Maximum Medical Improvement: General

Paterson v. Montana Contractor Compensation Fund, 1999 MT 158 Substantial evidence supported WCC's determination that construction worker seeking TTD had reached maximum medical healing prior to non-work related aggravation of back condition, relieving the insurer of liability for compensation or medical benefits caused by the nonwork-related aggravation pursuant to section 39-71-407(5), MCA (1993). WCC relied on physician's testimony that MMI was reached if certain facts were established and Court's own finding that those facts existed, to wit: that claimant resumed work after the first injury and engaged in heavy labor for extended periods of time without exhibiting apparent back problems or complaining, that claimant was not fearful of losing employment through complaining, and that affordable medical care was available to claimant.
Paterson v. Montana Contractor Compensation Fund, 1999 MT 158 Returning to work does not, in and of itself, resolve the issue of maximum healing.
Briney v. Pacific Employers Insurance Co., 283 Mont. 346, 942 P.2d 81 (1997) Where physician testified that the most significant injury contributing to claimant’s current disability was the original injury for which the insurer was liable, WCC erred in concluding that insurer was relieved of liability due to subsequent exacerbations following MMI. Even though intervertebral disc had returned to its normal anatomical configuration, the deterioration of claimant’s condition and his present physical impairment was traced to the injury for which the insurer was liable.

Tuttle v. First Liberty Insurance Corp. [10/23/12] 2012 MTWCC 37 Although Petitioner’s treating physician found her at MMI, the Court disagreed.  It can hardly be said that a definitive determination of Petitioner’s condition had been made, with no investigation of the cause of her lumbar pain and sciatic complaints.

Hale v. Liberty Mutual Middle Market [09/13/10] 2010 MTWCC 28 Since MMI is a point in the healing process when further material improvement is not expected from primary medical treatment, an injured worker whose treating physician opines should improve with additional treatment is not at MMI.

Hunter v. Hartford Ins. Co., 2007 MTWCC 13 [03/11/07] Where a subsequent knee injury arguably aggravated Petitioner’s preexisting knee condition, Respondent is liable for Petitioner’s knee injury because it failed to meet its burden of proving (1) Petitioner had not reached maximum medical healing with respect to his 1983 accident or (2) Petitioner’s 1998 accident did not permanently aggravate the underlying condition.
Lockwood v. LIberty NW Ins. [3/2/04] 2004 MTWCC 21 Where the claimant has access to but fails to take advantage of the only treatment prescribed for her injury, she is at MMI.
Lockwood v. LIberty NW Ins. [3/2/04] 2004 MTWCC 21 Where the claimant suffered a work-related dislocated patella; an orthopedic physician testified that the claimant likely reached MMI within six weeks of a patellar dislocation; the claimant returned to work and worked steadily for the next nine months; the claimant by her own admission was experiencing no knee symptoms a week prior to a subsequent injury which occurred nine months later; and by her own admission during the month prior to the subsequent injury her knee "bothered her every now and then," and only when she stood for a long time; and then the claimant again dislocated her patella in another accident, the Court finds that the claimant had reached MMI prior to the subsequent injury.
Boster v. Liberty Mutual Fire Ins. [12/19/02] 2002 MTWCC 64 MMI occurs at the point of time when further treatment is not reasonably expected to materially improve claimant's condition.
Lindeman v. Connecticut Indemnity Co. [1/17/02] 2002MTWCC 3 Where a preponderance of the evidence demonstrates that claimant's condition may be materially improved with further medical evaluation and treatment, she has not reached MMI.

Key v. Liberty NW Ins. [9/13/01] 2001 MTWCC 53 Where claimant's pain would be materially improved by his participation in a pain clinic or pain program, he has not reached MMI.

Key v. Liberty NW Ins. [9/13/01] 2001 MTWCC 53 Evaluation and testing to determine what treatment is appropriate is part of treatment. Where further evaluation or testing is necessary to determine whether and what further treatment is appropriate, the claimant is not at MMI.
Daulton v. MHA Workers' Comp. Trust [8/03/01] 2001 MTWCC 37A Claimant's subjective complaints that her condition was worsening does not contradict a finding that she has reached maximum medical improvement where she has presented no medical evidence that further medical treatment would materially improve her condition. 39-71-116(18), MCA (1997-1999).
Seigler v. Liberty Ins. Corp. [5/15/01] 2001 MTWCC 23 . MMI opinion of physician who treated claimant over longer period of time and over more recent period of time, and who was subjected to deposition, is adopted over that of earlier treating physician.
Schneider v. Liberty Mutual Ins. [4/20/01] 2001 MTWCC 14 Where claimant's symptoms are subjective and where he has a history of non-compliance with respect to recommended treatment or the treatment has been previously attempted and was unsuccessful, there is no reasonable prospect for further, material improvement in his condition, and he has reached MMI.
Peone v. Liberty NW [2/01/01] 2001 MTWCC 6 Where medical opinion that claimant has not reached maximum medical improvement is based on the fact that claimant would benefit from physical therapy, and the claimant has had the opportunity for the therapy but failed to pursue it, the claimant has reached MMI and is not entitled to temporary total disability benefits.
Beyl v. Liberty Northwest Ins. Corp.[12/21/00] 2000 MTWCC 75 A claimant who needs surgery has not reached maximum medical improvement where he is willing to undergo the surgery.

