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Armstrong v. State: Maximum Medical Improvement in Workers’ Compensation Cases

Armstrong v. State, an appeal from the Supreme Court of Nebraska, involved claimant who injured herself while working as a staff nurse at a veteran’s hospital. Both claimant and her employer stipulated (formally agreed) she tore a hole in the rotator cuff of her right shoulder to a severity entitling her to compensation for her on-the-job injury.

1158314_nurse_1.jpgHer employer paid her temporary total disability (TTD) workers’ compensation benefits from May 2010 to April 2010. At this point, doctors opined she had reached her maximum medical improvement (MMI).

MMI means doctors have done all they can feasibly do to improve a patient’s condition, and there is nothing else worth doing to improve his or her condition. Essentially, a doctor is saying he or she has done everything that could be done, and it’s not worth trying anything else in terms of cost and patient discomfort.

As our Boston workers’ compensation attorneys can understand, patients, doctors, employers, and workers’ compensation insurance carriers may differ as to whether they believe a patient has reached MMI. The reason this is important is because, when a patient reaches MMI status having not made a complete recovery, workers’ compensation commissioners will need to determine if claimant is still disabled. If a claimant is not disabled, he or she can be sent back to work. If a claimant is still disabled, he or she may or may not be able to return to work, depending on limitations, but may be given a permanent disability rating in place of a temporary disability rating the commission has currently established.

A permanent disability rating can be a total permanent disability (TPD) rating, or a partial permanent disability (PPD) rating, depending on the severity of disability. In case of a partial permanent disability rating, a patient will be given a percentage of total disability benefits. For example if a claimant is 75 percent disabled, he or she will be entitled to 75 percent of total disability benefits.

In Armstrong, after her doctor determined she had reached MMI, other doctors opined she had developed another painful condition as a result of her rotator cuff injury, known as Complex Regional Pain Syndrome (CRPS). Here evaluating physician for her earlier MMI assessment looked at additional medical records and concluded, while she did have CRPS, she had reached MMI on that condition, as well. He limited her to permanently working four hours per day.

In response to this, two more physicians evaluated claimant and had two distinct opinions about her condition. One doctor did not believe there was any evidence of CRPS, and the other doctor opined her bilateral upper extremity syndrome was present, but her 2010 work-related accident was not the cause.

The commission found she was permanently partially disabled with a disability rating of 75 percent. She appealed this decision, claiming anyone who was limited to working four hours per day should be considered permanently disabled for purposes of workers’ compensation. Ultimately the court of appeals affirmed lower court’s findings. The case was still reversed on a minor point to hold additional hearings to see if she was entitled to mileage compensation.

If you or someone you love has been injured a Boston work accident, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:
Armstrong v. State, Feb. 25, 2015, Nebraska Supreme Court
More Blog Entries:
City of Danville v. Tate: Workers’ Compensation Double Recovery, Jan. 25, 2015, Boston Workers’ Compensation Lawyer Blog