Maximizing Worker's Compensation Benefits: Can I Continue If My Injury Is Non-Healing?

When facing a non-healing injury that prevents you from returning to work, one critical question is whether you can continue collecting workers compensation benefits. This article provides comprehensive guidance on this subject, ensuring you have the information needed to navigate this challenging situation effectively.

Understanding the Types of Benefits

Worker's compensation benefits are typically divided into two main categories: temporary disability benefits and permanent disability benefits.

Temporary Disability Benefits

These benefits are designed for employees who are unable to work for a limited period due to their injury. If your injury is ongoing, you may continue to receive these benefits as long as your inability to work persists. However, maintaining the support of medical documentation is crucial for your claim.

Permanent Disability Benefits

When your condition is deemed permanent, you may be eligible for permanent disability benefits. This usually requires a medical evaluation to determine the extent of your disability. Your inability to return to work or any job may qualify you for these benefits.

Importance of Ongoing Medical Evidence

Ongoing medical documentation is essential to support your claim for worker's compensation benefits. This includes medical records, treatment plans, and assessments from healthcare professionals regarding your ability to work. Regular updates and evaluations are necessary to maintain your benefit eligibility.

State Regulations and Claim Reviews

Worker's compensation laws vary by state. Some states have specific rules about the duration of benefits and the process for transitioning from temporary to permanent disability benefits. Regular claim reviews may be required, and you may need to attend evaluations or provide updates on your condition.

Legal Assistance and Support

If you have concerns about your benefits or the process, it might be beneficial to consult a worker's compensation attorney. These professionals can provide guidance based on your specific situation and jurisdiction, ensuring you understand your rights and the steps needed for maximum support.

What Is Major Medical Improvement (MMI)?

Major Medical Improvement (MMI) is the point at which further recovery is unlikely regardless of additional medical treatment or rehabilitation. Your treating physician generally determines the MMI date, but an insurance provider may request an independent medical examination to confirm this.

Criteria for Determining MMI

A doctor may rely on several criteria to determine MMI, including:

Results from medical testing Physician notes Examination from specialists

Impact on Benefits

Once MMI is established, you will no longer be eligible for temporary disability benefits. Your physician will provide you with an impairment rating, which will then determine your disability benefits. This rating may be a whole-person impairment (WPI) or a partial impairment rating (PIR).

Medical Treatment After MMI

Medical treatment may cease or be reduced after establishing MMI. You may receive care only to manage symptoms, and co-pays may be required for doctor's visits, depending on your earnings.

Your provider may advise your employer to make accommodations, such as allowing you to sit instead of stand or transferring you to a different department. If such accommodations are not possible, you may become eligible for permanent total disability (PTD) benefits under Wisconsin law.

Seeking a Second Opinion

If you feel you have not reached maximum improvement after reaching MMI, you are entitled to a second opinion. Similarly, if your condition worsens within two years, you should seek medical attention again. The physician will then determine whether further treatment is necessary.

Protecting Your Rights After MMI

Upon reaching MMI, many people face the loss of benefits or inadequate disability ratings. Insurance companies may pressure doctors to provide false MMI ratings. If you are struggling to maintain your benefits, consider seeking help from a highly experienced worker's compensation attorney to protect your rights.

Need for Help?

At Workers Comp Wisconsin, we are dedicated to providing the assistance you need. Contact us today for a free consultation if you have been injured at work.