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Maximum Medical Improvement and Florida Workers Compensation Eligibility

Recently, Florida’s First District Court of Appeal issued an opinion addressing a claimant’s eligibility to temporary partial disability benefits after an expert medical advisor opined that he reached maximum medical improvement.

Under the Florida State Workers’ Compensation Program, employees who suffered injuries at their workplace or during the scope of their employment, have the right to recover costs associated with their medical expenses and lost wages. To collect benefits through the state’s workers’ compensation program, employees must report their injuries to their employer within 30 days of either the injury or when it was discovered to be related to work. Employees must provide as much information as possible, including details regarding the accident and the symptoms they are experiencing.

After reporting an injury, employers should contact their insurance company and send the employee to an occupational doctor of their choosing. The doctor will treat the patient until they reach “maximum medical improvement” (MMI). Under the statute, MMI is when a reasonable medical professional determines that an individual’s condition has reached a point where they should not expect any further recovery. A finding of MMI does not necessarily mean that an employee is fully recovered or that they are not experiencing functional limitations. Further, reaching MMI does not automatically terminate entitlement to treatment. However, reaching MMI is a critical point in the employee’s treatment, because once MMI is reached, an employee’s insurance carrier can reduce or terminate benefits. Issues arise because there are instances where doctors are under pressure to categorize patients as reaching MMI, even if that is not the case.

When a person reaches MMI, their workers’ compensation will end, and they will only receive benefits if they are totally and permanently disabled. Not many employees are permanently and totally disabled, and an MMI classification can have disastrous financial consequences for injured Florida workers. Employers and insurance carriers often fail to notify employees of their rights to continuing benefits or how to appeal a finding of MMI.

In the case above, the occupational doctor provided two contradicting ambiguous opinions regarding the claimant’s MMI status. This finding caused the Judge of Compensation and Claims (JCC) to determine that the claimant was not entitled to benefits. On appeal, the court reversed the ruling, finding that that the record did not support the JCC’s erroneous finding that the claimant was not entitled to benefits.

Have You Been Denied Florida Workers’ Compensation Benefits?

If you or someone you know has suffered injuries at the workplace, you may be entitled to workers’ compensation benefits. Injured Florida workers should contact Friedman, Rodman & Frank, P.A. to discuss your rights and potential remedies. Our Florida workers’ compensation attorneys have extensive experience handling the various issues that arise when an individual tries to collect workers’ compensation benefits. These benefits are crucial to maintaining financial stability and physical recovery. If your employer or insurance carrier denies you coverage, we can help you recover the benefits you are entitled to. Contact our office at 877-448-8585 to schedule a free initial consultation with an attorney on our team.

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