My Doctor Says I am at MMI and Released Me. Can I Still Get Medical Care Through Workers’ Comp?
In Florida, there are two types of care provided through workers’ compensation: remedial and palliative. The medical dictionary defines remedial care as “curative, or acting as a remedy.” Or, to put it another way, remedial care means that your medical team is making you better. Once you reach a point of medical improvement where your doctor concludes that you’re not going to make any more progress, you are at a plateau, which is referred to as maximum medical improvement (MMI).
Before we discuss palliative care and your rights under workmans’ comp, let’s take a closer look at MMI for a better understanding of what it does and does not mean. When your doctor determines you have attained maximum medical improvement, it is NOT an admission that:
- You have made a full and complete recovery.
- You have overcome any or all functional limitations resulting from your work injury.
- You no longer need treatment for your work injury or injuries.
- Your workers’ compensation case is closed.
- You do not qualify for further care.
According to Florida Law (Fla. Stat. 440.02(10), MMI is the “date after which further recovery from, or lasting improvement to, an injury or disease can no longer be reasonably anticipated, based upon reasonable medical probability.”
In other words, when your doctor determines that you have reached MMI, it means there are no other invasive or curative medical options available to facilitate your healing and improve the current condition you’re in as a consequence of your work injury.
What Is Palliative Care?
Despite reaching MMI, you may still have pain and symptoms. At that point, you are entitled to palliative care under workmans’ compensation. What does palliative care involve? Get Palliative Care.org explains:
Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.
Palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.
Are There Limitations to Workers’ Comp Benefits for Palliative Care?
Workers’ comp covers palliative care for relief from your lingering pain and symptoms, which maintains your medical “status quo.” However, you will be responsible for a $10 co-pay at your office visits, after you’ve been placed on MMI.
As soon as your doctor determines you have attained MMI, your right to receive indemnity benefits for being out of work, or having work restrictions placed upon you that prevent you from performing your normal job duties, terminates. What happens if you have multiple injuries or if your injuries require the expertise of a variety of specialists? In that case, you may not be at “overall” MMI; as an injured worker, you could continue to receive indemnity benefits until you achieve “whole body” or “statutory” MMI.
Understanding Statutory MMI
Statutory MMI places a limit on your ability as an injured worker to receive indemnity workers’ compensation benefits. Under Florida law, an injured worker can receive up to a maximum of 260 weeks of indemnity benefits. Regardless of whether these indemnity checks from the insurance company are for Temporary, Total, or Partial Disability, once the workers’ compensation insurance company has paid you 260 weeks of indemnity checks, you have reached statutory MMI.
Constitutional Challenges to Florida’s Workers’ Compensation Law
In April 2016, the Florida Supreme Court ruled that it did not have jurisdiction in a case that challenged the constitutionality of Florida’s workers’ comp system. The case, Daniel Stahl v. Hialeah Hospital questioned the effectiveness of Florida’s workers’ comp system in the aftermath of a major overhaul in 2003. It also challenged the legality of lawmakers’ decision to eliminate a type of partial disability benefits. Ultimately, the Florida Supreme Court ruled it did not have jurisdiction in the case, stating, “After further consideration and hearing oral argument in this case, we have determined that we should exercise our discretion and discharge jurisdiction. Accordingly, we dismiss review.”
As of 2019, the state of Florida is still confronting numerous challenges in the effort to reform its workers’ compensation system.
Do you have questions or need assistance in obtaining temporary, total, or partial disability benefits due to a work-related injury?