What To Do When The Doctor Changes Your Maximum Medical Improvement Rating

18 August 2018
 Categories: Law, Blog


Receiving a maximum medical improvement (MMI) rating on a workers' comp claim signifies your injury or illness has healed as much as it's going to and no further treatment will make it any better. While the doctor should be certain of his or her decision, sometimes the medical professional will change the rating at a later date. Here's what you should do if that happens in your case.

Ask the Doctor's Reasoning

At the first opportunity, ask the doctor why he or she changed your MMI rating, especially if the new one negatively impacts your workers' comp benefits. Doctors are not infallible, so there's a good chance the person made a mistake. The healthcare provider should be willing and able to clearly explain to you why he or she felt the first MMI was incorrect and how the revised one better reflects your condition. If possible, get the explanation in writing so you have proof of what was said.

You should immediately be concerned if the doctor is unable to adequately answer your questions or appears to be dodging you. Unfortunately, some doctors tend to favor workers' comp insurance providers and will render diagnoses that are favorable to the company. If you suspect this is the case, investigate the doctor's background. You may have a case for bias if the medical professional appears to consistently side with the insurance company or employers in medical cases.

Get a Second Opinion

The second thing you should do is get a second opinion from another doctor, even if the first doctor's explanation appears reasonable. If the original doctor was correct, then the second doctor would only confirm the person's findings. On the other hand, you could prevent workers' compensation from shortchanging you on your benefits if the first doctor's new diagnosis turns out to be wrong.

Since your first doctor will typically send his or her finding to the insurance company, you'll need to open a dispute with the insurance company and send in the diagnosis from the second doctor as part of your evidence about the first doctor's error.

Be aware, though, the insurance company may require you to be evaluated a third time by an independent medical examiner in an effort to get to the truth. These evaluations can be problematic in a number of ways, so be sure to consult with your workers' comp attorney beforehand to learn about ways to protect yourself at your appointment.

If you're having trouble with a doctor who suddenly has a change of heart about your MMI, contact a workers' comp attorney for advice on how to handle the situation.