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Hilton v. Flakeboard America Limited: Maximum Medical Improvement in Workers’ Comp.

In Hilton v. Flakeboard America Limited, a case from the Supreme Court of South Carolina, an individual was injured when he was bitten by a spider or insect while on the job.  There was no issue in this case as to whether the injury and related illness was compensable under the relevant workers’ compensation status, as it was clearly was, and there was no issue that the injured worker was an employee within the meaning of the statute.

workIn this case, the issue dealt with the concept of maximum medical improvement (MMI).   When someone is injured on the job, and the injury is treatable, they should be given as much treatment as is reasonably necessary to improve the injured workers’ condition. In some cases, this means treatment until the worker is fully recovered, while, in other cases, the worker will never make a full recovery.

As you can discuss with your Boston workers’ compensation attorney, when doctors feel that you have been given all the treatment that is feasible and that you would not improve with any more treatment, the employer will likely try to stop paying for any further treatment.  In some cases, you will be healed enough to go back to work, and, in other cases, it will mean that you are permanently disabled and should be awarded permanent disability benefits after treatment is terminated.

In this case, employee was claiming that he had not yet reached MMI, and his employer or his workers’ compensation insurance policy holder should pay for more treatment. The commissioner assigned to his case agreed with claimant that he not yet attained MMI.  The reason this issue was more complex than it first appeared was because employee had made several statements that seemed to indicate he was not getting any better.

However, this single commissioner felt that any of these statements were a direct result of the cognitive defects claimant suffered from a brain injury not related to this insect or spider bite case. At this point, the employer’s workers’ compensation insurance company appealed the denial of their petition that employer had reached MMI.  It its appeal, insurance company argued that if claimant had such severe brain injuries that called into question the validity of his statements, he was not competent to testify in this matter.

While the appellate court could not make a determination from the record alone whether employee was competent to testify, the commissioner should have conducted a formal inquiry into claimant’s competency and remanded the case for further proceedings so this question could be answered.  If it is determined that claimant is not competent to testify, a guardian ad litem would likely be appointed who can represent the best interests of the claimant, since he would not be able to do so himself.

While a finding that he had reached MMI would mean the insurance company would have to pay benefits for many years to come, they would not have to pay medical bills for new treatments in addition to the workers’ compensation lost wages portion of the award.

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:

Hilton v. Flakeboard America Limited, October 12, 2016, South Carolina Supreme Court

More Blog Entries:

OSHA’s New Injury Reporting Rule and Employee Drug Testing, July 14, 2016, Boston Workers’ Compensation Lawyer Blog