Can you get medical treatment after you have been rated?

The short answer is YES. But not without a fight.

The term “maximum medical improvement” is music to the ears of any insurance company adjuster because it means that the injured worker is as good as he or she is going to be following the medical and surgical treatment rendered to date. It is an opinion from either the treating physician, or a physician of the insurance company’s choosing, that the claimant’s condition has stabilized to a point from which further significant improvement or deterioration cannot be expected. For the insurance adjuster, it represents an opportunity to cut off the injured worker’s temporary total or temporary partial (light duty) benefits. From the insurance adjuster’s perspective, it also means that the insurance company has no further exposure to pay for medical treatment since the claimant has reached a plateau in his or her symptoms.

It is a fallacy to argue that because a claimant has reached maximum medical improvement he or she is not entitled to any further medical care. The test is whether such care is curative or palliative in nature. If the requested care is curative in nature, it will be allowed by the Commissioner. Curative in Connecticut means either calculated to return the injured worker to gainful employment, or to allow the worker to continue at work. A classsic example is a claimant who has been rated following a back surgery, but needs periodic epidural injections to keep him or her on the job working, and without which, the claiant would be unable to continue working. Another example is where an employee has suffered an knee injury which will eventually require a knee replacement, but in the meantime will require joint-kubricating injections of Synvisc. This procedure may allow the worker to continue to be gainfully employed, and to stave off the inevitable surgery for several years. In such cases, if there is solid substantiation from the pysician, such treatment after reaching maximum medical treatment will be allowed.

If the treatment is merely palliative, that is it makes you feel better temporarily, but does not restore the worker’s health, and is not calculated to return her to work, or keep her at work, then such care will generally not be allowed.

The use or narcotics for chronic pain will be the subject of a future post.

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