Maximum Medical Improvement: When Reached

O'Mahoney v. Liberty Insurance Corp. [03/08/13] 2013 MTWCC 6 At the time of trial, Petitioner was still undergoing evaluation and treatment at a pain clinic where she was referred by her treating physician and for which the Respondent accepted liability.  Despite the treating physician’s determination of MMI, he found her pain complaints credible enough for the pain clinic referral, and while Petitioner undergoes evaluation and treatment for her pain, she is not at MMI. Therefore, her claim for permanent total disability benefits is premature.

Sherwood v. Watkins & Shepard Trucking [02/15/11] 2011 MTWCC 4 Because the medical evidence indicates that Petitioner would benefit from further treatment to regain medical stability, he is not at MMI.
Sherwood v. Watkins & Shepard Trucking [02/15/11] 2011 MTWCC 4 The Court concluded Petitioner, who developed a dependency on the pain medications prescribed to treat his industrial injury, was not at MMI where the medical evidence indicated that Petitioner would benefit from further treatment for pain management to reduce his dependency on pain medication.

Wilson v. Uninsured Employers' Fund [12/09/10] 2010 MTWCC 33 Where Petitioner’s treating physician testified that he did not believe further psychological counseling or cognitive behavior therapy would benefit Petitioner and a neuropsychologist did not make any recommendation that additional cognitive behavioral therapy would benefit Petitioner, the Court found that Petitioner would not be reasonably expected to derive material improvement from further treatment of his psychological condition and concluded that Petitioner had reached MMI.

Hale v. Liberty Mutual Middle Market [09/13/10] 2010 MTWCC 28 Where a treating physician opined that Petitioner was at MMI, but also opined that Petitioner could benefit from additional treatment, the Court concluded Petitioner was not at MMI.  An injured worker cannot be simultaneously at MMI and expected to improve with further treatment.

Hale v. Liberty Mutual Middle Market [09/13/10] 2010 MTWCC 28 Although Petitioner’s treating physician found him to be at MMI at one point, the physician later found Petitioner’s condition to have deteriorated and recommended additional treatment.  Petitioner therefore was no longer at MMI.

Liberty v. Valor Re: Handel [01/30/08] 2008 MTWCC 7 Where, at the time the claimant was discharged from the care of his treating physician, the doctor opined that the claimant was “very probably” at MMI, and where the claimant continued to treat with another doctor who opined that the claimant was not at MMI a short time later, the Court finds that the treating physician chose his words carefully in not actually finding the claimant to be at MMI on the date of his last appointment. Therefore, the Court concluded the claimant was not at MMI on the date of his last appointment with his treating physician.
Feuerherm v. Liberty Northwest Insurance [12/04/07] 2007 MTWCC 50 Where a doctor’s uncontroverted opinion is that a complete tear of the subscapularis tendon was missed by the radiologist who initially examined Petitioner’s films, Petitioner was placed at MMI on the basis of that misread MRI film, and Petitioner’s treating physician testified that Petitioner’s condition would be reasonably expected to improve with surgery, the Court concludes Petitioner has not reached MMI from her industrial injury.
Porter v. Liberty [10/19/07] 2007 MTWCC 42 Where a claimant’s treating physician opined that the claimant had reached maximum medical improvement (MMI) when he had not treated the claimant in 14 months, and where the claimant had treated with other doctors in the interim, and where the treating physician then withdrew his opinion upon learning that the claimant had treated with other doctors since his last appointment with the treating physician, the Court does not find the claimant to be at MMI.
Copeland v. Montana State Fund [12/28/06] 2006 MTWCC 45 Maximum healing occurs at the point of time when further treatment cannot be reasonably expected to materially improve the injured worker’s condition. Boster v. Liberty Mutual Fire Ins. Co., 2002 MTWCC 64, ¶ 72. Since in the present case, it cannot be said that further material improvement would not be reasonably expected from primary medical treatment where Petitioner has not been given the opportunity to pursue further treatment, the Court concludes that Petitioner is not at MMI from his industrial accident.
Copeland v. Montana State Fund [12/28/06] 2006 MTWCC 45 Where a treating physician did not see a claimant in a year and a half and assumed that the claimant’s condition was unchanged and that the claimant must therefore be at MMI, the Court did not find the physician’s opinion that the claimant had reached MMI to be persuasive.
Crawford v. Liberty NW [4/3004] 2004 MTWCC 41 A claimant who has not reached maximum medical improvement is not eligible for permanent total disability benefits. 39-71-702, MCA (1995-2001) and 39-71-116(23), MCA (1995). Lacking a factual foundation to do so, the Court will not address a contention that the provisions for permanent total disability allows permanent total disability benefits to be paid where the claimant has not reached maximum medical improvement with respect to all of his injuries but some of the claimant's injuries are at maximum medical improvement and are in themselves permanently totally disabling.
Fellenberg v Transportation Ins. Co. [3/19/04] 2004 MTWCC 29 Where the claimant suffers from a degenerative, progressive occupational disease that will never get better with any medical treatment, he is at maximum medical improvement (MMI). Affirmed in Fellenberg v. Transportation Ins. Co., 2005 MT 90
Thompson v. Liberty Northwest Ins. Corp. [6/12/02] 2002 MTWCC 34 Testing and medical evaluation is a part of medical treatment, therefore claimant has not reached MMI where further diagnostic tests and evaluation are deemed medically reasonable and necessary even though it may subsequently be determined that no further treatment would benefit claimant or where further treatment is identified and claimant refuses the treatment. Where treatment is recommended and refused, or not undertaken within a reasonable time, then MMI is reached at that time.
Burtell v. State Fund [3/18/02] 2002 MTWCC 18 A claimant who has reached MMI may return to non-MMI status where her condition deteriorates to the point that further treatment would materially benefit her condition.
Burtell v. State Fund [3/18/02] 2002 MTWCC 18 Maximum medical improvement is reached where further treatment would not materially improve claimant's condition, or claimant refuses or fails to follow through with treatment which might improve her condition.
Burtell v. State Fund [3/18/02] 2002 MTWCC 18 The fact that claimant's condition may later deteriorate and require treatment which will improve her condition does not negate the fact that she was MMI prior to the deterioration of her condition. MMI means only that she would not benefit from further treatment at the time of the MMI determination.