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  1. #1
    Join Date
    Feb 2008
    Posts
    10

    Default What Happens When You Reach MMI

    My Doctor told me yesterday he didnt think I was going to get any better then how I am now with my knee, he hasnt put me at MMI but I think he is going to when I see him again in a couple of weeks. I still have trouble with my knee and cant go up/down stairs well, kneel or squat without pain.
    Nothing is showing up on the MRIs and the doc said it is just how my knee is going to be. I have yet to get a 2nd opinion on it also.
    What is my next steps from there? Do I try to file for disability? Wait for the isurance co problems to start? My job also told me they can not hold my position for me any longer.

    Thanks

  2. #2
    Join Date
    Nov 2007
    Posts
    197

    Default Re: What Happens When You Reach MMI

    in my opinion, i wouldnt think that you could apply for disability until you know what you disability rating is, or until you know what permenant restrictions you will be on, and until you find out whether or not you are hireable. if you dont have an attorney, i would get one now. a board certified wc attorney. the ic drs are PAID to rush you back to work, to say that you CAN work..just to get you out of the system. the dr might tell you today that you are as good as you are gonna get...but he MIGHT NOT put that in his final report, and he MIGHT put you at a lower rating that what you should be. thats the way the majority of the wc drs are. if you dont have an attorney, and dont "think" you need one (as many of us "thought", but later found out that we really did need one!!)....at least talk to one. they are free to talk to...and they cant/dont charge you unless they win your case for you.

  3. #3
    Join Date
    Feb 2008
    Posts
    191

    Default Re: What Happens When You Reach MMI

    ic drs got paid a lot just ot be in favor to the insurance company..i just had my ime appointment lst monday then tuesday my director of nursing called me that i was released by the ime doctor back to work without restriction..which this ime dr just spent not even 5 mins to examine me.. so i guess he put me on mmi right?or? so no more treatment if you reach mmi?

  4. #4
    Join Date
    Mar 2008
    Location
    Pennsylvania
    Posts
    24

    Default Re: What Happens When You Reach MMI

    I reached MMI in january. all that happened to me so far is the IC sent a vocational rehab counslor to interview me at my attorneys office and I had another IME. I want to settle but I am not stupid enough to terminate my medical like the IC wants me to do and they will not give a figure they will settle for without it so my lawyer and the IC are so far at an impasse.

  5. #5
    Join Date
    May 2007
    Posts
    95

    Default Re: What Happens When You Reach MMI

    Are you guys getting TTd or any WC benefits?

  6. #6
    Join Date
    Jan 2008
    Location
    Round Lake
    Posts
    288

    Default Re: What Happens When You Reach MMI

    I reached MMI 4/07 and continued to get TTD until 12/07. Then I was cut-off with no reason. The IC still has not taken any step since then other than an IME i March 08. Anxiously awaiting my hearing in late May.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: What Happens When You Reach MMI

    Being "Permenant & Stationary" or having reached "Maximum Medical Improvement'' does not mean you are not entitled to additional/further treatment...it means you are not expected to experience a change in your condition in the next year or so with or without treatment.

    Once you are determined "P&S/MMI" a ratable/final report is done by your PTP and/or QME/IME and a ''value'' to the PD indemnity is determined..that is the basis for your settlement/award. A final offer to C&R your case would also include the monies for ''future medical''...IF there is a need for a fair amount of additional treatment, it probably is a better idea to take the bi-weekly payments on the PD indemnity, and leave the medical open...you're entitled to treatment to this injury for ''life'' in most states. There may be limitations on how long you have to ''re-open'' your case, but that doesn't stop the medical entitlement.

    There are usually time requirements for ''face to face'' evaluations with an IME, but most/the majority of the evaluation is done based on your medical records. That is why it is important that your PTP include adequate/complete reporting in the dictation done at your visits/exams.
    ANY doctor should be able to review your case based on the medical reporting and offer an opinion...and that is all the QME/IME is doing...an ''opinion''.

    ic drs got paid a lot just ot be in favor to the insurance company..
    That simply is not true... most states have a Official Medical Fee Schedule/"OMFS"...it is not the same amount as the ''usual & customary'' fees doctors charge to patients who don't have any insurance. In some cases it is not even the same as the Medicare approved charges.
    No matter what doctors you see/treat with, some are going to be ''applicant'' friendly, some are going to be ''defense'' friendly, the same as you have opinions/bias to one or another political candidate...unless the state provides the list/names of QME's or IME's, there are doctors the ER/IC's use on a regular basis to do evaluations...if those doctors don't provide ''defense friendly'' med/legal evaluations...they just aren't used any longer.

    If the names are provided by the state, you have a chance to investigate the evaluator to see where the bulk of the reporting lies...applicant or defense. (In Calif, the IW gets to choose the QME/IME).
    That is also why it is important to see an attorney BEFORE you see a med/legal evaluator. The AA may have an objection to the doctor choosen by you or the ER/IC...

    I want to settle but I am not stupid enough to terminate my medical like the IC wants me to do and they will not give a figure they will settle for without it so my lawyer and the IC are so far at an impasse.
    Attorneys would naturally like to see a C&R to all their cases... they get the fee based on the entire amount of the ''award''....but there is no law that requires the ER/IC to offer you a C&R, and you can't force one.
    The ER/IC are free to let the PD indemnity pay out bi-weekly and leave the medical open for as long as they wish. There in nothing that jeapordizes the IW in doing this...you still get the benefits/treatment that is ''reasonable, and necessary'' to "cure and/or relieve'' your injury.

    In many states the ACOEM guidelines are used...the problem there is that most doctors, even those who contributed to the guides say they don't apply to the ''acute stage'' of an injury, and the guides themselves provide that they do not apply to the ''chronic stage''...after 90 days an injury is considered ''chronic''.

    So...as all treatment has to be determined ''reasonably necessary'', WHO makes the determination...your PTP, or the ER/IC...?
    THAT is the reason for the delays, denials, and modifications of treatment, and why the need for an QME/IME to be involved.

  8. #8
    Join Date
    Mar 2008
    Posts
    112

    Default Re: What Happens When You Reach MMI

    [QUOTE=BvIA;87410]That simply is not true... most states have a Official Medical Fee Schedule/"OMFS"...it is not the same amount as the ''usual & customary'' fees doctors charge to patients who don't have any insurance. In some cases it is not even the same as the Medicare approved charges.
    No matter what doctors you see/treat with, some are going to be ''applicant'' friendly, some are going to be ''defense'' friendly, the same as you have opinions/bias to one or another political candidate...unless the state provides the list/names of QME's or IME's, there are doctors the ER/IC's use on a regular basis to do evaluations...if those doctors don't provide ''defense friendly'' med/legal evaluations...they just aren't used any longer.

    I have examples of court cases in my state where the IME report was thrown out when it was proven (by my lawyer) that the IC's IME doctor received a $2,500 "bonus" for a favorable report. He advised on my IME doctor and was correct that he was "fair". He aggreed w/ the emergency room and my PCP and approved treatment.

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