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Thread: WC After MMI

  1. #1
    Join Date
    Oct 2010
    Posts
    2

    Default WC After MMI

    My workers compensation claim was made in the State of: PA

    I was injured about 7 months ago on the job...MRI showed Herniated Disc and deterioration. I've been able to work modified since then..but after 3 injections and 25 Physical Therapy visits the Dr. finally scheduled me for a Functional Capacity Exam..showing I needed permanent restrictions.

    I've continued work with my new restrictions..and the Dr. transferred me to a pain specialist after marking me at MMI with what looks like Lumbar D.D.D. (his handwriting is attrocious). I'm scheduled to go back to the pain specialist this week and look at new options..and i've been notified that I can seek a new doctor...but I'm curious if I'm still being covered by WC. Will I start having to pay for all upcoming procedures and pain prescriptions...or are they still covered?

    -thank you for your time

  2. #2
    Join Date
    Mar 2010
    Posts
    13

    Default Re: WC After MMI

    Hi Mike, I am in the same boat you are (being MMI but still in the dark about the future). Are you represented? You need to find out if the PM Dr is going to say that you will need further treatment long term, because if you do, then you need to have your Atty file for you to get FMC. If you are granted FMC then anything medical that pertains to your injured area will be covered by WC. I am assuming that since you are going to a PM doc that you will need FMC. From what I have seen on here that the IC atty will try to talk you into settling your case and buying out the FMC so that they can get rid of you and completely close the case. I hope that this helps at least a little. Have a good day.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: WC After MMI

    Unless the statute provides otherwise, the claim/medical stays open until you cash out the benefits, or reach a statutory limitation.
    FMC/Future Medical Care is generally a result of a Stipulated award, or resolution to the claim. Once the IW is MMI, and rated for impairment/permenant impairment, the amount of indemnity due is calculated, and the body parts agreed to that require FMC. Being stable/MMI doesn't mean further medical care isn't necessary, only that your condition is not expected to change better/worse in the next 12 months or so. Medical care is provided based on necessity, and the same procedures you now face in getting prior authorization.
    marking me at MMI with what looks like Lumbar D.D.D. (his handwriting is attrocious).
    DDD is Degenerative Disk Disease, common in about 80% of the population... a condition due mainly to the ageing process...and you can go years w/o symptom of DDD. Aggreviation to a pre existing condition/DDD is a compensable injury in WC. (even though you never knew DDD was present)

  4. #4
    Join Date
    Oct 2010
    Posts
    2

    Default Re: WC After MMI

    Thanks! You guys are great. I feel much less nervous. I don't feel like i'm at the point of needing surgery...surgery still really scares me, but I was thinking of seeing if they'd send me to a Chriropractor to see if that would help. Since I really wouldn't be able to afford all of the co-pays for this type of treatment.....or even any expenses from surgery or the prescriptions...I'm hoping I can get WC to cover it.

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