A medical only claim is when the insurance carrier picks up a case and states that they are going to pay for the medical costs only. Many times, they will provide some initial medical treatment, but they are hoping the injured worker has a minor injury to recover from and that there will not be any permanent disability, wage loss, or need for future medical treatment.
To determine the circumstances surrounding your maximum medical improvement in your Charleston workers’ compensation case, it is imperative to contact a lawyer immediately. A workers’ compensation attorney in Charleston can build a case to help maximize any potential damages you may be owed. En Español.
Role of the Insurance Company
In a Charleston medical only claim, there is not really an acceptance of the claim. On the surface, it appears that the insurance company is attempting to work with the injured worker in rectifying the situation but in reality, they may be trying to keep the injured worker from talking to a lawyer. When speaking with an attorney, an individual will learn what their rights are, which is what an insurance company does not want. They want the problem to go away after a bit of medical treatment.
Anytime someone is injured on the job, they should be seeking full benefits. In addition to the medical benefits, the person needs to make sure they have a completely compensable and admitted claim for all body parts and medical conditions.
Defining Maximum Medical Improvement
In Charleston medical malpractice cases, maximum medical improvement is a term of art used in the medical community that says that the injured worker has reached the plateau after a certain period of time after the accident. If an individual looks to the American Medical Association guides for permanent impairment, it typically tells doctors to wait 6 to 12 months after a surgery or after the original injury date.
Maximum medical improvement does not say that the injured worker is completely better or that they have recovered completely from their injuries. It states that the injured worker has reached the plateau where they may get worse, they may get better, but likely, their current condition is where they will likely remain.
At that point, the doctor can give final opinions on any future medical treatment that may be needed for the injured worker and what permanent work restrictions will be imposed on the injured worker going forward. They can also note any type of permanent impairment to the body parts or medical conditions suffered as a result of the work-related accident.
Reaching a Medical Plateau
There are several available options for individuals who have reached maximum medical improvement in their Charleston workers’ compensation case but are still unable to return to work. The first is to perhaps get a second opinion or an independent medical evaluation to see if there is, in fact, some other medical treatments or modalities that are available that may lessen the disability.
Secondly, if all medical treatment has been exhausted and there is an agreement that there is nothing more that can be done other than to medically treat the issue to help manage it, then an individual must get a vocational opinion to look at their restrictions. These restrictions include work restriction, impairments, age, education, transferable skills, past work history, and similar elements to determine if there is a suitable job in which the injured worker can perform.
If there is not a job they can return to, then the injured worker would likely move for total and permanent wage loss and seek maximum compensation benefits under the act. In the event that the employer is able to return to a different job earning less money but they cannot return to their old job, then the injured worker would move for a permanent partial wage loss. This would be the difference between their pre-accident wages and the wages they were able to earn after their work accident and after reaching maximum medical improvement.