Benefits Denied after I&F Establishes Petitioner is at MMI

Inman & Fitzgibbons recently prevailed at arbitration and on review in a recent case handled by Jynnifer Bates on the petitioner’s 19b / 8(a) Motion for additional medical treatment.  The petitioner’s claim was accepted with respect to his diagnosed herniated disc, for which he treated conservatively.  Respondent denied additional medical treatment after its IME doctor opined  that the petitioner had reached maximum medical improvement and was able to return to full duty work.  Petitioner continued to treat.  In January 2011, the petitioner was discharged from physical therapy, and he stated that he experienced 85% improvement in his condition.

The Arbitrator found that the treatment that the petitioner through the date of trial was medically causally related to his work accident, and that the treatment rendered through the date of trial was reasonable and necessary.  He awarded 12% person as a whole for the petitioner’s herniated disc, and found that the petitioner was in need of no additional medical treatment, and that he had reached maximum medical improvement for his compensable accident.  The Arbitrator also awarded TTD benefits and payment of medical expenses through the date of the petitioner’s discharge from physical therapy.

Petitioner appealed to the Commission on the issues of the claimed entitlement to additional medical treatment, his entitlement to vocational rehabilitation, and the nature and extent of his injury.  Petitioner argued that the petitioner had experienced significant improvement, but not maximum medical improvement, at the time of trial.  The Commission affirmed the Arbitrator’s decision, and found that the petitioner failed to show that he was entitled to additional medical treatment, and that an Arbitrator is permitted to reach a finding regarding maximum medical improvement even in the absence of a medical expert’s categorical statement regarding a petitioner’s permanent condition.  The Commission also affirmed the Arbitrator’s decision that the petitioner’s injury was valued at 12% person as a whole, thereby affirming that the petitioner was not entitled to vocational rehabilitation or wage differential benefits.

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