Hoff v. UEF and Laubach & Laubach [11/1/00] 2000 MTWCC 67 Treating physician's MMI opinion persuasive where subsequent treatment by other physicians does not materially improve the claimant's condition.

Block v. Indemnity Ins. Co. of North America [4/18/00] 2000 MTWCC 23 Where records from numerous medical providers documented claimant's drug seeking behavior, and claimant was not credible witness, Court rejected her testimony about continued disability and that of physician who opined claimant had not reached MMI but had not reviewed complete set of medical records.
Schneider v. Liberty Northwest Ins. Corp. [4/4/00] 2000 MTWCC 18 Claim for 49 day benefits under 39-71-610 rejected because claimant has not shown prima facie case for reinstatement of TTD benefits. Physician opining he had not reached MMI rested opinion on his need for PT and work hardening, but record indicated claimant had been offered those treatments but failed to attend.
Hams v. Liberty Northwest Insurance Corporation [2/10/00] 2000 MTWCC 6 WCC resolved conflict in opinions of two physicians to find claimant had not reached MMI because further medical treatment, on a more probable than not basis, would significantly improve claimant's depression and head, neck and myofascial pain. Significant to court's decision to credit one physician were facts that other doctor had not reviewed pre-injury medical records, was not the treating physician, did not address some causation issues, and agreed that a change in medications and elimination of caffeine and tobacco should improve claimant's symptoms. Court ordered reinstatement of TTD benefits retroactive to date of discontinuation.
Kelly v. State Compensation Insurance Fund [10/4/99] 1999 MTWCC 60 Claimant suffered a neck injury in 1986, and another neck injury in 1987. In a prior proceeding in the Workers' Compensation Court, and on appeal to the Supreme Court, it was held that claimant reached maximum medical healing prior to second injury, making claimant's status after the second injury the result of the second injury for workers' compensation purposes, under an extension of Belton v. Carlson Transport, 202 Mont. 384, 385-386, 658 P.2d 405, 406 (1983). Claimant now alleges his current deteriorated condition is a result of the 1986 injury. Insurer's motion for partial summary judgment on this issue granted. Res judicata applies, barring any present claim that claimant's post-1987 condition is attributable to the 1986 injury.
Hall v. State Compensation Insurance Fund [1/13/99] 1999 MTWCC 3 Where insurer accepted OD claim on diagnosis of multiple chemical sensitivity, and persuasive medical testimony indicated claimant had reached MMI on physical symptoms arising from workplace exposure, but had not reached MMI on somatoform disorder arising from the physical exposure, claimant was entitled to TTD benefits during period of treatment of somatoform disorder.
Paterson v. Montana Contractor Compensation Fund [6/22/98] 1998 MTWCC 55 Where claimant reached MMI on a minor back injury prior to suffering a permanent aggravation of his back condition in a nonwork-related incident, section 39-71-407(5), MCA (1993) relieved the insurer of liability for compensation and medical benefits following the nonwork aggravation. [Note: WCC decision affirmed in Paterson v. Montana Contractor Compensation Fund, 1999 MT 158.]
Klein v. Liberty Northwest Ins. Corp. [3/4/97] 1997 MTWCC 7 Where exercise, physical therapy, or other therapy is prescribed by a claimant's treating physician, the claimant has an obligation to follow through with the treatment or risks suspension of benefits. See Meidinger v. Western Energy Co., 254 Mont. 18, 23, 834 P.2d 1382, 1385 (1992).
Klein v. Liberty Northwest Ins. Corp. [3/4/97] 1997 MTWCC 7 Injured CNA was not at maximum medical improvement where her deconditioning prevented her from returning to her normal CNA duties. Where a sustained exercise program promised to increase claimant's conditioning sufficiently for her to resume her job, there was a reasonable potential for "material improvement" in her condition within section 39-71-116(17), MCA, (1993). She was entitled to TTD benefits during the period she still required conditioning. This does not mean, however, that insurers must pay to train claimants as athletes or that additional conditioning will result in "material improvement" in every case.
Ranes v. Lumbermens Mutual Casualty Co. [7/5/96] 1996 MTWCC 49 Where the evidence indicates claimant has carpal tunnel syndrome as the result of employment, and her unrebutted testimony indicates she cannot perform her time-of-injury job due to the condition, she is entitled to temporary total disability benefits until she reaches MMI and evidence is developed regarding the impact of her condition on her employability.