office of Workers’ Compensation Programs (OWCP). At the hearing, you must present evidence that contradicts the doctor’s MMI determination. The insurance carrier will also have an opportunity to present their case.

There are various types of evidence you can use to do this:

  • Testimony from your treating physician
  • Testimony from a medical expert
  • Documentation of your ongoing symptoms and functional limitations
  • The opinion of an independent doctor

If the OWCP finds that there is enough evidence to overturn the MMI determination, they will schedule a second medical evaluation. This evaluation will be conducted by an independent doctor who will consider all the available evidence before making a final determination.

According to North Carolina’s Workers’ Compensation Act §97-25(b), an employee is allowed to ask their employer to approve a second opinion. Once this doctor has completed their examination, they’ll let both your workers compensation lawyer and the insurance carrier know their decision. They will also inform the Industrial Commission as to their findings.

When to Contact a Charlotte Workers Compensation Lawyer for MMI Disputes

Disputing a workers compensation doctor’s finding of maximum medical improvement can be a difficult process, but it is possible. If you want the best chance of overcoming this finding, you should retain a Charlotte workers comp attorney immediately.

Your attorney knows what it’ll take to challenge your doctor’s determination. They have been dealing with the insurance companies for years. They are also familiar with local physicians who can conduct your independent examination.

Call us today at 704.706.2689 and schedule your free, initial consultation.